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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma


IMPACT FACTOR 2018: 1.239

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2191-0251
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Volume 32, Issue 1

Issues

Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus

Yukiyo Yamamoto
  • Corresponding author
  • Director of Medical Education, Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu City 807-8555, Japan
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Toru Kikuchi
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
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  • De Gruyter OnlineGoogle Scholar
/ Tatsuhiko Urakami
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
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  • De Gruyter OnlineGoogle Scholar
/ Motohide Goto
  • Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
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/ Kohji Tsubouchi
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Chuno Kosei Hospital, Gifu, Japan
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Goro Sasaki
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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/ Haruo Mizuno
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Departments of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  • Other articles by this author:
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/ Yuki Abe
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Kazuteru Kitsuda
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Kitasato University, Kanagawa, Japan
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/ Shin Amemiya
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Shigetaka Sugihara
  • The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan
  • Department of Pediatrics, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-12-05 | DOI: https://doi.org/10.1515/jpem-2018-0329

Abstract

Background

Treatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients.

Methods

The registration data including hemoglobin A1c (HbA1c), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort).

Results

The proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0–5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA1c values between the two cohorts.

Conclusions

The popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.

Keywords: basal-bolus insulin treatment; glycemic control; hypoglycemia; insulin analog; type 1 diabetes mellitus (T1DM)

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About the article

Corresponding author: Yukiyo Yamamoto, MD, PhD, Director of Medical Education, Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu City 807-8555, Japan; The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan; and Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu 807-8555, Japan, Phone: +81-936917254, Fax: +81-936919338

aYukiyo Yamamoto and Toru Kikuchi equal contributors.


Received: 2018-07-25

Accepted: 2018-11-08

Published Online: 2018-12-05

Published in Print: 2019-01-28


Author contributions: Y.Y. and T.K. researched data, equally contributed to the discussion as the first authors and wrote the manuscript. T.U. researched data and wrote the manuscript. K.T., G.S., H.M., Y.A and K.K. contributed to the discussion. S.A. and S.S. were the chairpersons of the 2008 and 2013 cohorts, respectively, and researched data and contributed to the discussion. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: This study was funded by Japan Diabetes Foundation 2015.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 32, Issue 1, Pages 1–9, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2018-0329.

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