Tratamiento con insulina glargina vs infusor continuo de insulina en niños y adolescentes con diabetes tipo 1 / Continuous subcutaneous insulin infusion vs multiple daily injections with glargine in children and adolescents with type 1 diabetes

Objetivo: Evaluar la eficacia y la seguridad de dos tipos de terapia intensiva: la infusión subcutánea continua de insulina (ISCI) y el tratamiento con múltiples dosis de insulina (MDI) utilizando análogos de acción rápida preprandiales e insulina glargina, en niños y adolescentes con diabetes mellitus tipo 1 (DM1). Pacientes y métodos: Cuarenta y dos pacientes con DM1 en tratamiento intensivo con MDI con NPH y análogos de acción rápida o insulina regular fueron trasferidos 21 a ISCI y 21 a MDI con insulina glargina. No había diferencias significativas entre los dos grupos ni en las características clínicas ni metabólicas al inicio. Se analizan: índice de masa corporal (IMC), dosis total de insulina al día, incidencia de hipoglucemias graves, descompensaciones cetoacidóticas, niveles de hemoglobina glicada (HbA1c) y grado de satisfacción al inicio y al año de la nueva terapia. Resultados: La HbA1c mejora en ambos grupos, más en el grupo tratado con ISCI [7,89 ± 1,46 a 7,51 ± 0,79%] vs glargina [7,80 ± 0,53 a 7,65 ± 0,62%]. El aporte de insulina disminuye un 17% en el grupo de ISCI [0,98 ± 0,24 a 0,81 ± 0,16u/kg/d] (p < 0,05) y un 10,6% en el de glargina [0,94 ± 0,27 a 0,84 ± 0,22u/kg/d] (p < 0,05). La frecuencia de hipoglucemias graves fue más baja en el grupo tratado con ISCI aunque disminuye en ambos grupos. El IMC no se modifica en el grupo de ISCI y disminuye en el de glargina. Solo evidenciamos cetoacidosis en un paciente con ISCI. El grado de aceptación de la terapia fue bueno en ambos grupos. Conclusiones: El tratamiento con ISCI o con MDI con glargina constituye una buena alternativa terapéutica en los pacientes pediátricos con DM1. Permiten mejorar el control metabólico sin aumentar la incidencia de complicaciones agudas

Objective: To evaluate the efficacy and safety of two different forms of intensive therapy, continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) using premeal insulin rapid analogs and insulin glargine, in children and adolescents with type 1 diabetes mellitus (1DM). Patients and methods: Forty-two diabetic patients, previously treated with MDI using NPH and premeal rapid insulin or shortacting analogs, were changed to CSII (21 subjects) or MDI using glargine. There were not significant differences between both groups, neither in the clinical characteristics nor in the metabolic data at the beginning. Body mass index (BMI), total daily insulin dose, severe hypoglycemic episodes incidence, ketoacidosis events, glycosidase hemoglobin (HbA1c) levels, and quality of life at the beginning and after one year of treatment were analyzed. Results: HbA1c has improved in both groups. This improvement is more significant in the group treated with CSII [7,89 ± 1,46 to 7,51 ± 0,79%] than in the glargine group [7,80 ± 0,53 to 7,65 ± 0,62%]. Insulin dose has declined 17% in CSII patients [0,98 ± 0,24 to 0,81 ± 0,16u/kg/d] (p < 0,05) and 10,6% in glargine patients [0,94 ± 0,27 a 0,84 ± 0,22u/kg/d] (p < 0,05). The number of hypoglycaemic episodes was lower in the CSII group, although it has decreased in both groups. BMI did not change in the CSII patients and was reduced in the glargine patients. There was only one ketoacidosis episode in one patient treated with CSII. The new treatment was very well accepted in both groups. Conclusions: CSII and MDI using insulin glargine are good alternatives to control children and adolescents with type 1 diabetes mellitus. They improve metabolic control without increasing acute complications

Therapy with insulin glargine (Lantus) in toddlers, children and adolescents with type 1 diabetes.

OBJECTIVE: To determine the efficacy and safety of insulin glargine (IG) in children and adolescents with type 1 diabetes. In a prospective, 6-month study, 80 patients, aged 2-19 years, received IG once daily plus insulin regular or rapid analogue before meals. The data of body mass index, frequency of severe hypoglycaemia, daily mean blood glucose, fasting blood glucose, haemoglobin A1c and total daily insulin dosage before and after institution of glargine therapy were collected. RESULTS: After 6 months, the average HbA1c level in the entire cohort dropped from 7.63+/-0.81 to 7.14+/-0.70% (p<0.001). Fasting blood glucose decreased from 161+/-37 to 150+/-35 mg/dl (p<0.05) in the total group. Severe hypoglycaemic episodes were reduced from 0.18 events per patient in the 6 months before IG therapy to 0.11 events per patient in the 6 months after IG therapy. The total daily insulin dose was reduced in the entire group from 0.90+/-0.32 to 0.83+/-0.29 u/kg/day (p<0.05). Body mass index (BMI) remained unchanged. In the 14 preschooler children, the HbA1c dropped from 7.54+/-0.60 to 6.96+/-0.57% (p<0.05). CONCLUSIONS: Insulin glargine is an efficacious treatment to improve metabolic control in children and adolescents with type 1 diabetes. It also improved the metabolic control in preschool-age children, without increasing the number of hypoglycaemic events.

Electrophysiological evidence for the existence of a posterior cortical-prefrontal-basal forebrain circuitry in modulating sensory responses in visual and somatosensory rat cortical areas.

The prefrontal cortex (PFC) receives input from sensory neocortical regions and sends projections to the basal forebrain (BF). The present study tested the possibility that pathways from sensory cortical regions via the PFC-BF and from the BF back to specific sensory cortical areas could modulate sensory responses. Two prefrontal areas that responded to stimulation of the primary somatosensory and visual cortices were delineated: an area encompassing the rostral part of the cingulate cortex that responded to visual cortex stimulation, and a region dorso-lateral to the first in the precentral-motor association area that reacted to somatosensory cortex stimulation. Moreover, BF neurons responded to PFC electrical stimulation. They were located in the ventral pallidum, substantia innominata and the horizontal limb of the diagonal-band areas. Of the responsive BF neurons 42% reacted only to stimulation of 'visually-responsive,' 33% responded only to the 'somatosensory-responsive' prefrontal sites and the remaining neurons reacted to both prefrontal cortical areas. The effect of BF and PFC stimulations on somatosensory and visual-evoked potentials was tested. BF stimulation increased the amplitude of both sensory-evoked potentials. However, stimulation of the 'somatosensory-responsive' prefrontal area increased only somatosensory-evoked potentials while 'visually-responsive' prefrontal-area stimulation increased only visual-evoked potentials. Atropine blocked both facilitatory effects. The proposed cortico-prefronto-basalo-cortical circuitry may have an important role in cortical plasticity and selective attention.