From the Guidelines
Oral medications are not recommended as a primary treatment for pediatric Type 1 diabetes, and insulin therapy remains the cornerstone of treatment. Insulin therapy is essential for children with Type 1 diabetes, as they have an absolute insulin deficiency due to autoimmune destruction of pancreatic beta cells. All children with Type 1 diabetes require insulin administration, usually through multiple daily injections or an insulin pump.
- The American Diabetes Association states that there is insufficient evidence to support the routine use of adjunctive medical therapies in children with type 1 diabetes 1.
- While some adjunctive oral medications, such as metformin, may occasionally be used in specific situations for pediatric Type 1 diabetes patients, these are not replacements for insulin therapy.
- For example, metformin might sometimes be added to insulin therapy in adolescents with Type 1 diabetes who have insulin resistance or weight concerns, typically at doses of 500-1000 mg twice daily.
- SGLT-2 inhibitors have been studied in adults with Type 1 diabetes but carry significant risk of diabetic ketoacidosis and are not FDA-approved for pediatric Type 1 diabetes.
- GLP-1 receptor agonists are being investigated but are not standard treatment.
- Parents and healthcare providers should understand that oral medications alone cannot manage Type 1 diabetes in children, and insulin therapy remains essential for survival and prevention of complications like diabetic ketoacidosis 1.
- The basal/bolus insulin regimen, which uses a long-acting insulin analog combined with a rapid-acting insulin analog, has been shown to result in stable glycemic control and less hypoglycemia compared to other regimens 1.
From the FDA Drug Label
Type 1 Diabetes - Pediatric In a non-blinded, randomized, controlled clinical study (Study D, n=347), pediatric patients (age range 6 to 17) with type 1 diabetes were treated for 26 weeks with a basal-bolus insulin regimen LEVEMIR and NPH human insulin were administered once- or twice-daily (bedtime or morning and bedtime) according to pretrial dose regimen. Bolus insulin aspart was administered before each meal. LEVEMIR-treated patients had a decrease in HbA1c similar to that of NPH human insulin
There is no oral medication mentioned in the provided drug label for the treatment of type 1 diabetes in pediatric patients. The label only discusses the use of insulin (LEVEMIR and NPH human insulin) in combination with bolus insulin aspart. 2
From the Research
Type 1 Diabetes Management in Pediatrics
- Type 1 diabetes requires lifelong administration of exogenous insulin, with the primary goal of maintaining near-normoglycemia and preventing complications 3.
- The best therapeutic option for patients with type 1 diabetes is basal-bolus therapy, either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) 3.
- Effective insulin therapy must be provided on the basis of the needs, preferences, and resources of the individual and the family for optimal management of type 1 diabetes 3.
Insulin Therapy in Children and Adolescents
- Insulin replacement therapy is essential for managing type 1 diabetes in children and young people, and requires careful management to ensure blood glucose levels stay within the target range 4.
- Regular and ongoing monitoring of blood glucose levels, quarterly measurement of glycated haemoglobin, and management of hyperglycaemia and hypoglycaemia are crucial for effective management 4.
- Advanced insulin formulations, tailored insulin regimens, and delivery systems combined with age-appropriate education and ongoing support can help pediatric patients achieve their treatment goals 5.
Oral Medication for Type 1 Diabetes
- There is no evidence to suggest that oral medication is a suitable replacement for insulin therapy in pediatric patients with type 1 diabetes 3, 4, 5, 6, 7.
- Current therapies for type 1 diabetes still do not match the endogenous insulin profile of pancreatic β-cells, and all pose risks of suboptimal control, hypoglycemia, and ketosis in children and adolescents 3.
Considerations for Pediatric Patients
- Pediatric patients with type 1 diabetes have special and changing needs that must be recognized and addressed, including physiological, medical, psychological, social, and emotional differences 5.
- Primary care physicians should be aware of diabetes technology, sick- and well-child considerations, and commonly associated conditions to better care for children with type 1 diabetes 6.
- Continuous intravenous insulin infusion therapy can be effective in minimizing blood glucose fluctuations and preventing metabolic deterioration in pediatric patients with type 1 diabetes during intercurrent illness and surgery 7.