ISPAD Guidelines 2018 -Chapter 9: Insulin treatment in children and adolescents with diabetes

Chapter 9: Insulin treatment in children and adolescents with diabetes
Thomas Danne,  Moshe Phillip, Bruce Buckingham, Przemyslawa Jarosz-Chobot, Banshi Saboo, Tatsuhiko Urakami, Tadej Battelino, Ragnar Hanas and Ethel Codner 

Chapter Highlights:

·         The 2018 ISPAD Clinical Practice Consensus Guidelines on Insulin treatment describes how insulin remains at the core of all recent advances in the treatment of children with diabetes.

·         The chapter details how to use traditional insulins and new insulin analogs appropriately in each individual based on factors including: age, duration of diabetes, lifestyle (dietary patterns, exercise schedules, school, work commitments etc.), targets of metabolic control and particularly individual patient/family preferences.

·         It summarizes current pediatric recommendations for insulin injection and of devices for insulin delivery

·         It gives updated advice for pediatric insulin dose adjustments and  guidance on approaches for persistent deviations of glucose levels from target

·         It reviews the evidence how the traditional insulins have certain clinical limitations and how the development of new analogs, rapid and long-acting, have resulted in some improvement in the care of diabetes, but that their beneficial extent in a long-term clinical setting is not fully established.

·         The chapter points out that biosimilars might lower the price for insulin, make it more accessible and affordable for many pediatric patients but bioequivalence has to be established through proper clinical trials and pharmacovigilance with reporting of any side effects observed.

·         It confirms that the currently available data continues to show the safety of insulin analogs also for pediatric use.

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