TY - JOUR
T1 - Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control
T2 - Comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus
AU - Yamamoto, Yukiyo
AU - Kikuchi, Toru
AU - Urakami, Tatsuhiko
AU - Goto, Motohide
AU - Tsubouchi, Kohji
AU - Sasaki, Goro
AU - Mizuno, Haruo
AU - Abe, Yuki
AU - Kitsuda, Kazuteru
AU - Amemiya, Shin
AU - Sugihara, Shigetaka
N1 - Funding Information:
Acknowledgments: We thank all the patients, their families and members of the JSGIT. The members of the Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT) are as follows: Akemi Koike, Koike Child Clinic; Aki Nishii, JR Sendai Hospital; Akira Endo, Iwata City Hospital; Akira Ohtake, Saitama Medial University; Eishin Ogawa, Teikyo University; Emiko Tachi-kawa, Tokyo Women’s Medical University School of Medicine; Hanako Tajima, Nippon Medical School; Hideaki Tashita and Tomohiro Hori, Gifu University; Hideo Cho and Makoto Anzo, Kawasaki Municipal Hospital; Hiroki Matsuura, Shinshu University; Hiroko Kadowaki, Sanno Hospital; Hiroshi Mochizuki and Katsuya Aizu, Saitama Children’s Medical Center; Hisakazu Nakajima and Kitaro Kosaka, Kyoto Prefectural University of Medicine; Ichiro Yokota and Yumiko Kotani, Tokushima University School of Medicine and Shikoku Medical Center for Children and Adults; Ikuko Takahashi, Akita University Graduate School of Medicine; Ikuma Fujiwara, Tohoku University Hospital; Jiro Iwamoto, Aso-Izuka Hospital; Junichi Nagaishi, Tottori Municipal Hospital; Junko Ito, Torano-mon Hospital; Jyunichi Arai, Hosogi Hospital; Kanako Ishii and Kenji Ihara, Kyushu University School of Medicine; Kanshi Minamitani, Teikyo University Chiba Medical Center; Kaori Sasaki, Tokyo Women’s Medical University Yachiyo Medical Center; Kazuhiko Jinno, Hiroshima Prefectural Hospital; Kazutaka Konishi, Abuyama Pediatrics Clinic; Keiichi Hanaki, Tottori Prefectural Kousei Hospital; Keisuke Nagasaki, Niigata University Graduate School of Medical and Dental Sciences; Ken Okada, Hiroshima University; Kenichi Miyako, Fukuoka Children’s Hospital; Kentaro Shiga, Yokohama City University Medical Center; Kimitoshi Nakamura, Kumamoto University School of Medicine; Kisho Kobayashi, University of Yamanashi Faculty of Medicine; Kohei Sato, SapproFactory Kids Clinic; Koji Takemoto, Ehime University Graduate School of Medicine; Kosei Hasegawa, Okayama University School of Medicine; Mahoko Hurujyo, Okayama Medical Center; Masanori Adachi, Kanagawa Children’s Medical Center; Masaru Inoue, Okayama Red Cross General Hospital; Michiko Okajima and Yoshihito Kasahara, Kanazawa University School of Medicine; Naoto Shimura, Dokkyo Medical University; Nobuo Matsuura, Sagamidai Hospital; Nobuyuki Kikuchi, Department of Pediatrics, Yokohama City Minato Red Cross Hospital; Noriyuki Takubo and Shigeyuki Ohtsu, Kitasato University School of Medicine; Reiko Horikawa, National Center for Child Health and Development; Rika Kizu, Yokosuka Kyosai Hospital; Ryuzo Takaya, Osaka Medical College; Sachiko Kitanaka, The University of Tokyo School of Medicine; Satoshi Mat-suo, Matsuo Child Clinic; Shinichi Teno, Teno Clinic; Shin-ichiro Miyagawa; National Hospital Organization Kure Medical Center; Shinji Kadoya, Nishinomiya Municipal Central Hospital; Shiro Yamada, Gunma University Graduate School of Medicine; Shoji Nakayama and Taisuke Okada, Mominoki Hospital; Shun Soneda, St. Marianna University School of Medicine; Susumu Kanzaki, Tottori University Faculty of Medicine; Susumu Konda, Konda Children’s Clinic; Tadayuki Ayabe, Dokkyo Medical University Koshigaya Hospital; Takahiro Mochizuki, Osaka Police Hospital; Takanori Kowase, Gunma Seishiryoyo Garden; Takao Fujisawa, National Mie Hospital; Takashi Hamajima, Aichi Children’s Health and Medical Center; Tetsuo Mori, National Hospital Organization Shinshu Ueda Medical Center; Tokuo Mukai, Asahikawa-Kosei General Hospital; Tomoyuki Hotubo, NTT-East Sapporo Hospital; Tomoyuki Kawamura, Osaka City University Graduate School of Medicine; Toshi Tatematsu, Chubu Rosai Hospital; Toshihisa Okada, Kumamoto Hatsuiku Clinic; Toshikazu Takahashi, Takahashi Clinic; Tsutomu Ogata, Hamamatsu University School of Medicine; Utako Sato, Tokyo Hitachi Hospital; Yasuko Uchigata, Tokyo Women’s Medical University School of Medicine Diabetes Center; Yasusada Kawata, Kyushyu Rosai Hospital; Yoshiro Amano, Nagano Red Cross Hospital; Yoshiya Ito, Kitami Red Cross Hospital; Yukashi Ohki, Nippon Medical School; Yusuke Tanahashi, Asahikawa Medical University; Yutaka Igarashi, Igarashi Children’s Clinic; and Zenro Kizaki, Japanese Red Cross Kyoto Daiichi Hospital. Author contributions: Y.Y. and T.K. researched data, equally contributed to the discussion as the first authors and wrote the manuscript. T.U. researched data and wrote the manuscript. K.T., G.S., H.M., Y.A and K.K. contributed to the discussion. S.A. and S.S. were the chairpersons of the 2008 and 2013 cohorts, respectively, and researched data and contributed to the discussion. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Research funding: This study was funded by Japan Diabetes Foundation 2015. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Treatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients. The registration data including hemoglobin A 1c (HbA 1c ), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort). The proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0-5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA 1c values between the two cohorts. The popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.
AB - Treatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients. The registration data including hemoglobin A 1c (HbA 1c ), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort). The proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0-5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA 1c values between the two cohorts. The popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.
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U2 - 10.1515/jpem-2018-0329
DO - 10.1515/jpem-2018-0329
M3 - Article
C2 - 30517078
AN - SCOPUS:85058352526
VL - 32
SP - 1
EP - 9
JO - Journal of Pediatric Endocrinology and Metabolism
JF - Journal of Pediatric Endocrinology and Metabolism
SN - 0334-018X
IS - 1
ER -