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Review
. 2018 May;9(5):157-166.
doi: 10.1177/2042018818763247. Epub 2018 Mar 19.

Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?

Torben Biester  1 , Olga Kordonouri  2 , Thomas Danne  2
Affiliations
Review

Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?

Torben Biester et al. Ther Adv Endocrinol Metab. 2018 May.

Abstract

For paediatric patients with type 1 diabetes, intensified insulin therapy with either multiple daily injection or insulin pump therapy is currently the only method of treatment. To optimize this therapy, insulin analogues are fixed parts of all therapy regimens. New ultra-rapid insulins seem to be beneficial not only in adults but also in this age group. New developments in long-acting analogues have demonstrated safety and will be regular in paediatrics, we hope, soon. Furthermore, the psychosocial approach for consideration of real-life aspects becomes more the focus of therapeutic regimens and is implemented into international guidelines. Technical improvements, such as continuous glucose monitoring, particularly in combination with pump therapy, support the great success of rapid-acting analogues by reducing hypoglycaemias. Non-insulin agents such as SGLT2-inhibitors show beneficial aspects in people with type 1 diabetes. For outpatient care with these currently off-label-used drugs, special training for measurement of ketones should be imperative.

Keywords: insulin therapy; paediatric diabetology; sensor-augmented pump therapy; type 1 diabetes.

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Conflict of interest statement

Conflict of interest statement: TB received honoraria and research support from Medtronic, Ypsomed, DexCom travel support Novo Nordisk. OK received honoraria and research support from Abbott, Eli Lilly, Medtronic, Novo Nordisk, and Sanofi, and is a shareholder of DreaMed Ltd. TD received honoraria and research support from Abbott, Bayer, BMS/ AstraZeneca, Boehringer Ingelheim, DexCom, Eli Lilly, Medtronic, Novo Nordisk, Sanofi and Roche, and is a shareholder of DreaMed Ltd.

Figures

Figure 1.
Figure 1.
Various regimens of basal insulin therapy. (a) The physiologic insulin effect; (b) three-time administrations with NPH insulin; (c) twice administration with Detemir; (d) one-time administration of glargine.
Figure 2.
Figure 2.
Insulin administration examples in different meal settings. (a) Normal insulin for a main meal and a snack; (b) a meal with fast-analogue insulin.
Figure 3.
Figure 3.
Evaluation of the Diabetes-Patienten-Verlaufsregister (DPV) database for the diabetes centre Auf der Bult. Proportion of patients using analogue insulins: median 85.5%; AUF DER BULT 87%.
Figure 4.
Figure 4.
Example of sensor-assisted pump therapy in case of imminent hypoglycaemia. Upper curve, glucose sensor; lower curve, insulin administration; in blue, the interruption of the insulin supply by the pump before the glucose curve falls below the limit value (red line). Successful stabilization of the course. Patient from Diabetes Centre, Hannover The orange bubbles can bei either taken out or be referred as “insulin bolus”. The “I” is for “IU”, international untis, cut off. Units of y axis is mg/dl as stated, x axis is time. CHO (ex), carbohydrate exchanges; SG, Sensor glucose; BG, blood glucose.
See this image and copyright information in PMC

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