Classification of Distinct Baseline Insulin Infusion Patterns in Children and Adolescents With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Therapy

Abstract

OBJECTIVE -We hypothesized systematic differences in the patterns of programmed basal insulin infusion rates in children and adolescents with type 1 diabetes on continuous subcutaneous insulin infusion (CSII). We aimed at classification of basal insulin infusion rate regimens and comparing patients' underlying clinical characteristics. RESEARCH DESIGN AND METHODS -The German/Austrian diabetes data acquisition system for prospective surveillance database for quality control and scientific surveys in pediatric diabetology served as the primary data source. Latest (September 2004) basal insulin infusion rates of all 1,248 patients with type 1 diabetes on CSII (0.38 -18 years) were analyzed (dataset 1). Basal insulin infusion rates per hour were expressed relative to mean basal insulin infusion rates per 24 h. Unsupervised clustering was used to classify basal insulin infusion rate patterns. Clinical characteristics of patients falling into distinct basal insulin infusion rate clusters were compared by Kruskal-Wallis test. Changes of basal insulin infusion rates in 64 patients were followed from initial settings before CSII to latest programming in an independent dataset 2.RESULTS -Seven different basal insulin infusion rate patterns occurred in dataset 1. A dawn-dusk pattern was used in 708 patients (14.9 Ϯ 2.4 years) with the peak basal insulin infusion rate at 5 A.M. Additional patterns showed only one basal insulin infusion rate oscillation per 24 h with a backshift of peak basal insulin infusion rates in younger children (P Ͻ 0.000001) (1 A.M.: n ϭ 152, 12.4 years and 9 P.M.: n ϭ 117, 8.9 years). All but two patients in dataset 2 were initially set on dawn-dusk patterns but showed a comparable diversification of basal insulin infusion rates during follow-up with backshift of peak basal insulin infusion rates in younger children (P Ͻ 0.01).CONCLUSIONS -Pediatric diabetologists shape distinct basal insulin infusion rate profiles during treatment of CSII patients, mainly reflecting differences in age. Our data strongly suggest that age-dependent endocrine changes during childhood (e.g., puberty) affect circadian distribution of insulin needs in CSII, which should be kept in mind when considering basal insulin infusion rate strategies in children and adolescents. Diabetes Care 30:568 -573, 2007C ontinuous subcutaneous insulin infusion (CSII) therapy has become an increasingly used, effective, safe treatment in children and adolescents with type 1 diabetes (1-5). A growing number of even very young children are treated with CSII (6 -8). CSII has been demonstrated to effectively reduce hypoglycemia (3,9 -12), while ketoacidotic events are not increased (2,3,6,10). Several studies have demonstrated improvement of metabolic control due to CSII as assessed by A1C (2, 9 -13). Compared with multiple daily injections, CSII allows for higher flexibility in timing meals and snacks, which is of particular importance in young children with often unpredictable food intake, enabling intensive treatment with painless insulin deli...

Difference in Insulin Usage Patterns with Pubertal Development in Children with Type 1 Diabetes During Transition from Multiple Daily Injections to Continuous Subcutaneous Insulin Infusion (CSII) and Through the CSII Treatment

“…Holterhus et al 24 showed that age is the most important determinant of basal insulin infusion rate in children and adolescents with type 1 diabetes in CSII treatment. Their data suggested that age-dependent endocrine changes during childhood affect circadian distribution of insulin needs in CSII treatment.…”

Changes in Insulin Requirements From the Onset of Continuous Subcutaneous Insulin Infusion (CSII) Until Optimization of Glycemic Control

“…15 The number of basal segments per day was almost 5 at the end of the follow-up period, also in accordance with the literature. 16 The hourly basal rate was highest late in the evening and in the second half of the nocturnal period when insulin requirements are physiologically higher (dawn phenomenon). This dawn phenomenon was higher and lasted longer in males than in females.…”

The Use of Insulin Pumps in Youth with Type 1 Diabetes

“…Generally, prepubertal children tend to have peak basal rates at 9-10 p.m., whereas pubertal patients have peak basal rates in the early morning hours. 10 Following initiation of insulin pump therapy, we adjust basal rates on a daily basis as needed in the first week and then on a less frequent basis, focusing on identification of patterns. Basal rate changes will have their desired effect in 1-2 h, and therefore basal rate changes should be made with this understanding.…”