Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The effect of Lantus on glycemic control in children and adolescents with type 1 diabetes mellitus

1형 당뇨병을 가진 소아와 청소년에서 란투스 치료의 혈당 조절에 대한 효과

  • Rhie, Young Jun (Department of Pediatrics, Severance Children's Hospital, Instituite of Endocrinology, Yonsei University College of Medicine) ;
  • Chae, Hyun Wook (Department of Pediatrics, Severance Children's Hospital, Instituite of Endocrinology, Yonsei University College of Medicine) ;
  • Kim, Ho Seong (Department of Pediatrics, Severance Children's Hospital, Instituite of Endocrinology, Yonsei University College of Medicine) ;
  • Kim, Duk Hee (Department of Pediatrics, Severance Children's Hospital, Instituite of Endocrinology, Yonsei University College of Medicine)
  • 이영준 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원, 내분비 연구소) ;
  • 채현욱 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원, 내분비 연구소) ;
  • 김호성 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원, 내분비 연구소) ;
  • 김덕희 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원, 내분비 연구소)
  • Received : 2007.04.13
  • Accepted : 2007.05.02
  • Published : 2007.06.15
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Abstract

Purpose : With a duration of action of approximately 24 hours and peakless levels, Lantus is a more physiologic basal insulin analogue compared with NPH. The aim of this study was to compare the glycemic control of Lantus plus Humalog with that of premixed insulin in children and adolescents with type 1 diabetes mellitus. Methods : The subjects consisted of 25 patients with type 1 diabetes mellitus, aged 12-19 years, who changed their insulin regimen from premixed insulin to Lantus plus Humalog. Daily insulin doses, frequency of hypoglycemia, fasting blood glucose, C-peptide concentration and HbA1c before and 6 months after Lantus treatment were compared. 24 hour blood glucose of 11 patients among Lantus treatment group (n=25) and premixed insulin treatment group (n=10) were self-monitored and compared. Results : 6 months after Lantus treatment, the episodes of hypoglycemia were reduced by 50%(15.1 vs. 7.6 events/month), especially nocturnal hypoglycemia by 67%(6.7 vs. 2.5 events/month). HbA1c was reduced from 9.3% to 8.7% after Lantus treatment. Self-monitored blood glucose of Lantus treatment group at postbreakfast 30, 60, 90 and 120 minutes were 171.1, 169.5, 171.0 and 154.1 mg/dL respectively and lower than those of premixed insulin treatment group (259.7, 282.7, 280.0 and 250.9 mg/dL respectively). Conclusion : Compared with premixed insulin, Lantus plus Humalog is more effective in glycemic control and reduction in nocturnal hypoglycemia in children and adolescents with type 1 diabetes mellitus.

목 적 : 란투스는 최대효과 없이, 24시간 동안 효과가 지속되기 때문에 NPH에 비해 생리적인 기저 인슐린 대체 제제이다. 1형 당뇨병 소아 및 청소년에서 란투스와 휴마로그의 병합 치료와 혼합형 인슐린의 혈당 조절 효과를 비교하기 위해 본 연구를 시행 하였다. 방 법 : 혼합형 인슐린에서 란투스와 휴마로그의 병합 치료로 인슐린 요법을 바꾼 1형 당뇨병을 가진 20세 미만의 환아 25명을 대상으로 란투스 시작 전과 시작 6개월 후의 하루 인슐린 투여량, 월간 저혈당 횟수, 공복시 혈당, C-peptide 농도 및 당화혈색소를 비교하였다. 이들 중 11명의 환아와 혼합형 인슐린을 사용하는 10명의 환아를 대상으로 24시간 자가 혈당 검사를 시행하여 매 식사 30분 전과 식후 30분 간격으로 2시간 동안의 혈당과 취침 전의 혈당 비교하였다. 결 과 : 란투스 치료 6개월 후 저혈당 빈도가 월간 15.1회에서 7.6회로 50% 감소하였으며, 특히 야간 저혈당 빈도는 월간 6.7회에서 2.5회로 67% 감소하였다. 당화혈색소는 란투스 치료 6개월 후 9.3%에서 8.7%로 감소하였다. 24시간 혈당 검사에서는 란투스를 사용하는 군에서 아침 식후 30분, 60분, 90분, 120분에서의 혈당이 혼합형 인슐린을 사용하는 군보다 유의하게 낮았고, 24시간 평균 혈당은 란투스 사용군이 $164.1{\pm}78.2mg/dL$로 혼합형 인슐린 사용군의 $211.5{\pm}108.7mg/dL$보다 유의하게 낮았다. 결 론 : 1형 당뇨병 소아 및 청소년에서 란투스와 휴마로그의 병합 치료는 혼합형 인슐린과 비교하여 혈당 조절에 보다 효과적이고, 특히 야간 저혈당 감소에 유효한 것으로 생각된다.

Keywords

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