Insulin Degludec in Adolescents with Type 1 Diabetes: Is Newer Better? - A Retrospective Self-Control Case Series in Adolescents with a History of Diabetic Ketoacidosis.
INTRODUCTION
Insulin degludec (IDeg) is the longest-acting basal insulin available. Whether IDeg compared to shorter-acting basal insulins like insulin glargine U100 (IGlarU100) reduces the rate of diabetic ketoacidosis (DKA) in adolescents with type 1 diabetes is unknown.


OBJECTIVE
We hypothesized that adolescents with type 1 diabetes would have lower DKA rates and mean hemoglobin A1c (HbA1c) when using IDeg as compared to IGlarU100.


METHODS
To avoid selection bias, we used self-control case series methodology. Adolescents with type 1 diabetes treated for DKA from January 2015 through December 2018 who switched basal insulin from IGlarU100 to IDeg were eligible for analysis. Thirty-five patients were included, each acting as their own control. Mean HbA1c and DKA rate for the 12 months prior to and after switching to IDeg were compared.


RESULTS
Mean HbA1c prior to and after switching to IDeg was unchanged (97 ± 20 vs. 97 ± 21 mmol/mol [11.0 ± 1.8 vs. 11.0 ± 1.9%]). Median DKA rate (admissions/year) while on IGlar-U100 was 1 with an interquartile range (IQR) of 1-2. After switching to IDeg, median DKA admission rate remained 1, however the IQR decreased to 0-1 (one-sided p value 0.0004). Median change in DKA rate was 1 fewer admission per year, with a maximum reduction of 3 admissions. Higher baseline rates of DKA increased the odds of a patient reducing his/her DKA rate by 1 admission per year or more.


CONCLUSIONS
Using IDeg for basal insulin in adolescent patients may decrease the rate of DKA relative to IGlarU100 despite no improvement in HbA1c and may be cost-effective.
['Schmitt|Jessica|J|', 'Scott|Mary Lauren|ML|']
D000293:Adolescent D002648:Child D003922:Diabetes Mellitus, Type 1 D016883:Diabetic Ketoacidosis D005260:Female D006442:Glycated Hemoglobin A D006801:Humans D007004:Hypoglycemic Agents D000069036:Insulin Glargine D049528:Insulin, Long-Acting D008297:Male D012189:Retrospective Studies
Insulin degludec Adolescent Diabetic ketoacidosis Insulin glargine Type 1 diabetes mellitus