Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: Should payer source influence the choice of therapy?

Joni K. Beck, Teresa V. Lewis, Kathy J. Logan, Donald L. Harrison, Andrew Gardner, Kenneth C. Copeland

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: Should payer source influence the choice of therapy?: Intensive insulin management (IIM) in type 1 diabetes facilitates improved glycemic control and a reduction in long-term diabetes complications. We hypothesized that IIM can be started at diagnosis without deleterious effects on hemoglobin A1c (A1c), body mass index (BMI), and severe hypoglycemia regardless of payer source. Type 1 diabetes patients aged 0-18 yrs, in an academic endocrinology practice were identified for a retrospective chart review. Fifty-four patients on conventional insulin management (CIM) were compared to 51 on IIM. Insulin regimens, payer, and A1c values were compared at baseline, 12, 15, and 18 months. Secondary analyses included BMI changes and hypoglycemia frequency. Overall mean A1c values for the IIM group (8.15 ± 1.41) were lower across all time periods compared to the CIM group (8.57 ± 1.52). Repeated measures anova revealed a significant treatment group effect (p = 0.01) with no time effect (p = 0.87) or interaction (group by time) effect (p = 0.65). Private insurance patients had lower mean A1C values than Medicaid patients (χ2 = 4.5186, p < 0.05), regardless of regimen. A1c values between IIM and CIM were not statistically different within the Medicaid group. BMI changes between groups were not different. Chi-square analysis for severe hypoglycemia revealed no group differences. In conclusion, IIM had improved glycemic control. Private insurance vs. Medicaid patients had lower mean A1c values regardless of treatment group. Considering Medicaid patients only, IIM was not inferior, and for those with private insurance, IIM was superior. IIM, initiated at diagnosis, is a reasonable approach for newly diagnosed children with diabetes regardless of payer source.

Original languageEnglish (US)
Pages (from-to)368-373
Number of pages6
JournalPediatric Diabetes
Volume10
Issue number6
DOIs
StatePublished - Sep 8 2009

Fingerprint

Insulin
Medicaid
Therapeutics
Insurance
Hypoglycemia
Body Mass Index
Type 1 Diabetes Mellitus
Endocrinology
Diabetes Complications
Hemoglobins

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism

Cite this

Beck, Joni K. ; Lewis, Teresa V. ; Logan, Kathy J. ; Harrison, Donald L. ; Gardner, Andrew ; Copeland, Kenneth C. / Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes : Should payer source influence the choice of therapy?. In: Pediatric Diabetes. 2009 ; Vol. 10, No. 6. pp. 368-373.
@article{b40745c27a384e0f9e8403eac71552f9,
title = "Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: Should payer source influence the choice of therapy?",
abstract = "Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: Should payer source influence the choice of therapy?: Intensive insulin management (IIM) in type 1 diabetes facilitates improved glycemic control and a reduction in long-term diabetes complications. We hypothesized that IIM can be started at diagnosis without deleterious effects on hemoglobin A1c (A1c), body mass index (BMI), and severe hypoglycemia regardless of payer source. Type 1 diabetes patients aged 0-18 yrs, in an academic endocrinology practice were identified for a retrospective chart review. Fifty-four patients on conventional insulin management (CIM) were compared to 51 on IIM. Insulin regimens, payer, and A1c values were compared at baseline, 12, 15, and 18 months. Secondary analyses included BMI changes and hypoglycemia frequency. Overall mean A1c values for the IIM group (8.15 ± 1.41) were lower across all time periods compared to the CIM group (8.57 ± 1.52). Repeated measures anova revealed a significant treatment group effect (p = 0.01) with no time effect (p = 0.87) or interaction (group by time) effect (p = 0.65). Private insurance patients had lower mean A1C values than Medicaid patients (χ2 = 4.5186, p < 0.05), regardless of regimen. A1c values between IIM and CIM were not statistically different within the Medicaid group. BMI changes between groups were not different. Chi-square analysis for severe hypoglycemia revealed no group differences. In conclusion, IIM had improved glycemic control. Private insurance vs. Medicaid patients had lower mean A1c values regardless of treatment group. Considering Medicaid patients only, IIM was not inferior, and for those with private insurance, IIM was superior. IIM, initiated at diagnosis, is a reasonable approach for newly diagnosed children with diabetes regardless of payer source.",
author = "Beck, {Joni K.} and Lewis, {Teresa V.} and Logan, {Kathy J.} and Harrison, {Donald L.} and Andrew Gardner and Copeland, {Kenneth C.}",
year = "2009",
month = "9",
day = "8",
doi = "10.1111/j.1399-5448.2009.00538.x",
language = "English (US)",
volume = "10",
pages = "368--373",
journal = "Pediatric Diabetes",
issn = "1399-543X",
publisher = "Blackwell Munksgaard",
number = "6",

}

Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes : Should payer source influence the choice of therapy? / Beck, Joni K.; Lewis, Teresa V.; Logan, Kathy J.; Harrison, Donald L.; Gardner, Andrew; Copeland, Kenneth C.

