Predictors of changing insulin dose requirements and glycaemic control in children, adolescents and young adults with Type 1 diabetes

Teló, Gabriela Heiden; Dougher, Carly E.; Volkening, Lisa K.; Katz, Michelle; Laffel, Lori M.

doi:10.1111/dme.13699

Cited by 20 publications

(10 citation statements)

References 31 publications

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“…In this study of insulin patterns in children and adolescents with T1D, we found that the number of patients on insulin pump therapy decreased significantly with age in both female and male patients, meaning that there is a marked age dependency for pump use, with a strong increase observed in the youngest age group. This is in line with other studies that reported less common insulin pump use in older age groups 5,13 . This finding may indicate that young children are the most probable to benefit from insulin pump therapy and is in accordance with current International Society for Pediatric and Adolescent Diabetes guidelines, which recommend insulin pump therapy for young children aged younger than 7 years 14 .…”

Section: Discussionsupporting

confidence: 92%

“…The daily insulin dose required varies depending on the patient's age and therapy type. While patients on MDI need a higher total amount of insulin units per day, the daily insulin dose (U/kg/d) was significantly lower in patients on insulin pump therapy 4,5 . Younger children have a lower overall insulin requirement than older children or young adults.…”

Section: Introductionmentioning

confidence: 97%

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Patterns of insulin therapy and insulin daily doses in children and adolescents with type 1 diabetes in Germany

Boom

Kostev²

2021

Diabetes Obesity Metabolism

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Aim To describe the different insulin therapy patterns and insulin daily doses in children and adolescents (aged 1‐17 years) with type 1 diabetes. Methods This cross‐sectional study based on the longitudinal prescription (LRx) database (IQVIA) included children and adolescents who received at least two insulin prescriptions of the same drug from 1 January 2016 to 31 December 2019. The study outcomes included the proportion of patients with insulin pumps and multiple daily injection therapy, human insulin and insulin analogue use, as well as insulin daily doses. A multivariable linear regression model was used to study the association between age, sex, insulin drugs, and daily dose. Results A total of 22 512 children and adolescents (mean age: 13.5 years, 47.1% female) were included. The proportion of patients using insulin pump therapy decreased with age, from 72.6% (females) and 73.0% (males) in the age group of younger than 6 years to 30.8% (females) and 26.1% (males) in adolescents. Insulin aspart was the most common short‐acting insulin, with the proportion of users increasing from 56% in the age group of younger than 6 years to 69%‐70% in the 13‐17 years age group. The daily dose of insulin pump therapy was 10 units lower than multiple daily injection (MDI) (P < .001). Conclusion We found a marked age dependency for pump use, with a strong increase observed in the youngest age group. Insulin aspart was the most frequently used analogue insulin. A higher total daily insulin dose was shown in patients on MDI versus insulin pump, along with a significant age dependency.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 97%

Patterns of insulin therapy and insulin daily doses in children and adolescents with type 1 diabetes in Germany

Boom

Kostev²

2021

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…More frequent use of pumps in female adolescents in this and other reports (19,(24)(25)(26)(27) may be related to higher HbA 1c than in male adolescents (28,29), being an indication for pump therapy (1,30). Moreover, preprogrammed basal patterns can be used when days of differing insulin sensitivity are predictable during menstruation (1).…”

Section: Discussionmentioning

confidence: 61%

Temporal Trends and Contemporary Use of Insulin Pump Therapy and Glucose Monitoring Among Children, Adolescents, and Adults With Type 1 Diabetes Between 1995 and 2017

