Relationship Between Insulin Injection Regimen and Metabolic Control in Young Danish Type 1 Diabetic Patients

In 1987 and 1989 nationwide screening for HbA1c was carried out in Denmark. Twenty‐one paediatric departments treating children with diabetes participated in the first study and twenty‐two in the second. During this 2‐year period metabolic control deteriorated despite the fact that the use of multiple injection regimens increased from 39% to 54%. The possible reasons for the deterioration in metabolic control were examined in the 429 children (≥9 years, 1987) and adolescents (<18.8 years, 1989) who participated in both studies. All had diabetes duration of greater than one year (1987) and all were treated by the same departments during the study period. The children were divided into three subgroups according to injection regimen. Group A (n=128) received twice‐daily insulin injections; group B (n=171) were on multiple injections (three or more) while group C (n=130) shifted from twice‐daily insulin to multiple injections during the 2‐year period. A deterioration of blood glucose control as assessed by HbA1c was observed in all three treatment groups. For group C the 2‐year increase in daily insulin dose was more pronounced for males (19%) than for females (6%). Body mass index increased significantly in all treatment groups during the study period. The 1989 mean levels were higher in group B (males 20.6 kg m−2, females 22.0 kg m−2) than group A (males 19.3 kg m−2, p=0.002; females 20.7 kg m−2, p=0.000003) and group C (males 19.4 kg m−2, p=0.0005; females 20.7 kg m−2, p=0.008). Growth velocity was reduced for both sexes in group B compared to group A and C (males, p=0.0005; females, p=0.007). In conclusion all subgroups showed a deterioration of metabolic control from 1987 to 1989. Even the group changing from twice daily insulin to three or more injections did not improve blood glucose control.