Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2022, Article ID 2862682, 5 pages
https://doi.org/10.1155/2022/2862682
Research Article
Comparison of the Efficacy of Different Insulin Administration
and Blood Glucose Monitoring Methods in the Treatment of Type 1
Diabetes Mellitus in Children
Qian Deng , Yuqing Chen , Xin Wang, Wenjuan Cai, Yanping Han, and Juanjuan Wang
Endocrine Metabolism Department, Anhui Provincial Children’s Hospital, Hefei 23000, Anhui, China
Correspondence should be addressed to Qian Deng; dengqian202206@126.com and Yuqing Chen; dq725@qq.com
Received 22 June 2022; Revised 5 August 2022; Accepted 17 August 2022; Published 14 September 2022
Academic Editor: Zhiqian Zhang
Copyright © 2022 Qian Deng et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective. To compare the clinical efficacy of different insulin administration methods and blood glucose monitoring methods in
treating type 1 diabetes mellitus in children. Methods. Patients were divided into four groups: multiple daily injection
(MDI) + fingertip blood glucose detection, continuous subcutaneous insulin infusion (CSII) + fingertip blood glucose detection,
MDI + continuous glucose monitoring system (CGMS), and CSII + CGMS. After six months of treatment, followed by telephone
and at least once a month in an outpatient clinic, insulin doses were adjusted according to the children’s blood glucose levels.
Blood glucose control and the daily dose of insulin were compared among the four groups after treatment, and the incidence of
hypoglycemia in each group was recorded during the treatment. We also compare the incidence of the adverse event among the
four groups. Results. 6 months later, the levels of HbA1c, FBG, and two h PG in each group were lower than those before
treatment. There were significant differences in HbA1c, two h PG, and the daily insulin dose among the four groups. There were
differences in the frequency of hypoglycemia among all the groups. The frequency of hypoglycemia in groups C and D was lower
than in group A. Conclusions. CSII was better than MDI, and the blood glucose monitoring effect of CGMS was better than the
fingertip blood glucose detection. The patients treated with CSII combined with CGMS had the best clinical efficacy. The patients
treated with CSII combined with CGMS had the lowest adverse events incidence.
1. Introduction
Type 1 diabetes mellitus (T1DM) is an autoimmune disease
caused by T lymphocyte-mediated directed destruction of
islet β cells, which leads to absolute insufficiency of insulin
secretion and disorders of glucose, lipid, and protein
metabolism [1, 2]. Epidemiological studies have shown that
the incidence of T1DM is increasing year-by-year globally,
with a trend of younger age [3], and the annual growth rate
of T1DM in children <5 years old is 3–4% [4]. Due to poor
compliance in children, blood sugar management is significantly different from that of adults. The incidence of
T1DM in China is 2/100,000 ∼ 5/100,000, with an increase of
about 6,000 cases per year [5, 6]. T1DM cannot be cured
completely. Once diagnosed, children need to control their
diet, monitor blood glucose, and rely on insulin therapy for
life. T1DM has become a chronic lifelong metabolic disease
that seriously threatens the health of children and adolescents. Therefore, strengthening the diagnosis, treatment, and
long-term care of children with type I diabetes in China is of
positive significance.
Children with T1DM are in the continuous growth stage,
and insulin might not fully meet the growth needs, so blood
glucose is relatively difficult to control. With the acceleration
of growth in puberty, the change of secretory hormone is
more evident and complex, further interfering with the
pancreas. The effect of insulin makes it particularly difficult
to control blood glucose during this period. There are two
commonly used treatment methods for T1DM in children.
One is multiple daily injections (MDI). The other simulates
physiological insulin secretion through continuous subcutaneous insulin infusion (CSII), also called an insulin
2
pump. In less developed countries, MDI is frequently used in
T1DM to heal children. Nevertheless, there existed several
problems in best blood glucose control because children’s
compliance with MDI is poorer than that of adults; thus, just
a minor quantity of sufferers complete the blood glucose
aims by MDI. As a substitute for treating MDI, CSII is the
most extraordinary insulin remedy in China, more intimately imitating insulin exudation and is described to
reach a considerably lesser hazard of hypoglycemic occurrence without diabetic ketoacidosis [7]. In addition to insulin injection, monitoring blood glucose stability to guide
treatment is also crucial. Commonly used blood glucose
monitoring methods in clinical practice include the measurement of blood glucose on fingertip by the trace glucose
meter and continuous glucose monitoring system (CGMS).
