Glycemic Control for Type 1 Diabetic Children on Multiple Daily Insulin Therapy Tripoli Children Hospital

Abstract

Diabetes is a the most common chronic endocrine disorder of childhood; the management of type 1 DM
has changed dramatically over the past 30 years; to maintain near-normal glycaemia.
The aim of study to compare two different strategies of insulin therapy ; twice daily insulin and multiple
daily injections by assessment of patient’s growth, level of HbA1c and occurrence of acute complications.
A prospective study includes patients who were diagnosed as T1DM for at least 1year at endocrine clinic
in Tripoli children’s hospital (2006-2007). 20 Patients who were on conventional therapy (twice daily
insulin injections) for >1year and changed to MDI before our study were reviewed; 30 patients who on
twice daily injections with poor diabetic control (HbA1c > 9) were switched to MDI, then all (50 patients)
followed up for 1 year to compare between HbA1c results, growth parameters& occurrence of acute
complications before and after 1year of MDI therapy.
The age of patients at the time of diagnosis of DM ranged from 2-16yrs old with mean 8.2( ± 3.2) years,
88% of patients were on twice daily therapy for about 1-6years before we switch them to MDI; mean
age at starting MDI 13( ± 2.4 )years . After one year of follow up we assess the growth of patients; we
found 70% of them have normal weight, 24% were under weight and 6% were overweight. Regarding
HbA1c we found 2% of patients who were on conventional therapy had good glycemic control (HbA1c
< 7%) raised to 26% after one year on MDI . 30% of conventional therapy had accepted control( HbA1c
7-9%) which raised to 56% after one year on MDI and 68% of those on conventional therapy had poor
glycemic control( HbA1c > 9%), which reduced markedly to 18% on MDI for one year; it was statistically
significant P value < 0.001. 26% of patients on conventional insulin therapy had attacks of hypoglycemia
reduced to only 2% after 1 year on MDI, occurrence of DKA: 14% of patients on conventional insulin
therapy were suffered from DKA episodes and no episode of DKA recorded after one year therapy on
MDI therapy.
We concluded most of our patients who were receiving MDI have better growth, good glycemic control
& less occurrence of hypoglycemia and diabetic ketoacidosis.