2008 Faculty Researchers

Bachrach, Bert MD & Rife, Danita RN, APRN

70/30 Insulin Antiquated or State of the Art

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Summary

70/30 insulin with 2 shots per day is utilized by the Pediatric Diabetes Department as the initial insulin treatment for new onset diabetes patients. The goal of initiating new onset diabetics on this regimen is to keep things simple, straightforward, and easy to learn for patients and families as the initial diagnosis is often significantly traumatic to everyone involved.

The Diabetes Control and Complications Trial has demonstrated that tight control can prevent the complications of diabetes. Furthermore, multiple daily injections with intensive insulin therapy has shown to improve the control of diabetes patients and be beneficial in preventing long term complications. In fact, at this time the majority of institutions utilize long acting insulin lantus and short fast acting insulins like humalog with carbohydrate as the initial treatment plan.

Thus at this time the utilization of 70/30 by the University of Missouri program as the initial regimen comes into question by Pediatric Endocrinologists and diabetes caregivers at other institutions. However, the anecdotal experience of the diabetes program at the University is that this is still a viable regimen secondary to the simplicity and family to adjust. In addition, the patients appear to remain in a prolonged honeymoon period with fifty percent of our patients HbA1c below 6.5 % or less a year out from diagnosis.

At this time we would like to perform a chart review on new onset patients diagnosed over the past 3 years to determine their discharge dose of insulin after initial diagnosis, the length of their honeymoon period, ability to adjust to the regimen and length of time to when they were transitioned to an intensive insulin regimen, and any variance and variability depending upon age of diagnosis.

Thus we will be applying for IRB approval to perform a chart review on our New Onset Diabetes patients with the criteria of being trained initially at the University of Missouri. When approval is received we would like this student to perform a chart review recording the initial insulin regimen, age, dose at discharge, length of time in honeymoon period, and timing of transition to intensive insulin regimen.