Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand: A survey of current practice

Selvakumar, Dharrshinee; Al‐Sallami, Hesham S.; Bock, Martin de; Ambler, Geoffrey; Benitez‐Aguirre, Paul; Wiltshire, Esko; Tham, Elaine; Simm, Peter; Conwell, Louise S.; Carter, Phillipa J; Albert, Benjamin B.; Willis, Jinny; Wheeler, Benjamin J

doi:10.1111/jpc.13631

Cited by 6 publications

(10 citation statements)

References 21 publications

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“…No data currently exists regarding safety of the approaches described in this work. However, outpatient practice was anecdotally reported as safe, and would be in line with the current practice of some hospitals to conduct general education of newly diagnosed diabetes patients in an outpatient setting, with no hospitalisation occurring at all [15]. With regards insulin pump smart features, the impact of delayed use and its overall contribution to safety is unknown, but it has been found that many patients using insulin pumps find manually calculating bolus insulin doses challenging [18].…”

Section: Discussionmentioning

confidence: 62%

“…In addition, variations on resourcing, as well as the motivations and beliefs expressed relating to these various pump start approaches also varied, demonstrating team preference and differing interpretations of the available literature. This sort of variation in clinical paediatric diabetes practice has been observed in other core aspects of care such as insulin regimen decisions at new diagnosis and beyond [15,16].…”

Section: Discussionmentioning

confidence: 94%

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Insulin pump initiation and education for children and adolescents – a qualitative study of current practice in New Zealand

Aziz

Al‐Sallami

Wiltshire

et al. 2019

J Diabetes Metab Disord

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Purpose Worldwide, the use of insulin pumps for the management of type 1 diabetes is increasing. There are no national or international published guidelines and few guidance recommendations detailing the education and training required to commence insulin pump therapy. The aim of this study is to describe current clinical practice regarding initiation of insulin pump therapy in children and adolescents with type 1 diabetes in New Zealand. Methods Pediatric diabetes nurse specialists from selected New Zealand hospitals (n = 16) were identified and invited to participate in this qualitative study. For those consenting, structured interviews were conducted. The questions covered basic hospital demographics and various aspects of insulin pump initiation including pump start planning, education, and aspects of follow-up and after-care. Results The response rate was 100% (16 out of 16 hospitals). Diabetes clinics interviewed varied in size from 50 to 450 pediatric patients and frequency of insulin pump use from 11%-46%. Clinical practice differed between clinics. Important differences related to: use of continuous glucose monitoring (12/16); and differing views on immediate vs. delayed use of pump advanced features. Location of pump starts also varied, with both in-patient (2/16) and outpatient (14/16) approaches seen. The motivations and beliefs relating to these various pump start approaches also varied. Conclusions Differences seen between hospitals reflected team preference, and possibly a lack of consensus/guidance from the medical literature. Lessons may be learnt and further rationalisation and improvement in education remains possible by combining and adopting strengths from different hospitals.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 94%

Insulin pump initiation and education for children and adolescents – a qualitative study of current practice in New Zealand

Aziz

Al‐Sallami

Wiltshire

et al. 2019

J Diabetes Metab Disord

Self Cite

View full text Add to dashboard Cite

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“…There is currently no international consensus on the starting dose of insulin in this patient group. This is reflected in a recent survey of medical professionals caring for children with T1DM in Australasia that showed variable insulin starting doses [2]. This variability and the subsequent need for dose adjustments possibly contributes to an increased duration of hospital stay, as patients are stabilised on insulin before discharge.…”

Section: Discussionmentioning

confidence: 99%

“…However, many questions remain regarding optimal management, and manifest in considerable variation in practice, often in areas that on first glance would appear straightforward. One such example is insulin regimen where variation exists both within and between countries [2,3].…”

Section: Introductionmentioning

confidence: 99%

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The influence of patient variables on insulin total daily dose in paediatric inpatients with new onset type 1 diabetes mellitus

Müller

Wheeler

Blackwell

et al. 2018

J Diabetes Metab Disord

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Purpose Insulin dose requirements at new diagnosis of type 1 diabetes mellitus (T1DM) vary widely. Current guidelines recommend an initial total daily dose (TDD) ranging from 0.5 to 1.0 IU/kg/day. It often takes several days of frequent dose adjustments before an optimal insulin dose is achieved. The aim of this study was to identify the influence of patient variables on the dose-requirement of insulin in newly diagnosed children with T1DM. Methods A retrospective chart review of children (≤ 18 years old) admitted to hospital between 2010 and 2016 due to new onset T1DM was undertaken. Demographic, clinical, insulin dosing, and laboratory data were recorded. The influence of patient characteristics on insulin TDD was analysed statistically by performing univariate and multivariate linear regression analyses. Results Complete clinical records for 70 patients were available for analysis. The median insulin TDD on first day of admission was 21 (4.5 to 75 units) and that on the day before discharge was 27 (5.5 to 124 units). In the multivariate regression analysis, body size (total body weight and fat-free mass), glycated haemoglobin (HbA1C), and blood ketone concentration were found to be significant predictors of optimal insulin TDD (p < 0.05). Conclusion In addition to body size, HbA1c and ketone concentrations are useful in calculating initial TDD in newly diagnosed children with T1DM. This could potentially decrease the number of days needed to reach a stable dose and result in improved early glycaemic control.

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Twice-daily injections and multiple daily injections of insulin in toddlers with type 1 diabetes: a retrospective cohort study

Wang

Feng

Cao

et al. 2023

Chinese Medical Journal

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Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand: A survey of current practice

Cited by 6 publications

References 21 publications

Insulin pump initiation and education for children and adolescents – a qualitative study of current practice in New Zealand

Insulin pump initiation and education for children and adolescents – a qualitative study of current practice in New Zealand

The influence of patient variables on insulin total daily dose in paediatric inpatients with new onset type 1 diabetes mellitus

Twice-daily injections and multiple daily injections of insulin in toddlers with type 1 diabetes: a retrospective cohort study

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