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Mitsui Y, Kuroda A, Ishizu M, Mori H, Kurahashi K, Kondo T, Yoshida S, Akehi Y, Aihara K, Endo I, Abe M, Matsuhisa M. Basal insulin requirement in patients with type 1 diabetes depends on the age and body mass index. J Diabetes Investig 2022; 13:292-298. [PMID: 33740836 PMCID: PMC8847154 DOI: 10.1111/jdi.13547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/11/2021] [Accepted: 03/10/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS/INTRODUCTION To investigate the basal insulin requirement in patients with type 1 diabetes who are on multiple daily injections (MDI) and to assess the patient characteristics that affect the percent of total daily basal insulin dose to the total daily insulin dose (%TBD/TDD). MATERIALS AND METHODS The subjects of this study were 67 inpatients with type 1 diabetes who were served diabetic meals of 25-30 kcal/kg standard body weight during several weeks of hospitalization. The basal insulin requirement was adjusted to keep the blood glucose level from bedtime to before breakfast within a 30 mg/dL difference. The bolus insulin dose before the meal was adjusted to keep the blood glucose level below 140 and 200 mg/dL before and 2 h after each meal, respectively. The total daily insulin dose (TDD), the percent of total daily basal insulin dose (TBD) to TDD (%TBD/TDD), and clinical characteristics were collected. RESULTS The median (Q1, Q3) of TDD was 33.0 (26.0, 49.0) units, and the %TBD/TDD was 24.1 ± 9.8%. The %TBD/TDD was positively correlated with the body mass index (BMI) and negatively correlated with the age at the onset and at the examination according to a univariate analysis. However, the %TBD/TDD was dependent on the BMI (β = 0.340, P = 0.004) and the age at examination (β = -0.288, P = 0.012) according to the multiple regression analysis. CONCLUSIONS The average %TBD/TDD in patients with type 1 diabetes on MDI was approximately 24% under inpatient conditions. The basal insulin requirement was dependent on the BMI and the age at examination.
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Affiliation(s)
- Yukari Mitsui
- Department of Hematology, Endocrinology and Metabolism Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Akio Kuroda
- Diabetes Therapeutics and Research CenterTokushima UniversityTokushimaJapan
| | - Masashi Ishizu
- Diabetes Therapeutics and Research CenterTokushima UniversityTokushimaJapan
| | - Hiroyasu Mori
- Diabetes Therapeutics and Research CenterTokushima UniversityTokushimaJapan
| | - Kiyoe Kurahashi
- Department of Hematology, Endocrinology and Metabolism Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Takeshi Kondo
- Department of Endocrinology and MetabolismTokushima Red Cross HospitalKomatsushimaJapan
| | - Sumiko Yoshida
- Department of Hematology, Endocrinology and Metabolism Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Yuko Akehi
- Diabetes Therapeutics and Research CenterTokushima UniversityTokushimaJapan
| | - Ken‐ichi Aihara
- Department of Community Medicine and Medical ScienceTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Itsuro Endo
- Department of Bioregulatory SciencesTokushima University Graduate School of Medical SciencesTokushimaJapan
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research CenterTokushima UniversityTokushimaJapan
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Proportion of Basal to Total Insulin Dose Is Associated with Metabolic Control, Body Mass Index, and Treatment Modality in Children with Type 1 Diabetes-A Cross-Sectional Study with Data from the International SWEET Registry. J Pediatr 2019; 215:216-222.e1. [PMID: 31345576 DOI: 10.1016/j.jpeds.2019.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To investigate in a large population the proportion of daily basal insulin dose (BD) to daily total insulin dose (TD) (BD/TD) and its association with glycated hemoglobin A1c (HbA1c), body mass index (BMI)- SDS, and treatment modality in children with type 1 diabetes. STUDY DESIGN Cross-sectional study in subjects with type 1 diabetes, age ≤18 years, and ≥2 years of diabetes duration, registered in the international multicenter Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference registry in March 2018. Variables included region, sex, age, diabetes duration, treatment modality (multiple daily injections [MDI] or continuous subcutaneous insulin infusion [CSII]), self-monitoring blood glucose, HbA1c, BD/TD, and BMI-SDS. BMI was converted to BMI-SDS using World Health Organization charts as reference. Hierarchic linear regression models were applied with adjustment for age, sex, and diabetes duration. RESULTS A total of 19 687 children with type 1 diabetes (49% female, 49% CSII users) with median age 14.8 (11.5; 17.2) years and diabetes duration 6.0 (3.9; 9.0) years were included. HbA1c was 63 (55; 74) mmol/mol (7.9 [7.2; 8.9]%), and BMI-SDS 0.55 (-0.13; 1.21). Unadjusted, a lower BD/TD was associated with lower HbA1c, male sex, younger age, shorter diabetes duration, lower BMI-SDS, higher numbers of self-monitoring blood glucose and CSII (all P < .01). After adjustment for confounders, lower BD/TD was associated with lower HbA1c (P < .01) and lower BMI-SDS (P < .01) in children on CSII, but not on MDI. CONCLUSIONS Lower BD/TD is positively associated with lower HbA1c and lower BMI-SDS in children with type 1 diabetes on CSII. It remains to be investigated in a prospective study whether reducing BD/TD insulin will improve metabolic control and normalize body weight in children with type 1 diabetes.