The limitations of point-of-care blood glucose (BG) monitoring in the hospital highlight the tremendous clinical need
for an automated real-time continuous glucose monitoring
system (CGMS) that can accurately measure the concentration of glucose every few minutes [8].
This study retrospectively analyzed the clinical treatment
practices of our hospital from May 2018 to October 2020 and
compared the effects of different insulin administration
methods and blood glucose monitoring methods on the
clinical efficacy of children.
2. Materials and Methods
2.1. Research Subjects. This study was a retrospective study,
and 134 children with T1DM treated in our hospital’s Department of Endocrinology and Rheumatology from May
2018 to October 2020 were selected as the subjects. They were
divided into four groups according to insulin administration
and blood glucose monitoring methods: group A :
MDI + fingertip blood glucose detection; group B :
CSII + fingertip blood glucose test; group C : MDI + CGMS;
and group D : CSII + CGMS. The inclusion criteria include the
following: (1) patients with age <18; (2) patients who met the
diagnostic criteria of T1DM in Chinese Guidelines for Diagnosis and Treatment of Type 1 Diabetes Mellitus [9]; (3)
patients who met the diagnostic criteria of T1DM by the WTO
and American Diabetes Association [10]; (4) patients with
perfect clinical data; and (5) patients with their families signed
written informed consent. The exclusion criteria include the
following: (1) patients with other types of diabetes; (2) patients
with a course of disease less than one year; (3) patients with
acute or chronic complications of diabetes requiring emergency treatment; (4) patients complicated with the insufficiency of other vital organs (liver and kidney); (5) patients
were taking or recently taking drugs that affect insulin sensitivity and hypoglycemic drugs; and (6) patients in a state of
disease stress. The Medical Ethics Committee approved this
study of Anhui Children’s Hospital.
2.2. Methods
2.2.1. Data Collection. General data, such as gender, age,
height, weight, course of diabetes, HbA1c level, fasting blood
glucose level, liver function, and kidney function, were
Evidence-Based Complementary and Alternative Medicine
collected through Anhui Children’s Hospital’s electronic
medical record system, the BMI of patients was calculated.
2.2.2. Therapeutic Methods. All the children received
routine treatment, including fluid rehydration treatment,
electrolyte balance, acid-base balance, diet control, and
strengthening exercise, based on which the insulin therapy
was given. The children in groups A and C were given
multiple subcutaneous injections, with the total insulin
dosage being 0.5∼1 U/(kg·d). Gansulin 30R (SFDA approval number: S20020092) was injected subcutaneously
within half an hour before meals. Gansulin N (SFDA approval number: S20020091) was injected subcutaneously
before bedtime. The children in groups B and D were
injected with the insulin pump. Fornia insulin pump was
selected. The needle was connected to the insulin pump
through a continuous catheter, and the needle was subcutaneously implanted for 24 h continuous infusion of
Gansulin R. The total amount of insulin was 0.5–1 U/(kg·d),
50% of the total daily amount of insulin as the necessary
amount, and the remaining 50% as the additional amount
based on the feeding situation and blood glucose level of
the children. The treatment was pumped within half an
hour before meals. Children and their families were taught
how to change the insulin pipeline, set large, essential, and
large supplemental doses, dispose of various alarms, and
suspend the insulin pump. In groups A and B, a blood
glucose monitor was used to extract blood from fingertips
to measure the blood glucose level, and insulin usage was
adjusted according to the blood glucose level. Group C and
D were a dynamic blood glucose monitoring system
(Medtronic dynamic blood glucose monitor), which closely
monitored the continuous blood glucose changes of the
children and adjusted the use of insulin according to the
blood glucose level.
2.3. Follow-Up and Observation Indicators. All the children
were treated for over half a year, followed by telephone and
outpatient. All the children underwent various examinations, including HbA1c, fasting blood glucose, liver function,
and kidney function, at least once a month in the outpatient
department, and the insulin dose was adjusted according to
the blood glucose level. Blood glucose control, including
fasting blood glucose level, two h postprandial blood glucose
level, and HbA1c level, was compared between the four
groups after six months of treatment. The daily insulin dose
was recorded six months after treatment, and the incidence
of hypoglycemia during treatment was recorded. According
to the diabetes guidelines updated by the American Diabetes
Association in 2020, diabetic patients with blood glucose
<3.9 mmol/L are considered hypoglycemia [11].
