Long-acting Insulin Analogs Effect on gh/igf Axis of Children with Type 1 Diabetes: a Randomized, Open-label, Two-period, Cross-over Trial.

Abstract

BACKGROUND:

Growth hormone (GH) secretion is increased in pre-pubertal children with type 1 diabetes and GH excess produces insulin resistance. Early-morning insulinopenia contributes to lower insulin-like growth factor (IGF-I) levels and to GH hypersecretion.

OBJECTIVE:

To evaluate differences in GH/IGF-I axis of pre-pubertal children with type 1 diabetes treated with glargine or detemir as long-acting insulin analogues, which was the main outcome measure, and to compare insulin effects in obtaining good metabolic control.

SUBJECTS:

Children with type 1 diabetes.

METHODS:

This was a 32-week, randomized, open-label, two-period, cross-over comparison between bedtime glargine and twice-daily detemir insulin, involving pre-pubertal children in care at a diabetes pediatric centre. After a 8-week-run-in period subjects were randomized to bedtime glargine or twice-daily detemir insulin administration. After a 12-week period treatments were inverted and continued for additional 12 weeks.

RESULTS:

Overall, 15 pre-pubertal children (53.3% males, mean age 8.6±1.5 years, duration of diabetes 4.2±1.5 years) completed the study. Groups did not differ for GH/IGF axis and HbA1c levels. Treatment with glargine was associated with lower fasting glucose values than treatment with detemir (8.1±1.5 vs. 8.2±1.7 mmol/L, p=0.01). Incidence rate of hypoglycemia was not different between insulin treatments (IRR=1.18, 95%CI 1.00-1.38; p=0.07). Detemir treatment was associated with a higher increase in body weight (p=0.008) and height (p=0.02) when compared with glargine.

CONCLUSION:

Detemir and glargine not show significant differential effects on the GH/IGFI axis. The greater weight gain and height associated with detemir treatment, apparently not related to the level of pubertal growth, deserve further investigation.

• Authors: V Cherubini, B Pintaudi, A Iannilli, M Pambianchi, L Ferrito, A Nicolucci
• Journal: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association (Exp Clin Endocrinol Diabetes) Vol. 124 Issue 5 Pg. 276-82 (May 2016) ISSN: 1439-3646 [Electronic] Germany
• PMID: 27023008 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Hypoglycemic Agents
• IGF1 protein, human
• Human Growth Hormone
• Insulin Glargine
• Insulin Detemir
• Insulin-Like Growth Factor I

Topics

• Child
• Cross-Over Studies
• Diabetes Mellitus, Type 1 (drug therapy)
• Female
• Human Growth Hormone (metabolism)
• Humans
• Hypoglycemic Agents (administration & dosage, pharmacology)
• Insulin Detemir (administration & dosage, pharmacology)
• Insulin Glargine (administration & dosage, pharmacology)
• Insulin-Like Growth Factor I (metabolism)
• Male
• Treatment Outcome