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Haase M, Kahle M, Janert M, Meier JJ, Nauck MA. Basal rate tests (24-hour fasts) performed in type-1 diabetic subjects with either absolute fasting or snacks containing negligible carbohydrate amounts result in similar glucose profiles: A randomized controlled prospective trial. Diabetes Obes Metab 2017; 19:783-790. [PMID: 28058800 DOI: 10.1111/dom.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 11/30/2022]
Abstract
AIMS Basal rate tests (24-hour fasting periods) may be necessary to optimize basal insulin replacement in type 1 diabetes. It was the aim of this study to prospectively compare the allowance of negligible carbohydrate snacks vs absolute fasting. METHODS A total of 20 patients with type 1 diabetes (age, 48 ± 15 years (9 women, 11 men); BMI, 28.5 ± 4.5 kg/m2 ; HbA1c, 8.8% ± 2.0% (73.0 ± 21.9 mmol/mol); insulin dose, 0.69 ± 0.31 IU/kg body weight and per day) participated in 2 basal rate tests lasting 24 hours in random order with unchanged basal insulin replacement. On 1 occasion, negligible carbohydrate snacks (salads and vegetables, up to 5.1 g carbohydrate and 276.3 kJ per portion) were allowed; during the second test subjects were obliged to fast absolutely. Plasma glucose profiles were determined using an exact laboratory method. Hypoglycaemic episodes (plasma glucose < 70 mg/dL) were compared. RESULTS Plasma glucose concentrations during fasting periods, with and without negligible carbohydrate snacks, did not differ significantly ( P = .65) and differences were negligible (95% confidence intervals always included a difference of 0 mmol/L). Also, there was no difference in the number of hypoglycaemic plasma glucose values (P = .40) or in compensatory carbohydrate intake. Basal rate testing with negligible carbohydrate snacks was better tolerated (questionnaire, P = .046) and the desire to discontinue the fasting period was significantly reduced (P = .023). CONCLUSIONS Allowing negligible carbohydrate snacks results in unchanged plasma glucose profiles during basal rate testing and is better tolerated by patients with type 1 diabetes.
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Affiliation(s)
- Maike Haase
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Melanie Kahle
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Martin Janert
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
| | - Juris J Meier
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Michael A Nauck
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Uday S, Gorman S, Feltbower RG, Mathai M. Ethnic variation in the correlation between waist to height ratio and total daily insulin requirement in children with type 1 diabetes: a cross-sectional study. Pediatr Diabetes 2017; 18:128-135. [PMID: 26843216 DOI: 10.1111/pedi.12363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/24/2015] [Accepted: 12/22/2015] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Total daily insulin required to achieve glycaemic control in type 1 diabetes (T1D) depends on numerous factors. Correlation of insulin requirement to body mass index and waist circumference has been variably reported in the literature and that of waist-to-height ratio has not been studied. AIMS To study the correlation between daily insulin requirement [total daily dose (TDD)] and waist-to-height ratio (WHtR) in a multiethnic population. METHODS A cross-sectional study of children (5-18 years) with T1D attending a diabetes clinic in a multiethnic population in Bradford, UK was conducted. Physical measurements were undertaken in the clinic setting and data collected from case notes and patients/carers. RESULTS Sixty nine patients with mean age 12.7(±3.1) yr, duration of diabetes 5.4(±3.5) yr and hemoglobin A1c (HbA1c) 80(±18)mmol/mol(9.5 ± 1.6%) were recruited. Nearly 54% (n = 37) were white and 46% were non-white (29 Asian Pakistani; 1 Indian; 2 mixed White Afro-Caribbean). The two groups had similar demographics and disease profiles. Non-whites compared with whites had a higher prevalence of obesity (15 vs 5%, p < 0.01), family history of type 2 diabetes (T2D) (49% vs. 33%), microalbuminuria (22% vs. 11%, p < 0.05) and deprivation (mean index of multiple deprivation score 42 vs. 30, p < 0.001). WHtR and TDD were poorly correlated in the whole group. There was however a significant positive correlation in Caucasians (r = 0.583, N = 37, p < 0.01) and a negative correlation in Asian Pakistanis (r = -0.472, N = 32, p < 0.01); with a significant negative correlation seen in subjects with relatives with T2D (r = -0.86, N = 6, p = 0.02). CONCLUSIONS The variation in correlations highlights that the two ethnic groups behave differently and should therefore be studied separately with regards to factors influencing insulin requirements with careful consideration to the presence of parental IR. Further prospective studies are required to explore the reasons for these differences.