2.4. Statistical Analysis. SPSS 22.0 software was used for
statistical analysis. Counting data were expressed in n (%),
and the χ 2 test was used to compare the groups. Measuring
data conformed to the normal distribution were expressed in
(x ± s), and a comparison between the two groups was
Evidence-Based Complementary and Alternative Medicine
performed using a t-test of independent samples while that
between the three groups using one-way ANOVA. P < 0.05
meant significant difference.
3. Results
3.1. Comparison of General Data. In total, 134 study participants were enrolled in this research. No statistical significance was observed in both the groups’ age, gender, and
BMI (p > 0.05), as shown in Table 1. In addition, no statistically significant differences were observed among the
four groups in the diabetes course, HbA1c, fasting blood
glucose, and two h postprandial blood glucose all P < 0.05.
Specific data are shown in Table 2.
3.2. Comparison of Blood Glucose Control and Daily Insulin
Dosage in the Four Groups after Treatment. After half a year
of treatment, HbA1c, fasting blood glucose, and two h
postprandial blood glucose levels in each group were lower
than before. There were significant differences in HbA1c, 2 h
postprandial blood glucose, and daily insulin dosage among
the four groups (P < 0.05, P < 0.01, and P < 0.05). Compared
with group A, the HbA1c levels in group B and D were
significantly lower (P < 0.01 and P < 0.05), the fasting blood
glucose levels in group D was significantly lower (P < 0.05),
and the 2 h postprandial blood glucose levels in groups B, C,
and D were significantly lower (P < 0.05, P < 0.01, and
P < 0.01); compared with group B, the HbA1c level in group
C was significantly lower (P < 0.05), and the 2h postprandial
blood glucose level in group D was significantly lower
(P < 0.05); no significant differences were seen in blood
glucose control and daily insulin dosage in other intergroup
comparisons (all P > 0.05, Table 3).
3.3. Comparison of Hypoglycemia Incidence among the Four
Groups during the Follow-Up. During the treatment, 23
patients in group A, 25 in group B, 26 in group C, and 21 in
group D had hypoglycemia, with 82.14%, 69.44%, 76.47%,
and 58.33%, respectively. No significant differences were
seen between the four groups (P > 0.05) and between every
two groups, all P > 0.05. However, the differences in the
frequency of hypoglycemia among the groups were statistically significant (P < 0.01). Compared with group A, the
frequency of hypoglycemia in groups C and D was markedly
lower (P < 0.05 and P < 0.01), while no significant differences were observed between the other in-pair comparisons
(all P > 0.05, Table 4).
3.4. Comparison of Adverse Events Incidence among the Four
Groups during the Follow-Up. Five episodes of diabetic
ketoacidosis in group A, three episodes of diabetic ketoacidosis in group B, two episodes of diabetic ketoacidosis in
group C, and only one episode of diabetic ketoacidosis in
group D were reported. Of 16 episodes of severe hypoglycemia reported, 7 cases were related to the MDI + fingertip
blood glucose detection group, 4 cases were related to the
CSII + fingertip blood glucose test group, 3 cases were
3
related to the MDI + CGMS group, and 2 cases were related
to the MDI + CGMS group, and 1 case was related to
CSII + CGMS. Moreover, five episodes of site infections in
group A, three episodes in group B, three episodes in group
C, and only one episode of site infections in group D were
reported. Of 10 episodes of pump failure reported, 4 cases
were related to the MDI + fingertip blood glucose detection
group, 3 cases were related to the CSII + fingertip blood
glucose test group, 1 case was related to the MDI + CGMS
group, and 2 cases were related to the MDI + CGMS group,
and 1 case was related to CSII + CGMS (Table 5).
4. Discussion
T1DM is a chronic disease that seriously threatens the health
of children and adolescents. Without timely intervention, it
will lead to various complications in children. Children with
T1DM must use insulin regularly and need effective blood
glucose monitoring due to their young age, difficult diet
control, fast physical growth, and a lot of exercises [12]. At
present, various glucose-reducing regimens emerge in
endlessly. This study retrospectively analyzed the four
commonly used hypoglycemic regimens in clinical practice
in our hospital and compared the therapeutic effects of
different glucose-reducing regimens.