In: Pediatric Diabetes, Vol. 10, No. 6, 08.09.2009, p. 368-373.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes

T2 - Should payer source influence the choice of therapy?

AU - Beck, Joni K.

AU - Lewis, Teresa V.

AU - Logan, Kathy J.

AU - Harrison, Donald L.

AU - Gardner, Andrew

AU - Copeland, Kenneth C.

PY - 2009/9/8

Y1 - 2009/9/8

N2 - Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: Should payer source influence the choice of therapy?: Intensive insulin management (IIM) in type 1 diabetes facilitates improved glycemic control and a reduction in long-term diabetes complications. We hypothesized that IIM can be started at diagnosis without deleterious effects on hemoglobin A1c (A1c), body mass index (BMI), and severe hypoglycemia regardless of payer source. Type 1 diabetes patients aged 0-18 yrs, in an academic endocrinology practice were identified for a retrospective chart review. Fifty-four patients on conventional insulin management (CIM) were compared to 51 on IIM. Insulin regimens, payer, and A1c values were compared at baseline, 12, 15, and 18 months. Secondary analyses included BMI changes and hypoglycemia frequency. Overall mean A1c values for the IIM group (8.15 ± 1.41) were lower across all time periods compared to the CIM group (8.57 ± 1.52). Repeated measures anova revealed a significant treatment group effect (p = 0.01) with no time effect (p = 0.87) or interaction (group by time) effect (p = 0.65). Private insurance patients had lower mean A1C values than Medicaid patients (χ2 = 4.5186, p < 0.05), regardless of regimen. A1c values between IIM and CIM were not statistically different within the Medicaid group. BMI changes between groups were not different. Chi-square analysis for severe hypoglycemia revealed no group differences. In conclusion, IIM had improved glycemic control. Private insurance vs. Medicaid patients had lower mean A1c values regardless of treatment group. Considering Medicaid patients only, IIM was not inferior, and for those with private insurance, IIM was superior. IIM, initiated at diagnosis, is a reasonable approach for newly diagnosed children with diabetes regardless of payer source.

AB - Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: Should payer source influence the choice of therapy?: Intensive insulin management (IIM) in type 1 diabetes facilitates improved glycemic control and a reduction in long-term diabetes complications. We hypothesized that IIM can be started at diagnosis without deleterious effects on hemoglobin A1c (A1c), body mass index (BMI), and severe hypoglycemia regardless of payer source. Type 1 diabetes patients aged 0-18 yrs, in an academic endocrinology practice were identified for a retrospective chart review. Fifty-four patients on conventional insulin management (CIM) were compared to 51 on IIM. Insulin regimens, payer, and A1c values were compared at baseline, 12, 15, and 18 months. Secondary analyses included BMI changes and hypoglycemia frequency. Overall mean A1c values for the IIM group (8.15 ± 1.41) were lower across all time periods compared to the CIM group (8.57 ± 1.52). Repeated measures anova revealed a significant treatment group effect (p = 0.01) with no time effect (p = 0.87) or interaction (group by time) effect (p = 0.65). Private insurance patients had lower mean A1C values than Medicaid patients (χ2 = 4.5186, p < 0.05), regardless of regimen. A1c values between IIM and CIM were not statistically different within the Medicaid group. BMI changes between groups were not different. Chi-square analysis for severe hypoglycemia revealed no group differences. In conclusion, IIM had improved glycemic control. Private insurance vs. Medicaid patients had lower mean A1c values regardless of treatment group. Considering Medicaid patients only, IIM was not inferior, and for those with private insurance, IIM was superior. IIM, initiated at diagnosis, is a reasonable approach for newly diagnosed children with diabetes regardless of payer source.

UR - http://www.scopus.com/inward/record.url?scp=69649093752&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=69649093752&partnerID=8YFLogxK

U2 - 10.1111/j.1399-5448.2009.00538.x

DO - 10.1111/j.1399-5448.2009.00538.x

M3 - Article

C2 - 19522746

AN - SCOPUS:69649093752

VL - 10

SP - 368

EP - 373

JO - Pediatric Diabetes

JF - Pediatric Diabetes

SN - 1399-543X

IS - 6

ER -