Insulin detemir compared with NPH insulin in children and adolescents with Type 1 diabetes

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Abstract
Aims  This study compared the effect of insulin detemir on glycaemic control (HbA1c, fasting plasma glucose and variability thereof) with that of Neutral Protamine Hagedorn human isophane (NPH) insulin, both combined with insulin aspart, in children with Type 1 diabetes mellitus, and compared the safety of these treatments.Methods  In this 26‐week, open‐label, randomized (2 : 1), parallel‐group study, 347 (140 prepubertal and 207 pubertal) children with Type 1 diabetes, aged 6–17 years, received insulin detemir (n = 232) or NPH insulin (n = 115) once or twice daily, according to the prestudy regimen, plus premeal insulin aspart.Results  The mean HbA1c decreased by ∼0.8% with both treatments. After 26 weeks, the mean difference in HbA1c was 0.1% (95% confidence interval −0.1, 0.3) (insulin detemir 8.0%, NPH insulin 7.9%). Within‐subject variation in self‐measured fasting plasma glucose was significantly lower with insulin detemir than with NPH insulin (SD 3.3 vs. 4.3, P < 0.001), as was mean fasting plasma glucose (8.4 vs. 9.6 mmol/l, P = 0.022). The risk of nocturnal hypoglycaemia (22.00–07.00 h) was 26% lower with insulin detemir (P = 0.041) and the risk of 24‐h hypoglycaemia was similar with the two treatments (P = 0.351). The mean body mass index (BMI) Z‐score was lower with insulin detemir (P < 0.001).Conclusions  Basal‐bolus treatment with insulin detemir or NPH insulin and premeal insulin aspart in children and adolescents with Type 1 diabetes mellitus improved HbA1c to a similar degree. The lower and more predictable fasting plasma glucose, lower risk of nocturnal hypoglycaemia and lower BMI observed with insulin detemir are clinically significant advantages compared with NPH insulin.

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