OPTIMAL REGIMENS OF THE BASAL-BOLUS INSULIN THERAPY IN ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS

This study was aimed to determine peculiarities in regimens of the pump insulin therapy and to reveal the optimal basal-to-bolus insulin ratio that are necessary for achieving optimal glycemic control in adoles-cents with type 1 diabetes mellitus (T1DM).  82 adolescents at the age of 14–18 with T1DM, using continuous subcutaneous insulin infusion (CSII) from 5 months to 7.5 years were monitored with continuous glucose monitoring (CGM) system «Guar-dian Real Time» or CGM system, built in MiniMed Paradigm Revel System 722 (Medtronic Minimed, USA). Assessing the quality of glycaemic control was based on the level of glycated haemoglobin (HbA1c). The results of CGM were reviewed and average for 3 days performances: total daily dose of insulin, dose of basal and bolus insulin, basal-to-bolus insulin ratio, carbohydrate content of the meal, expressed in BE, carbohydrate ratio, insulin sensitivity factor were determined. The patients were subdivided into 2 groups: group 1 – adolescents with the optimal/suboptimal glycemic control (n = 55), 2 – adolescents with long-standing poorly controlled T1DM (n = 27). Average total daily dose of basal insulin (U in a day, U per kg in a day) in adolescents group 1 was significantly higher, com-pared with patients in group 2 (р = 0.043; р = 0.038 respectively). Patients in group 2 received more car-bohydrates with a meal intake and had higher doses of average total daily bolus insulin. The average ba-sal-to-bolus ratio from group 1 patients was 51/49%, compared with group 2 patients – 45/55% (р = 0.026).  An important condition for achieving optimal glycemic control is a high level of compliance and skills of adolescents. Optimal well-balanced basal-to-bolus insulin ratio in adolescents with T1DM on CSII, which can provide improvements in blood glucose management and reducing the risk of complications of the disease, is 51/49%. 

1. Bashnina H.B., Kornalevskaya A.O., Triasova T.I. Insulinoterapiya u podrostkov s saharnym diabetom 1 tipa [Insulintherapy among teenagers with diabetes mellitus: problems and ways for solution]. Lechashchiy vrach – The Practitioner, 2012, no. 6, pp. 40–42. doi: http://www.lvrach.ru/ 2012/06/15435448/ (in Russian).

2. Greenbaum C.J. Insulin resistance in type 1 diabetes. Diabetes Metab. Res. Rev., 2002, no. 18, pp. 192–200.

3. Yemel’yanov A.O., Kurayeva T.L., Laptev D.N., Peter-kova V.A. Prospektivnoe nablyudeniye effektivnosti i bezopasnosti pompovoy insulinoterapii u detey i podrostkov [Prospective study of efficacy and safety of insulin pump therapy in children and adolescents]. Sacharniy diabet – Diabetes Mellitus, 2010, no. 3, pp. 143–146 (in Russian).

4. Galkina G.A., Eliseyeva T.A, Komkova M.V., Morozova N.V., Afonin A.A., Bocharova R.I. Kachestvo zhizni detey s saharnym diabetom 1 tipa, nahodyashhihsya na pompovoy insulinoterapii [The quality of life among children with type 1 diabetes mellitus using pump insulinotherapy]. Problemy endokrinologii – Problems of Endocrinology, vol. 2, no. 2, pp. 23–27 (in Russian).

5. Dedov I.I., Yemel'yanov A.O., Peterkova V.A., Kuraeva T.L. Insulinovaya pompa v lechenii sakharnogo diabeta u detei i podrostkov [Insulin pump for the treatment of the children and adolescents with type 1 diabetes mellitus]. Мoscow, 2008. 39 p. (in Russian).

6. Dedov I.I., Shestakova M.V. Algoritmy okazaniya speciali-zirovannoe medicinskoy pomoschi bol'nym sakharnym diabetom [Standards of specialized diabetes care]. 7th ed. Мoscow, 2015. 79 p. (in Russian).

7. Schwartz F.L., Guo A., Marling C.R., Shubrook J.H. Analy-sis of use of an automated bolus calculator reduces fear of hypoglycemia and improves confidence in dosage accuracy in type 1 diabetes mellitus patients treated with multiple daily insulin injection. J. Diabetes Sci. Technol., 2012, Jan 1, vol. 6, no. 1, pp. 150–152.