INSULIN THERAPY IN CHILDREN AND ADOLESCENTS IN KASHKADARYA REGION

Relevant. In parallel with the work on improving the insulin molecule and methods of its delivery, the requirements for glycemic control are also changing - target values of glycemia during the day, the level of glycated hemoglobin HbA1c, as well as new criteria for assessing the effectiveness and safety of glycemic control - indicators of glycemic variability. While working with children and adolescents, glycemic variability is one of the most important issues in achieving target glycemic levels. Therefore, work is continuously being carried out in Uzbekistan to improve the effectiveness of type 1 diabetes therapy, especially in children and adolescents. In particular, all children and adolescents are provided with analogue insulins at the expense of the state budget. However, it is clear that self-control training is great importance for achieving the goals of glycemic control. Therefore, in parallel with the provision of insulin, continuous work is carried out to teach children, adolescents and their parents to the correct calculations of insulin doses, taking into account individual coefficients, and training is being carried out to independently adjust the dose of insulin.

Material and methods. The data of self-monitoring of glycemia, the level of glycated hemoglobin, insulin doses were analyzed initially (January 2019) and 6 and 12 months after switching to analog insulins. Initially, children and adolescents received human insulins Insulatard and Actrapid. Switching to analog insulins Glargine 100 U and Glulizine was made after the initial assessment of the studied parameters and repeated training in self-control. A total of 235 patients with type 1 diabetes mellitus under the age of 18 were examined.

Results. In the dynamics, a statistically significant increase in the body mass index was observed, which corresponded to the normal dynamics of growth and weight indicators. 

The average level of HbA1c in children and adolescents was initially 8.46±2.23%; after 6 months of receiving analog insulins, we observed a statistically significant decrease in the level of glycated hemoglobin to 7.64±1.18%, which was accompanied by a corresponding decrease in fasting plasma glucose and postprandial glycemia. In terms of glycemic variability measures, we observed a clear decrease in variability after both 6 months

Discussion. In our research, already in 6 months after the transfer of children and adolescents from human insulins to analogues, we observed a statistically significant improvement in long-term glycemic control - glycated hemoglobin with an increase in the number of individuals who reached the target values recommended by ISPAD, also showed the possibility of achieving the target values of the standard deviation of variability glycemia 12 months after switching to analog insulins and therapeutic education of children and adolescents with type 1 diabetes and their parents, while a statistically significant reduction in the standard deviation of glycemic variability was observed after 6 months.

Conclusion. The use of analog insulins in children and adolescents with type 1 diabetes is the key to achieving target levels of glycemic control and improving the quality of life of children.