CSII is an effective way to treat T1DM by simulating the
insulin secretion function of the human body to control
blood glucose stability. Studies have found that CSII can
better control blood glucose than MDI [13]. HbA1c is an
essential indicator for evaluating blood glucose control and
predicting the occurrence and development of chronic
complications of diabetes, and it can effectively reflect the
average blood glucose level in 2∼3 months [14]. In the
present study, the HbA1c level was markedly lower in groups
B and D than in group A, indicating the insulin pump’s
relatively good hypoglycemic effect. Clinical data at home
and abroad show that CSII can reduce the insulin dosage.
Szypowska et al. [15] found that the insulin dosage used by
CSII patients is lower than that of patients receiving MDI
treatment. Wang et al. [16] found that the amount of insulin
can be effectively reduced after CSII treatment in children
with T1DM in Qingdao. In the present study, the daily
insulin dosage of groups B and D was lower than that of
groups A and C after half a year of treatment, which was
consistent with the literature research results, but the differences were not significant.
The benefit of MDI is that the blood glucose level could
be rigorously measured by various and self-regulating dose
modification; however, the repeated injection might be
uncomfortable and disturb children’s everyday living.
CGMS is a novel blood glucose monitoring method. By
monitoring the glucose level of interstitial fluid, it can reflect
the blood glucose level and blood glucose fluctuation
throughout the day, and it is easier to detect latent hypoglycemia and hyperglycemia [17, 18], which is conducive to
personalize adjustment of the insulin dosage and controlling
the stability of blood glucose [19]. Hypoglycemia is a major
limiting factor for glycemic control in children with T1DM,
so reducing the incidence of hypoglycemia is an integral part
4
Evidence-Based Complementary and Alternative Medicine
Table 1: General clinical data of the study participants.
Groups
Gender (male/female)
Age (y)
Weight (kg)
Height (cm)
BMI (kg/m2)
Group A
(n � 28)
19/9
7.26 ± 2.41
15.45 ± 2.48
70.23 ± 10.02
18.45 ± 1.40
Note: compared with group A, ∗ P < 0.05 and
&&
P < 0.01.
∗∗
Group B
(n � 36)
25/11
7.31 ± 2.16
16.73 ± 3.29
64.03 ± 5.15
18.68 ± 1.27
Group C
(n � 34)
22/12
6.74 ± 2.48
16.53 ± 2.60
62.78 ± 4.98
18.59 ± 1.65
Group D
(n � 36)
24/12
7.15 ± 2.71
15.42 ± 3.04
65.46 ± 6.99
18.82 ± 1.34
F
P
0.188
1.752
0.462
1.237
0.168
0.979
0.160
0.324
0.389
0.918
P < 0.01; compared with group B, # P < 0.05 and ## P < 0.01; and compared with group C, &P < 0.05 and
Table 2: Comparison of general clinical data of the four groups of children.
Group A
(n � 28)
3.14 ± 1.05
8.86 ± 2.19
7.78 ± 3.21
14.25 ± 1.29
Groups
The course of the disease (y)
HbA1c (%)
Fasting blood glucose (mmol/l)
2 h postprandial blood glucose (mmol/l)
Note: compared with group A, ∗ P < 0.05 and
&&
P < 0.01.
∗∗
Group B
(n � 36)
4.33 ± 2.07
8.75 ± 1.96
7.69 ± 3.25
14.13 ± 1.23
Group C
(n � 34)
4.06 ± 0.29
8.58 ± 1.86
7.84 ± 3.26
14.37 ± 1.16
Group D
(n � 36)
3.57 ± 1.13
8.96 ± 1.61
7.74 ± 3.37
14.43 ± 1.30
F
P
1.277
0.225
0.468
0.677
0.285
0.879
0.705
0.568
P < 0.01; compared with group B, # P < 0.05 and ## P < 0.01; and compared with group C, &P < 0.05 and
Table 3: Comparison of blood glucose control and daily insulin dosage in the four groups after treatment.
