Efficacy and Safety of Degludec in Children and Adolescents with Type 1 Diabetes

Objectives: Insulin degludec (IDeg) is a new basal insulin. Few data have been published on IDeg effects in childhood. Our purpose was to assess the efficacy and the safety of IDeg in children and adolescents with type 1 diabetes (T1D). Methods: Thirtyseven patients (12.6±4.89 yrs; 21 males; T1D duration 5.50±3.92 yrs; IGlar treatment at least 1 year) were switched to IDeg once daily. z-score BMI, HbA1c, FPG, severe hypoglycaemia rates, and insulin dose [IGlar or IDeg plus short-acting/regular] were collected at baseline (T0, during IGlar treatment), 3 months (T1), and 6 months (T2) after IDeg was started. Results: The switch from IGlar to IDeg allowed a longitudinal dose change of basal insulin (median -4.45% at T0, -0.77 at T1, and -1.53 ant T2; ANOVA Chi Sqr.=9.49, p=0.023) with a significant reduction of short-acting/regular mealtime (MT) (p=0.002) insulin. Despite the lack of statistical significance, mean HbA1c decreased from 7.6% to 7.3% (T1) and 7.4% (T2). FPG improved by 9.5% after 6-months. z-score BMI did not change and no episode of severe hypoglycaemia was reported. Conclusions: IDeg seems to improve the glycemic control than therapy with IGlar. Despite data from adults with T1D, our results in childhood suggest that the dose of IDeg should not be reduced and the MT bolus insulin appropriate replacement doses should be lowered by 8% for patients who previously received IGlar. IDeg might be considered a useful and well tolerated basal insulin also in childhood.