Endocrine Abstracts

Introduction: Insulin Dugludec is an ultra- long acting basal insulin. The management of diabetes in children is challenging due to the need of regularly injecting insulin, risk of hypoglycaemia, variation in the activity of different insulins available. Dugludec has a long half-life (25 hrs), lower variability and lasts 42 hours. Currently there are no guidelines or NICE recommendations advising the use of insulin dugludec in children with diabetes. Studies are few but have shown improved glycaemic control and reduced episodes of diabetic ketoacidosis and hypoglycaemia.

Methods: Retrospective study looking at clinic letters, blood results of children and adolescents with diabetes on dugludec over 4 years (2014–2018).

Results: Twenty-four children and adolescents (41.6% males, 58.3% females) with a mean age of 15.2 years were started on Degludec, of which 21 had type 1 diabetes and the remaining, type 2. Majority (92%) were commenced due to poor glycaemic control and poor compliance to other insulins. 1 child was started on it to reduce episodes of hypoglycaemia. 1 was started at diagnosis from overseas. Mean HbA1c levels before dugludec was 98 mmol/mol (69–134). HbA1c levels decreased in 15(63%), increased in 6(25%), static in 2(8%) and is too early to assess in 3(12%). The mean reduction of HbA1c levels was 12.5 mmol/mol (2–34). Social difficulties was the main deterrant to improvement.13(54%) patients had no hypoglycaemia episodes noted and 9 (37.5%) had hypoglycaemia.

Conclusion: Dugludec should be considered in patients with poorly controlled diabetes, multiple emergency admissions for hypoglycaemia/diabetic ketoacidosis and difficulty with injections. Choosing the cohort of patients most likely to benefit from dugludec is likely to be cost-effective.

References: Kalra S, Unnikrishnan AG, Sahay R Paediatric diabetes: Potential for insulin degludec 2014. Indian J Endocrinol Metab; 18 (Suppl): S6–S8.

Thalange N et al. Insulin dugludec in combination with bolus insulin aspart is safe and effective in children and adolescents with type 1 diabetes. Paediatric diabetes 2015: 16: 164–176.