Group A
(n � 28)
8.22 ± 2.14
7.04 ± 1.25
10.15 ± 1.46
0.76 ± 0.11
Groups
HbA1c (%)
Fasting blood glucose (mmol/l)
2 h postprandial blood glucose (mmol/l)
Daily insulin dosage
Note: compared with group A, ∗ P < 0.05 and
&&
P < 0.01.
∗∗
Group B
(n � 36)
7.72 ± 1.42∗∗
6.39 ± 1.22
9.96 ± 1.58∗
0.68 ± 0.24
Group C
(n � 34)
8.06 ± 1.64#
6.25 ± 1.32
9.67 ± 2.19∗∗
0.70 ± 0.16∗
Group D
(n � 36)
7.61 ± 1.35∗
6.07 ± 1.14∗
8.21 ± 1.63∗∗#
0.65 ± 0.12∗∗
F
P
3.610
1.445
7.507
3.823
0.015
0.233
0.000
0.012
P < 0.01; compared with group B, # P < 0.05 and ## P < 0.01; and compared with group C, &P < 0.05 and
Table 4: Comparison of hypoglycemia incidence among the four groups during the follow-up.
Groups
The number of cases with hypoglycemia
The number of cases without hypoglycemia
Frequency of hypoglycemia
Note: compared with group A, ∗ P < 0.05 and
&&
P < 0.01.
∗∗
Group A
(n � 28)
23 (82.14)
5 (17.86)
2.28 ± 1.09
Group B
(n � 36)
25 (69.44)
11 (30.56)
1.75 ± 1.31
Group C
(n � 34)
26 (76.47)
8 (23.53)
2.04 ± 1.27∗
Group D
(n � 36)
21 (58.33)
14 (41.66)
1.42 ± 1.36∗∗
F
P
0.142
0.085
4.146
0.008
P < 0.01; compared with group B, # P < 0.05 and ## P < 0.01; and compared with group C, &P < 0.05 and
Table 5: Comparison of adverse events incidence among the four groups.
Groups
Diabetic ketoacidosis
Severe hypoglycemia
Site infections
Insulin administration error
Pump failure
Group A
(n � 28)
5
7
5
3
4
Note: compared with group A, ∗ P < 0.05 and
&&
P < 0.01.
∗∗
Group B
(n � 36)
3
4
3
2
3
Group C
(n � 34)
2
3
3
1
1
Group D
(n � 36)
1
2
1
1
2
F
P
1.249
2.334
1.002
1.337
2.003
0.112
0.056
0.395
0.150
0.127
P < 0.01; compared with group B, # P < 0.05 and ## P < 0.01; and compared with group C, &P < 0.05 and
of glycemic management in T1DM [20]. In the present
study, the 2h postprandial blood glucose level in group D
was significantly lower than that in group B. The daily dose
of insulin in group C was significantly lower than that in
group A. During the treatment period, there were significant
differences in the frequency of hypoglycemia among the four
Evidence-Based Complementary and Alternative Medicine
groups (P < 0.05), and the frequency of hypoglycemia in
group C and D was significantly lower than that in group A
(P < 0.05). This indicated that CGMS was more comprehensive and accurate in monitoring blood glucose levels than
fingertip
blood
glucose
monitoring.
Moreover,
CSII + CGMS could adjust the insulin dose according to the
accurate blood glucose data to avoid blindness, which better
controlled the stable blood glucose, reduced the dose of
insulin use, and lowered the incidence of hypoglycemia. We
also compared the incidence of adverse events among the
four groups. The results suggested that the patients treated
with CSII combined with CGMS had the lowest adverse
event incidence. However, the objective of this study was to
evaluate the efficacy of different insulin administration and
blood glucose monitoring methods in treating type 1 diabetes mellitus in children, and the follow-up period is not
long enough.
In conclusion, for the clinical treatment of children with
T1DM, the therapeutic effect of CSII was better than that of
MDI, and the therapeutic effect of CGMS was better than
that of fingertip blood glucose monitoring. CSII combined
with CGMS showed the best clinical efficacy.
Data Availability
The labeled datasets used to support the findings of this
study are available from the corresponding author upon
request.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Acknowledgments
This research was supported by Clinical Application of
Electronic Ketone Meter in Children with Type 1 Diabetic
Ketoacidosis (no. 20etyy008).
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