Tolga ÜNÜVAR, Ali ATAŞ, Atilla BÜYÜKGEBİZ, Ece BÖBER, Ayhan ABACI

The effect of insulin detemir on the metabolic control in children and adolescents with type 1 diabetes mellitus

Amaç: Literatürde çocuk ve adolesan yaş grubunda insülin detemirin etkinliği, gece hipoglisemi sıklığındaki azalma ve kilo değişiklikleri hakkında sınırlı sayıda çalışma olması nedeniyle bu prospektif çalışmayı planladık. Materyal Metod: Kötü metabolik kontrollü ve/veya sabah hiperglisemileri olan 15 diyabetik hasta (10 erkek) çalışmaya dahil edildi. Hastaların ortalama yaşı 13.41±3.68 yıl ve ortalama diyabet süresi 5.03±1.74 yıldı. Hemoglobin A1c ve lipid düzeyleri, kan şekeri profilleri ve vücut kitle indeksleri başlangıçta ve detemir kulanımından 32±2.32 ay sonra değerlendirildi. Bulgular: Bazal insülin olarak insülin detemir uygulanmasından sonra ortalama HbA1c değerleri %9.08’den %8.31’e geriledi. Total ve LDL kolesterol düzeylerinde detemir sonrası istatiksel olarak anlamlı azalma görüldü. Detemire geçildikten sonra ortalama günlük kan şekeri profillerinde anlamlı azalma saptandı. Gece hipoglisemi sıklıklarında detemire geçiş sonrası anlamlı azalma saptandı. Hastaların günlük insülin dozları, bolus/bazal oranları ve BMI SDS değerlerinde anlamlı bir değişiklik olmadı. Sonuç: Bu çalışma, bazal – bolus rejimde günde tek doz detemir tedavisinin NPH ile karşılaştırıldığında özellikle dislipidemi riskinin azaltılmasında ve daha iyi metabolik kontrol sağlanmasında gece hipoglisemi riskini arttırmaksızın, etkin ve iyi tolere edilebilir olduğunu desteklemektedir.

Tip 1 diyabetes mellituslu çocuk ve adolesanlarda insülin detemirin metabolik kontrol üzerine etkisi

Aim: Since there is limited number of studies in medical literature regarding the eff iciency of insulin detemir, decrease in number of night hypoglycemia, weight changes and the improvement the lipid profile in pediatric and adolescent age group, we planned a prospective study to analyze abovementioned issues. Material and Method: 15 diabetic patients (10 male) with insuff icient metabolic control and/ or morning hyperglisemia were included in to the study. The average age of the patients was 13.41±3.68 years and the average duration of diabetes was 5.03±1.74 years. Hemoglobin A1c levels, lipid levels and home glucose monitoring profiles were measured before and 32±2.32 months after substitution with insulin detemir. Results: After insulin detemir administration as basal insulin, the mean HbA1c values decreased from 9.08 % to 8.31 %. Total and LDL cholesterol values decreased significantly after detemir. The mean four point blood glucose profiles showed a significant decrease after the substitution with detemir. There was a decrease in the nocturnal hypoglycemia frequency and the rates were statistically significant diff er before and after detemir. Daily insulin doses, bolus/basal rates and body mass index SDS of patients were not changed significantly before and after detemir. Conclusion: In pediatric diabetic patients, insulin detemir as basal insulin is safe and significantly lowers glucose levels compared with NPH insulin. This pilot study showed that the substitution of NPH with detemir provides a better glycemic control without increased hypoglisemic events.

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