Efficiency of insulin analogs in young patients with type 1 diabetes mellitus debut during pubertal period

Aim.
To identify factors responsible for the early development of microvascular complications in patients with type 1 diabetes mellitus (DM1)and to evaluate dependence of their prevalence on the type of insulin.
Materials and methods.
The study carried out from May 2002 to November 2007 included a random sample of patients with DM1 over 10 years in duration(n=5895, 100%, >=20 years) from the Central, Volga, Ural, Siberian, North-West and Southern federal districts. All patients underwentexamination of eye fundus and feet, measurement of microalbuminuria, creatinine, urea, serum lipid spectrum and HbА1с.
Results.
Mean HbА1с level in patients of group 1 (using insulin analogs) was significantly lower than in group 2 (using homan insulin) (Me 8,5?0,2%;9,7?0,4% SD* respectively) p>0,01. Mean daily insulin dose in group 1 and 2 was >1,0 and <=1,0 U per kg bw. Patients using human insulin analogshad few vascular and other diabetic complications than those using human insulins (p<0,05).
Conclusion.
The closest correlation between the use of insulin analogs and reduced risk of complications in group 1 was observed for nephropathy,diabetic foot, and delayed physical development.

state diabetes registry, glycated hemoglobin, one-step epidemiological survey, insulin analogs, diabetic nephropathy, diabetic retinopathy, diabetic foot syndrome, delayed physical development

1. Дедов И.И. Новые технологии в диагностике и лечении патологии почек при сахарном диабете. Пленарная лекция. Всероссийский конгресс «Диабет и почки» 17-20 мая, Москва - 2009.

2. Сунцов Ю.И., Дедов И.И., Шестакова М.В. Скрининг осложнений сахарного диабета как метод оценки качества лечебной помощи больным. Результаты 5-летней деятельности научно-практического проекта «Мобильный диабет-центр». М. - 2008.

3. Андрианова Е.А., Кураева Т.Л., Щербачева Л.Н. и др. Опыт применения аналога человеческого инсулина ультракороткого действия НовоРапид® (Аспарт) у детей //Сахарный диабет. - №4 (21). - 2003. - с. 22-27.

4. Silva Arslanian Managment of T1DM from children to adults Diabetes Faculty Forum. Barselona. 2008, Р. 24.

5. Diabetes Control and Complications Trial Research Group //N. Engl. J. Med. 1993; 329: Р. 977-86.

6. The DIAMOND Project Group //Diabet Med. 2006; 23: Р. 857-66.

7. Сeriello A. The post-prandial state and cardiovascular disease: relevance to diabetes mellitus //Diabetes Metab Res Rev 200; 16(2): Р. 125-132.

8. OhkudoY., Kishikewa H., Araki E., et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus:a randomized prospective 6-year study //Diabetes Res Clin Pract 1995; 28(2): Р. 103-117.

9. DeWitt D.E., Hirsch I.B. Outpatient insulin therapy in type 1 and type 2 diabetes mellitys: scintific review //JAMA 2003; 289(17): Р. 2254-2264.

10. Мarfella R., Quagliaro L., Nappo F., Ceriello A., Giugliano D. Acute hyperglycemia induces an oxidativ stress in healthy subjects //J. Clin. invest 2001;108(4): Р. 635-636.

11. Gerich J.E. Clinicalsignificance, pathologenesis and management of postpranial hyperglyctmia //Arch intern Med. 2003; 163(11): Р. 1306-1316.

12. Bolotskaya L.L. , Shestakova M.V., Yu.I. Sountsov. Еfficiency of insulin analogs application with patients suffering from Type 1 DM in the Russian populanion. ISPAD UAR. 2008, Р. 158.