No long-term data are available on the efficacy of
glargine insulin in comparison with continuous sc
insulin infusion (CSII) in children and adolescents affected by
Type 1 diabetes (T1D). Our aim was to compare the 2-yr efficacy of the 2
insulin approaches, in order to know how to best supply basal
insulin in these patients. Thirty-six 9 to 18-yr-old consecutive children with at least 3 yr previous T1D diagnosis were enrolled. As part of routine clinical care, the patients consecutively changed their previous
insulin scheme (
isophane insulin at bedtime and
human regular insulin at meals) and were randomly selected in order to receive either multiple daily
injections (MDI) treatment with once-daily
glargine and
human regular insulin at meals, or CSII with aspart or
lispro insulin. Both groups showed a significant decrease in
glycosylated hemoglobin (HbA1c) values during the 1st year of
therapy, though only in the CSII treated children was the decrease also observed during the 2nd year. The overall
insulin requirement significantly decreased only in the CSII group and exclusively during the 1st year, while no significant differences were observed concerning body mass index SD score, severe
hypoglycemic episodes and basal
insulin supplementation. The work illustrates the first long-term study comparing the efficacy of CSII to MDI using
glargine as basal
insulin in children. Only with CSII were better HbA1c values obtained for prolonged periods of time, so that CSII might be considered the gold standard of intensive
insulin therapy also for long-term follow-ups.