ORIGINAL ARTICLE The effect of insulin glargine and nutritional model on metabolic control, quality of life and behavior in children and adolescents with type 1 diabetes mellitus Damla Goksen Æ Sukran Darcan Æ Muammer Buyukinan Æ Timur Ko ¨se Æ Serpil Erermis Æ Mahmut Coker Received: 27 November 2006 / Accepted: 28 August 2007 / Published online: 11 October 2007 Ó Springer-Verlag 2007 Abstract To determine the impact of glargine insulin therapy with different nutritional models on key parameters of diabetes including quality of life, behavior in children and adolescents with type 1 diabetes. Age, duration of diabetes, HbA1c, anthropometric data and episodes of severe hypoglycemia were taken from patients’ charts. Diabetes quality of life scale and childhood behavior checklist questionnaires were given to each child at the start and at the end of 6 months. Mean age when starting on glargine insulin was 15.5 ± 3. 8 years. Duration of diabetes was 7.1 ± 4.3 years. About 14 of the patients chose to be in the carbohydrate counting group, whereas 24 of them continued with exchange meal plan as nutritional model. There was a reduction in HbA1c levels from 7.86 to 7.1% in the carbohydrate group and 8.8 to 8.0% in the exchange meal plan group. Total daily insulin dose did not change in both of the groups. BMI did not change in both of the groups. Diabetes-related worries decreased in car- bohydrate group. No change was found in the behavior scores in both of the groups at the end of the study period. The use of glargine therapy among adolescents with type 1 diabetes was associated with improved overall glycemic control. Keywords Type 1 diabetes Á Glargine Á Quality of life Á Behavior Introduction The main aims of diabetes care in children and adolescents are to achieve optimal glycemic control and normal psy- chosocial development. The more intensive the treatment [multiple daily insulin therapy with either multiple daily insulin (MDI) or continuous subcutaneous insulin infusion regimens (CSII)], the better the chance to delay the onset and the progression of complications [1]. Providing a constant supply of basal insulin that mimics that of healthy individuals is an essential aspect of maintaining tight gly- cemic control in patients with type 1 diabetes. The approach of intensive insulin therapy aims to mimic the diurnal insulin pattern seen in nondiabetic people. NPH insulin as basal insulin formulation does not provide con- stant and reliable 24 h basal insulin supply because the duration of action is short, and unwanted peaks of action in night can cause nocturnal hypoglycemia [2]. Insulin glar- gine provides sufficient basal insulin over 24 h when used in basal bolus regimen as shown in adult studies [3]. The short-acting insulin analogues can be given in small doses throughout the day and can be matched to the carbohydrate intake and also give the family flexibility at meal times [4]. The significant problem of intensive management may possibly affect the quality of life. Ingersoll and Marrero [5] prepared diabetes quality of life scale (DQOL) which is composed of three intercorrelated scales: a diabetes life D. Goksen Á S. Darcan Á M. Buyukinan Á M. Coker Department of Pediatric Endocrinology and Metabolism, Ege University Faculty of Medicine, Bornova, Izmir, Turkey T. Ko ¨se Faculty of Computer Engineering, Ege University, Izmir, Turkey S. Erermis Faculty of Medicine Department of Pediatric Psychiatry, Ege University, Bornova, Izmir, Turkey D. Goksen (&) Mithatpasa cad. No:1114/5, 35290 Guzelyali-Izmir, Turkey e-mail: damla.goksen@ege.edu.tr 123 Acta Diabetol (2008) 45:47–52 DOI 10.1007/s00592-007-0019-2