Effect of Timing of Insulin Degludec in Relation to Age in Type One Diabetic children and Adolescents (Single Center Study)

Abstract Background Glycemic control needs optimal adjustment of basal insulin timing for better health in children with diabetes, optimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depend on its duration of action and peakless profile. Aim of the Work This study aims to identify the best timing of long-acting basal insulin (degludec) in children with type 1 diabetes mellitus. Patients and Methods The current study is an observational study studying glycemic control as evidenced by HbA1c % in relation to the time of long-acting insulin (degludec) The study included 20 patients (age between 4:18 years), with type 1 diabetes received morning dose of insulin degludec then same dose but at night. participants are regularly following up at the Pediatrics and Adolescents Diabetes Unit (PADU), children’s Hospital, Ain Shams University in the period between October 2022 and April 2023, detailed history from participants was taken including: age, history of onset and duration of DM, associated co- morbidities, family history, Insulin regimen including mode of insulin delivery, total daily insulin dose (unit per Kg per day), type of insulin, frequency of injection and current injection timing, Thorough clinical examination: anthropometric parameters were assessed on WHO Z score and clinical evaluation of injection sites for apparent lipodystrophy. Investigations included the annual follow up investigations of the patient (CBC, lipid profile, thyroid profile, liver function tests, urinary albumin creatinine ratio, celiac screening, last hemoglobin A1c) and fundus examination. Glycemic control was assessed by pre-prandial and post-prandial readings and Hb A1c. Results The current study compares participants on morning regimen degludec followed by same dose at night regarding the impact on glycemic control, showed that Hb A1c % was better in children and adolescents using insulin degludec in the morning (mean of Hb A1c (8.23 ± 0.45%) compared to when using insulin degludec at night (mean of Hb A1c 9.16 ± 2.50%), irrespective of age. Conclusion Hb A1c as a measure of glycemic control was better when insulin Degludec was used in a morning regimen than when insulin degludec was given at night. Larger studies are needed to support this and recommend the best timing for insulin degludec in Pediatric age group.