Predictors of Insulin Regimens and Impact on Outcomes in Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

• Published in: The Journal of pediatrics Vol. 155; no. 2; pp. 183 - 189.e1
• Main Authors: Paris, Carolyn A., MD, MPH, Imperatore, Giuseppina, MD, PhD, Klingensmith, Georgeanna, MD, Petitti, Diana, MD, MPH, Rodriguez, Beatriz, MD, MPH, PhD, Anderson, Andrea M., MS, Schwartz, I. David, MD, Standiford, Debra A., RN, MSN, CNP, Pihoker, Catherine, MD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.08.2009; Elsevier
• Subjects: Adolescent; Age Factors; Biological and medical sciences; Blood Glucose Self-Monitoring - statistics & numerical data; Child; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - epidemiology; Diabetes. Impaired glucose tolerance; Educational Status; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; European Continental Ancestry Group; Female; General aspects; Glycated Hemoglobin A - analysis; Hospitalization - statistics & numerical data; Humans; Hypoglycemic Agents - administration & dosage; Income; Infusion Pumps, Implantable; Injections; Insulin - administration & dosage; Male; Medical sciences; Pediatrics; Sex Factors; United States - epidemiology; T1DM; FCP; Fasting C-peptide; MDI; Multiple daily injection; Diabetes mellitus; DM; American Diabetes Association; ADA; Diabetes Control and Complications Trial; DCCT; Type 1 diabetes mellitus; Endocrinopathy; Human; Immunopathology; Pediatrics; Pancreatic hormone; Prognosis; Prediction; Autoimmune disease; Insulin; Treatment; Type 1 diabetes; Scientific research; Adolescent; Evolution; Predictive factor; Therapeutic protocol
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2009.01.063

Objectives To describe the insulin regimens used to treat type 1 diabetes mellitus (T1DM) in youth in the United States, to explore factors related to insulin regimen, and to describe the associations between insulin regimen and clinical outcomes, particularly glycemic control. Study design A total of 2743 subjects participated in the SEARCH for Diabetes in Youth study, an observational population-based study of youth diagnosed with T1DM, conducted at 6 centers. Data collected during a study visit included clinical and sociodemographic information, body mass index, laboratory measures, and insulin regimen. Results Sociodemographic characteristics were associated with insulin regimen. Insulin pump therapy was more frequently used by older youth, females, non-Hispanic whites, and families with higher income and education ( P = .02 for females, P < .001 for others). Insulin pump use was associated with the lowest hemoglobin A1C levels in all age groups. A1C levels were >7.5% in >70% of adolescents, regardless of regimen. Conclusions Youth using insulin pumps had the lowest A1C; A1C was unacceptably high in adolescents. There is a need to more fully assess and understand factors associated with insulin regimens recommended by providers and the influence of race/ethnicity, education, and socioeconomic status on these treatment recommendations and to develop more effective treatment strategies, particularly for adolescents.