Real-world experience of using basal insulin analogues in children with type 1 diabetes: is twice-daily dosing of insulin detemir justified?

Dear Editor,
Insulin glargine (iGla) and detemir (iDet) are the two most commonly used basal insulins in basal-bolus regimens in type 1 diabetes (T1D) [1]. While both these analogues have similar onset of action, their duration of effect has remained a matter of intense debate [1]. Under steady-state conditions, the mean duration of action of iGla is 24–25.6 hours and that of iDet is 21.5 hours [1]. Consequently, a higher proportion of patients are prescribed a twice-daily dosing of iDet as compared to iGla for a full basal coverage [1]. In addition to the concerns regarding the last few hours of the iDet action, twice-daily dosing also results in increased costs and hence its limited use in resource-poor settings. Unfortunately, most of the studies on the efficacy and action duration have compared either of the insulin analogues with NPH, and head-to-head iGla-iDet comparisons are limited [2-4]. In particular, it is unknown whether there is really a waning of effect of iDet during the last few hours of its action duration in daily clinical practice, which would justify its twice-daily dosing. Self-monitored blood glucose (SMBG) records of the last three months in 22 randomly selected children with T1D (11 each using iDet and iGla in once-daily bedtime dosing) were compared. In addition, the mean HbA1c, mean daily total, and basal and mealtime bolus insulin doses were calculated. All patients were using either aspart or lispro as bolus insulin. We presumed that if the iDet effect really wanes, the required doses of evening insulin bolus might be higher in patients using iDet.
The mean age of the two groups of patients was similar (8.9 ±4.7 vs. 8.3 ±4.8 years, respectively). Five children in the iGla group and four in the iDet group were pubertal. The mean duration of diabetes was 3.2 ±2.3 years. In the iGla group, four (36%) families belonged to lower, five (45%) to middle, and two (18%) to upper socioeconomic status (SES). The iDet group had three (27%), five (45%), and three (27%) families in the lower, middle, and upper SES, respectively. The parents’ educational levels were also similar in the two groups. The glycaemic parameters, episodes of hypoglycaemia, and the requirement of daily basal and bolus insulin doses were also similar in the two groups (Table I).
These results indicate a similar efficacy of both basal analogues when used in once-daily dosing in routine clinical practice and are consistent with our previous studies...


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