COMPARISON OF INSULIN GLARGINE AND GLULISINE WITH INSULIN NPH AND REGULAR FOR GLYCEMIC CONTROL IN CHILDREN WITH TYPE -I DIABETES MELLITUS

Introduction: Among the various types of insulin analogs, some are long acting and some are short acting. Neutral Protamine Hagedorn (NPH) is one of the intermediate acting insulin analog with about 16 hours of duration of action with a peak between 6-14 hours. NPH is given with Regular (R) insulin, short acting insulin analogue with peak in 3-5 hr and duration of action till 8 hours. Objectives: To compare mean HbA1c level in type 1 diabetes mellitus children on glargine + glulisine basal bolus regimen with neutral protamine hagedorn (NPH) + regular insulin. Study design: Randomized controlled trial Settings: Pediatrics Unit-II and III ward, emergency and outpatient department, Allied Hospital, Faisalabad Study duration: 5th June 2017 to 4th January 2018 Materials & Methods: A total of 120 children of both genders of 5 to 15 years with type-I diabetes mellitus were included. Patients with type I diabetes with complications like diabetic ketoacidosis, celiac disease, mucocutaneous candidiasis, Addison's disease and hypoparathyroidism and Cushing's disease were excluded. Patient in group A was given glargine once daily and glulisine was given with each meal three times daily. Patients in group B were given NPH insulin and regular insulin twice daily before meals. Dose of insulin was calculated according to age and weight and given subcutaneously. Each patient was followed after 3 months through their contact numbers. HbA1c level was done one the first day and repeated after 3 months. Results: Mean age was 9.63 +/- 2.68 years. Out of 120 patients 79 (65.83%) were males and 41 (34.17%) were females with male to female ratio of 1.9: 1. Mean HbA1c level in type 1 diabetes mellitus children in Group A (glargine + glulisine basal bolus regimen) was 6.30 +/- 0.62 while in Group B ((NPH) + regular insulin) was 7.12 +/- 0.64 (p-value = 0.0001). Conclusion: This study concluded that children with type-I diabetes mellitus treated with insulin glargine as long acting insulin along with Insulin glulisine as ultra-short acting insulin have lower HbA1c than those taking NPH and regular insulin.