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Affiliation(s)
- Suma Uday
- Department of Paediatric Endocrinology and Diabetes, Leeds Children's Hospital, Leeds, UK
| | - Shaun Gorman
- Department of Paediatrics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Mathew Mathai
- Department of Paediatrics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Schulten RJ, Piet J, Bruijning PC, de Waal WJ. Lower dose basal insulin infusion has positive effect on glycaemic control for children with type I diabetes on continuous subcutaneous insulin infusion therapy. Pediatr Diabetes 2017; 18:45-50. [PMID: 26880282 DOI: 10.1111/pedi.12352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/29/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of our study was to explore a possible relationship between proportion of basal insulin dose (%BD/T) and glycaemic control in children with type I diabetes on continuous subcutaneous insulin infusion (CSII) therapy. METHODS All patients under the age of 18 with type I diabetes mellitus, treated in a general hospital in Utrecht, The Netherlands, who were on CSII therapy between 2000 and 2011 were selected for inclusion. All data as recorded during outpatient visits were retrospectively collected from patients' charts. Analyses were performed using R Statistical Software. RESULTS Data of 847 outpatient visits of 78 patients [31 males (39.7%) and 47 females (60.3%)] were analyzed. Mean age at diagnosis was 7.1 ± 3.7 yr, mean age at start of pump therapy 10.1 ± 3.8 yr. Mean HbA1c before pump start was 8.3 ± 1.0%, median BMI standard deviation score for age and gender was 0.64 (-1.89-3.79). Median follow-up time per patient was 29 months with an average of 10 visits (range: 3-25). Multivariate analysis revealed that a change of 10% in %BD/T resulted in a decrease or increase of HbA1c of 0.22% [95% confidence interval (CI): 0.15-0.29). No significant effect was observed from SDS BMI, sex, or duration of diabetes. CONCLUSION Low dose basal insulin infusion as a percentage of total insulin dose has a positive effect on metabolic outcome as expressed in HbA1c-levels. A change of 10% in %BD/T results in a decrease or increase of HbA1c of 0.22%. This supports the tendency to aim at the lowest basal insulin requirements in pump setting strategy.
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Affiliation(s)
- Ron J Schulten
- Department of Pediatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Jessica Piet
- Department of Pediatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Patricia Cjl Bruijning
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter J de Waal
- Department of Pediatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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Andersen AJB, Ostenfeld A, Pipper CB, Olsen BS, Hertz AM, Jørgensen LK, Høgsmose J, Svensson J. Optimum bolus wizard settings in insulin pumps in children with Type 1 diabetes. Diabet Med 2016; 33:1360-5. [PMID: 26773826 DOI: 10.1111/dme.13064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
AIM To evaluate current insulin pump settings in an optimally regulated paediatric population using bolus wizard. METHODS We used a retrospective study design to analyse data from 124 children on insulin pump therapy who had optimum HbA1c levels [< 59 mmol/mol (< 7.5%)] and no history of severe hypoglycaemic events. Bolus wizard settings were used to calculate the insulin to carbohydrate factors and insulin sensitivity factors. Multiple regression analysis was used to analyse the variables associated with the calculation factors. RESULTS Insulin to carbohydrate factor varied from 276 in the youngest group to 424 in the oldest group, and increased according to age. Insulin sensitivity factor was highest in the group aged 6 to < 12 years, with a value of 125. Age, amount of carbohydrates, number of boluses per day and insulin per kg were all significantly associated with both calculation factors. Furthermore, duration of insulin pump treatment was significantly associated with insulin sensitivity factor and percentage bolus/basal was significantly associated with insulin to carbohydrate factor. Gender, diabetes duration and BMI were not associated with any of the calculation factors. CONCLUSION Optimum insulin pump settings at pump initiation depend on both insulin requirements and use of the pump. Settings need to be individualized because the standardized calculation factors are not constant for children. There is a need to develop specific age- and insulin dose-dependent calculation factors.
