Impact of switching from neutral protamine hagedorn insulin (NPH) to glargine insulin on glycemic control and clinical outcomes in pediatric patients with type 1 diabetes

Background

Treatment of type 1 diabetes requires insulin therapy, and various types of insulin can be used. Insulin glargine has been shown to provide effective glycemic control with reduced hypoglycemia. However, there are no prior studies investigating the effects of switching from neutral protamine hagedorn (NPH) insulin to glargine insulin in Sudan, due to limited use of glargine insulin and funding constraints.

Objective

This study aimed to assess the impact of switching from NPH insulin to glargine insulin on glycemic control in children with type 1 diabetes, and to identify factors precipitating the switch.

Methods

This observational cross-sectional study included 221 children (aged 1–19 years) with type 1 diabetes who switched from NPH insulin to glargine insulin at Mohamed Alamin Hamid Pediatric Hospital. Simple random sampling was used to select participants.

Results

Of the 221 participants, 83 (37.5 %) switched to glargine insulin, 60 (27.1 %) continued on NPH insulin, and 78 (32.5 %) started on glargine from the beginning. Switching to glargine insulin was associated with a statistically significant reduction in HbA1c (P < 0.001) and a significant decrease in fasting blood glucose (FBG) levels (P < 0.001). Additionally, 69.9 % of participants experienced an increase in their insulin dose (P < 0.001). The primary reason for switching, as reported by 57.8 % of caregivers, was that mixed insulin had not effectively controlled blood glucose, with 60.4 % of these participants experiencing hypoglycemia. Of those who switched, 94 % were satisfied, with 33.3 % reporting better blood sugar control and 89.7 % indicating improvements in general health. A significant increase in weight was observed after switching to insulin glargine (P = 0.0001).

Conclusion

Switching from NPH to glargine insulin among Sudanese pediatric patients with type 1 diabetes offer significant benefits in glycemic control, as reflected by improved HbA1c and FBG levels. Additionally, insulin dose and weight increased, contributing to enhanced overall health and blood glucose management. Hypoglycemia was a major reason for switching.