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Insulin glargine U300 offers a flatter pharmacodynamic profile and longer duration of action than glargine U100, but pediatric real-world data are limited. This study evaluated the effects of switching from U100 to U300 on glycemic control, body composition, pain, and quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, single-center observational study included children aged 6\u201320 years with T1D who switched from U100 to U300. Assessments were performed at baseline, week12, and week24. The primary endpoint was change in HbA1c; secondary endpoints included insulin dose(U\/kg), hypoglycemia frequency, 3:00 a.m. glucose, lipid parameters, body composition, Numeric Rating Scale (NRS) for pain, and Pediatric Quality of Life Inventory (PedsQL) scores. Participants were stratified by baseline HbA1c (&lt;\u20099% vs.\u2009\u2265\u20099%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty-three participants (mean age 14.98\u2009\u00b1\u20093.53 years) were analyzed. Basal insulin dose increased significantly from 0.48\u2009\u00b1\u20090.12 U\/kg\/day on Gla-100 to 0.51\u2009\u00b1\u20090.14 and 0.51\u2009\u00b1\u20090.15 U\/kg\/day at weeks 12 and 24, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). HbA1c levels demonstrated a small but statistically significant change during follow-up (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048). (8.20 (5.9\u201314.8) %\u2192 8.00 (6.0\u201312.2) %\u2192 8.25 (5.7\u201312.6) %). Participants with HbA1c\u2009\u2265\u20099% showed a significant reduction(\u0394HbA1c\u2009\u2212\u20090.50 (\u2212\u20093.80\u20131.00) %;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014), while those\u2009&lt;\u20099% had a mild increase(\u0394HbA1c 0.10 (\u2212\u20090.90\u20135.30) %). Night-time (03:00 AM) blood glucose levels decreased significantly across the three time points (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), more prominently in the higher HbA1c group. NRS improved markedly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), though PedsQL scores were unchanged.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Switching from U100 to U300 maintained glycemic control with modest insulin dose increases. Greater benefits were observed in patients with higher baseline HbA1c, alongside reduced nocturnal glucose and injection pain.U300 appears to enhance comfort and nighttime stability in pediatric T1D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12902-026-02279-x","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T15:25:09Z","timestamp":1776439509000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world experience with insulin glargine U300 in pediatric type 1 diabetes: glycemic control, insulin requirements, and patient-reported outcomes"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2329-9223","authenticated-orcid":false,"given":"Ilayda","family":"Altun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0791-916X","authenticated-orcid":false,"given":"Didem","family":"G\u00fcne\u015f Kaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0635-2958","authenticated-orcid":false,"given":"Mert","family":"U\u00e7ar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4229-6391","authenticated-orcid":false,"given":"Yakup","family":"G\u00f6zderesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9535-3295","authenticated-orcid":false,"given":"G\u00f6k\u00e7e Velio\u011flu","family":"Ha\u015flak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2282-2606","authenticated-orcid":false,"given":"Hasan","family":"Karaka\u015f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6732-8823","authenticated-orcid":false,"given":"Elvan","family":"Bayramo\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4851-8637","authenticated-orcid":false,"given":"Olcay","family":"Evliyaoglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0121-3756","authenticated-orcid":false,"given":"Hande","family":"Turan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"2279_CR1","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1159\/000543266","volume":"97","author":"M De Bock","year":"2025","unstructured":"De Bock M, Agwu JC, Deabreu M, Dovc K, Maahs DM, Marcovecchio ML, et al. 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Approval was obtained from the ethics committee of Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty (Ethics Approval No.03.10.2024\/1107703). Electronic and medical records of patients were collected under ethical rules. A signed informed consent form was obtained from Legal guardians.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"166"}}