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Affiliation(s)
- A J B Andersen
- Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark.
| | - A Ostenfeld
- Paediatric Department, Copenhagen University Hospital, Herlev, Denmark
| | - C B Pipper
- Section of Biostatistics, Institute of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B S Olsen
- Paediatric Department, Copenhagen University Hospital, Herlev, Denmark
| | - A M Hertz
- Paediatric Department, Copenhagen University Hospital, Herlev, Denmark
| | - L K Jørgensen
- Paediatric Department, Copenhagen University Hospital, Herlev, Denmark
| | - J Høgsmose
- Paediatric Department, Copenhagen University Hospital, Herlev, Denmark
| | - J Svensson
- Paediatric Department, Copenhagen University Hospital, Herlev, Denmark
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Abstract
OBJECTIVE Factors influencing the development of hyperglycemia and pattern of insulin requirement in children undergoing cardiac surgery are poorly understood. This study investigated the impact of age on the pattern of hyperglycemia and insulin requirement in children after cardiac surgery. DESIGN Cohort study, based on a prospectively collected dataset for patients enrolled into the Control of Hyperglycemia in Pediatric Intensive Care trial. SETTING A 24-bedded multidisciplinary PICU. PATIENTS Children randomized to the tight glycemic control arm (target blood glucose, 4-7 mmol/L [72-126 mg/dL]) of the Control of Hyperglycemia in Pediatric Intensive Care trial following cardiac surgery. Children were categorized into four age groups (neonate, 1-30 d; infant, 31-365 d; young child, 1-5 yr; older child, 5-16 yr) for analyses of patterns of hyperglycemia and insulin requirement over the 12-hour period following initiation of insulin. INTERVENTIONS Insulin titration was performed based on blood glucose value and rate of change of blood glucose using an algorithm developed for the Control of Hyperglycemia in Pediatric Intensive Care trial. MEASUREMENTS AND MAIN RESULTS Of 92 children, 72 children (78%) randomized to the tight glycemic control group developed hyperglycemia (blood glucose, > 7 mmol/L [126 mg/dL]) and received insulin. Older age was associated with higher blood glucose and a higher insulin dose per kilogram over the first 3 hours of the study period (p ≤ 0.02). Cumulative insulin dose was significantly higher in older children (median, 1.3 U/kg [range, 0.2-5.75]) compared with other age groups (neonate, 0.37 [0.05-2.2]; infant, 0.45 [0.05-2.2]; young child, 0.35 [0.05-0.81]) (p = 0.004). Age group, rather than body mass index, carbohydrate intake, or cardiac surgery variables, was the only variable (coefficient: 1.14 ± 0.3; p < 0.001) associated with cumulative insulin dose on multivariate analysis. CONCLUSIONS When tight glycemic control is targeted in children who have undergone cardiac surgery, children in the older child age group (5-16 yr) require insulin at significantly higher doses. Further study is needed to understand the mechanisms involved.
