Ab Initio Intensive Insulin Therapy in Children and Adolescents with Type 1 Diabetes Mellitus

Introduction: Intensive insulin therapy is currently the recommended therapy for the treatment of type 1 diabetes mellitus (DM1) in children and adolescents. Combined with appropriate therapeutic education, it allows glycemic stability, greater dietary freedom and a better quality of life. Our objective was valuate the metabolic control in children and adolescents with DM1, under ab initio intensive insulin therapy; identify contributing factors to metabolic control; recognize cardiovascular risk factors present in this population. Material and Methods: Retrospective study of children and adolescents with DM1, followed in a grade III hospital, under intensive insulin therapy (multiple daily insulin injections [MAAI] or continuous subcutaneous insulin infusion [PSCI]), from diagnosis and during the first four years after diagnosis. Demographic, clinical and laboratory data were analyzed. Results: We obtained a sample of 110 children and adolescents, 51.8% were girls, and the mean age at diagnosis was 8.42 +/- 3.9 years. In the 4th year of follow-up, 81 cases (74%) were under MAAI and 29 (26%) under PSCI. The mean HbA1c in the four years of follow-up remained below the international target of 7.5%. In the 4th year of follow-up the PSCI group had an HbA1c lower than the MAAI group (7.3% vs 7.5%, p = 0.628). In the group under PSCI and in the small children (less than five years old) there was no statistically significant variation of HbA1c, over the four years of follow-up. In PSCI group we observed a decrease in non-severe hypoglycemia throughout the follow-up (p = 0.006), and at the 4th year of follow-up non-severe hypoglycemia was more frequent in the MAAI group (p = 0.471). During the four-year follow-up, there was no significant change in overweight/obesity (27%), hypertension (5.6%) or dyslipidemia (13%). Dyslipidemia was more frequent in the group with HbA1c > 7.5% at the 4th year (p = 0.004). Conclusion: Intensive insulin therapy since the diagnosis allows a good metabolic control. PSCI prevents the deterioration of the metabolic control during the follow-up. Despite good metabolic control, we found other metabolic risk factors, which remained stable during follow-up, and should be monitored. We did not observe an increase in overweight and obesity during follow-up.