Boom¹,

et al. 2019

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To investigate temporal trends and contemporary use of insulin pump therapy and glucose monitoring in type 1 diabetes. RESEARCH DESIGN AND METHODS In a population-based study, we analyzed the use of insulin pump therapy, continuous glucose monitoring (CGM), and self-monitoring of blood glucose (SMBG) from 1995 to 2017 in patients with type 1 diabetes identified from the Diabetes Prospective Follow-up (DPV) database in Germany and Austria. Patients were stratified by age, sex, migration background, and country. RESULTS Among 96,547 patients with type 1 diabetes (median age 17.9 years, 53% males), the percentage using insulin pump therapy increased from 1% in 1995 to 53% in 2017, with the highest rates in the youngest patients (92% in preschoolers, 74% in children, 56% in adolescents aged <15 years, 46% in adolescents aged ‡15 years, 37% in adults). The percentage of patients using CGM increased from 3% in 2006 to 38% in 2017, with the highest rates in the youngest patients (58%, 52%, 45%, 33%, and 15% of respective age-groups). Daily SMBG frequencies increased from 1995 to 2016 and decreased afterward, most prominently in the youngest patients. Between 2015 and 2017, pump therapy was more frequently used in female versus male adolescents and adults (all P < 0.001), while no sex differences were observed for pump use in children <10 years (all P 5 1.0) and for CGM use in all age-groups (all P 5 1.0). CONCLUSIONS Since 1995, insulin pump use has continuously increased, and insulin pump therapy is now standard in patients aged <15 years. CGM use sharply rose in recent years, particularly in young children.

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“…However, differences in fuel selection 17 and hormonal response 18 to an exercise stimulus between adults and children have previously been highlighted in healthy populations, indicating that care must be taken when extrapolating findings from adults to children. Moreover, age‐dependent differences in daily insulin dosages (i.e., insulin sensitivity) have been described in patients with T1D, indicating that differences in the physiological responses to exercise may exist between adolescents and adults with diabetes 18,19 . Unfortunately, knowledge on the effect of different types of exercise modalities on glucose levels during exercise in adolescents with T1D is scarce and to our knowledge, there is no previous study exploring the metabolic responses to different exercise modalities including isocaloric continuous, intermittent aerobic exercise bouts, and resistance exercise bouts.…”

Section: Introductionmentioning

confidence: 99%

Acute effects of aerobic continuous, intermittent, and resistance exercise on glycemia in adolescents males with type 1 diabetes

et al. 2021

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Objective: Increased levels of physical activity is often associated with reduced HbA1c in individuals with diabetes. However, the effect on glycemic control differs between different programs of exercise. The aim of this study was to compare the acute effects on glycemia of resistance and two aerobic continuous and intermittent exercise bouts in adolescent males with type 1 diabetes.Research design and methods: Eight active males with type 1 diabetes (17.5 ± 0.8 years, BMI: 20.8 ± 2.2 kg/m 2 , HbA1c: 7.2 ± 0.5% [54.9 ± 5.3 mmol/mol]) performed four experimental sessions-nonexercise (control), resistance exercise (RE) and two isocaloric continuous (CE) and intermittent (IE) cycling exercise trials-in a randomized order. Each session consisted of 45 min of exercise (except for the control modality) and 60 min of passive recovery. Venous blood was drawn for assessment of plasma glucose (PG). A two-way repeated-measures ANOVA was used for statistical comparisons.

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Predictors of changing insulin dose requirements and glycaemic control in children, adolescents and young adults with Type 1 diabetes

Abstract: This longitudinal assessment identifies clinically meaningful modifiable (e.g. insulin regimen) and non-modifiable (e.g. sex) factors predictive of insulin requirements and HbA levels in young people with Type 1 diabetes; anticipatory insulin adjustments may improve glycaemic control.

Cited by 20 publications

References 31 publications

Patterns of insulin therapy and insulin daily doses in children and adolescents with type 1 diabetes in Germany

Patterns of insulin therapy and insulin daily doses in children and adolescents with type 1 diabetes in Germany

Temporal Trends and Contemporary Use of Insulin Pump Therapy and Glucose Monitoring Among Children, Adolescents, and Adults With Type 1 Diabetes Between 1995 and 2017

Acute effects of aerobic continuous, intermittent, and resistance exercise on glycemia in adolescents males with type 1 diabetes

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