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Deeb A, Abu-Awad S, Tomy M, Suliman S, Mustafa H. Relationship between Basal insulin requirement and body mass index in children and adults with type 1 diabetes on insulin pump therapy. J Diabetes Sci Technol 2015; 9:711-2. [PMID: 25691654 PMCID: PMC4604548 DOI: 10.1177/1932296815572681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Samar Abu-Awad
- Endocrine Department, Shaikh Khalifa Medical Center, Abu Dhabi, United Arab Emirates
| | - Mary Tomy
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Shaker Suliman
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Huda Mustafa
- Endocrine Department, Shaikh Khalifa Medical Center, Abu Dhabi, United Arab Emirates
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Polymorphic basal rates of continuous subcutaneous insulin infusion among Taiwanese children with type 1 diabetes. BIOMED RESEARCH INTERNATIONAL 2015; 2015:250656. [PMID: 25802842 PMCID: PMC4329847 DOI: 10.1155/2015/250656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
Abstract
Introduction. The basal dose of insulin, proportion of total daily insulin, and circadian variation during continuous subcutaneous insulin infusion (CSII) therapy among children with type 1 diabetes mellitus (T1D) have not been fully elucidated. Materials and Methods. A total of 45 childhood patients with T1D receiving CSII therapy at Pediatrics Department of Chang Gung Memorial Hospital between 2004 and 2012 were analyzed. Patients were classified according to Tanner stage. Results. HbA1c was significantly reduced in all Tanner groups within three months of CSII therapy (from 67 mmol/mol (8.3%) to 54 mmol/mol (7.1%), P < 0.05). The actual basal proportion of total daily insulin use was 34–40%. The circadian distribution of basal insulin differed markedly between the five Tanner groups. Basal insulin requirement was highest between 3:00 and 7:00 h in Tanner stages 1-2. In stages 3-4, a lower nocturnal basal insulin that increased gradually until daytime was noted. Adolescents (stage 5) displayed a high insulin peak between 6:00 and 11:00 h, and a smaller peak between 19:00 and 23:00 h. Conclusions. A smaller proportion of basal insulin to total daily insulin use, as well as varied circadian patterns of insulin use, characterized these children with T1D.
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Cemeroglu AP, Thomas JP, Zande LTV, Nguyen NT, Wood MA, Kleis L, Davis AT. Basal and bolus insulin requirements in children, adolescents, and young adults with type 1 diabetes mellitus on continuous subcutaneous insulin infusion (CSII): effects of age and puberty. Endocr Pract 2014; 19:805-11. [PMID: 23757622 DOI: 10.4158/ep13099.or] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Guidelines for insulin dosing, including the insulin to carbohydrate ratio (I/C), insulin sensitivity factor (ISF), and basal/bolus ratio guidelines, have been well established for adults with type 1 diabetes mellitus (T1DM). However, clinical experience suggests that these guidelines are not appropriate for children. The purpose of this study was to determine the continuous subcutaneous insulin infusion (CSII) settings in children with T1DM at different ages and stages of puberty. METHODS A total of 154 patients data between the ages of 3 and 21 years with well-controlled T1DM according to American Diabetes Association guidelines were reviewed. Only patients on CSII who were not in the honeymoon period were included. RESULTS Patients were divided into 8 groups according to age, gender, and/or pubertal stage. Insulin requirements increased with puberty in both sexes (0.69, 0.97, and 0.90 U/kg/day in children <7 years of age, midpubertal girls, and late-pubertal boys, respectively). Basal insulin requirement was lowest in the youngest group (34%; P<.01). The youngest group had the lowest I/C prediction factor (PF) (mean, 315.7 ± 79.4; P<.01 with all groups), and the ISF-PF was higher than that of the oldest group (mean, 2,588.3 ± 1,101.8; P<.01). CONCLUSION CSII dose calculations vary with age and pubertal status in children with T1DM. These differences must be considered when calculating CSII dosing, especially for younger children.
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Affiliation(s)
- Ayse Pinar Cemeroglu
- Spectrum Health Medical Group, Pediatric Endocrinology and Diabetes Clinic, Helen DeVos Children's Hospital
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Abstract
Automated closed-loop insulin delivery, also referred to as the 'artificial pancreas', has been an important but elusive goal of diabetes treatment for many decades. Research milestones include the conception of continuous glucose monitoring in the early 1960s, followed by the production of the first commercial hospital-based artificial pancreas in the late 1970s that combined intravenous glucose sensing and insulin delivery. In the past 10 years, research into the artificial pancreas has gained substantial momentum and focused on the subcutaneous route for glucose measurement and insulin delivery, which reflects technological advances in interstitial glucose monitoring and the increasing use of the continuous subcutaneous insulin infusion. This Review discusses the design of an artificial pancreas, its components and clinical results, as well as the advantages and disadvantages of different types of automated closed-loop systems and potential future advances. The introduction of the artificial pancreas into clinical practice will probably occur gradually, starting with simpler approaches, such as overnight control of blood glucose concentration and temporary pump shut-off, that are adapted to more complex situations, such as glycemic control during meals and exercise.
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Affiliation(s)
- Roman Hovorka
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK.
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