Original Article Use of insulin glargine in children under age 6 with type 1 diabetes Dixon B, Chase HP, Burdick J, Fiallo-Scharer R, Walravens P, Klingensmith G, Rewers M, Garg SK. Use of insulin glargine in children under age 6 with type 1 diabetes. Pediatric Diabetes 2005: 6: 150–154. # Blackwell Munksgaard, 2005 Aim: Children under 6 yr have the highest incidence of severe hypogly- cemia (SH) and the greatest likelihood of brain damage from SH. The purpose of this study is to evaluate the use of insulin glargine (Lantus Ò ) in children under age 6 with type 1 diabetes (T1D). Methods: The electronic medical records were reviewed for patients under age 6 during the first 6 months of insulin glargine therapy and compared with age, sex, and duration of diabetes for matched control patients on neutral protamine Hagedorn (NPH) insulin. Data from 128 subjects (32 male pairs and 32 female pairs) were collected relating to the incidence of severe and non-severe hypoglycemic events, hemoglobin A1c (HbA1c) values, body mass index (BMI), and daily insulin dose. Additionally, parents were asked to complete a diabetes Quality of Life (QoL) survey. Results: In the 6 months before the study period, the glargine group had 16 SH events compared with three in the 6 months post-glargine. The comparison (NPH) group had seven and six SH events in their respective 6-month periods. Nighttime SH events in the glargine group decreased from 12 prestudy events to one during the study period. The average daily insulin dose in the glargine group was higher than that in the NPH group (0.8  0.2 vs. 0.7  0.2 U/kg/day; p ¼ 0.03). The HbA1c values, BMI, and QoL responses were not significantly different between the two groups. Conclusions: SH was decreased, particularly at night (from 12 episodes to one), after the introduction of glargine in young children with T1D. Brenner Dixon, H Peter Chase, Jonathan Burdick, Rosanna Fiallo-Scharer, Philippe Walravens, Georgeanna Klingensmith, Marian Rewers and Satish K Garg Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver, CO, USA Key words: children – diabetes – hemoglobin A1c – hypoglycemia – insulin glargine (Lantus Ò ) Corresponding author: H. Peter Chase, MD, Department of Pediatrics, University of Colorado Health Sciences Center, Barbara Davis Center for Childhood Diabetes, Mail Stop A140, PO Box 6511, Aurora, CO 80045-6511, USA. Tel: þ1 303 724 6744; fax: þ1 303 724 6779; e-mail: peter.chase@uchsc.edu Submitted 1 December 2004. Accepted for publication 16 February 2005 Severe hypoglycemia (SH) is a major concern for families of young children with type 1 diabetes (T1D) as this age group is less likely to identify hypo- glycemia, their activity is unpredictable, and they have many dietary inconsistencies. As a result, the increased risk of SH is an obstacle in young children when trying to improve glycemic control (1). SH is a particular concern in children under age 6 as the brain is still developing and is more susceptible to damage (2). Rovet and Ehrlich found that teens who had early onset of T1D (5 yr or younger) scored sig- nificantly lower in fine motor abilities and on a continuous performance attention task (3). Ryan et al. found that children with early onset of T1D performed significantly worse in measures of intelli- gence, school achievement, visuospatial ability, mem- ory motor speed, and hand-to-eye coordination (4). Rovet and Alvarez also observed a decrease in atten- tion in subjects with early onset of T1D (5). Although not conclusively proven, it is likely that the described changes are a result of hypoglycemia at a young age. Currently, the US Food and Drug Administration has not approved insulin glargine (Lantus Ò , glargine) for the treatment of T1D in children under age 6. Pediatric Diabetes 2005: 6: 150–154 Copyright # Blackwell Munksgaard 2005 All rights reserved Pediatric Diabetes 150