Age-specific Characteristics of the Basal Insulin-rate for Pediatric Patients on CSII

Abstract

Objective: This study intends to analyse the basal insulin dosage for pediatric patients (0-18 years) with type 1 diabetes on insulin-pump therapy (CSII).

Research design and methods: In a large German and Austrian prospectively documented data base (DPV) for children with diabetes, patients with CSII were identified. The documented basal rates from patients (0-18 years) were analysed and related to age, gender, duration of diabetes, body weight and type of insulin used in the pump. Data were evaluated for three age groups (0-6; >6-12; >12-18 years).

Results: Complete data sets with documented hourly intervals of basal rate were available from 743 patients. Basal insulin dosage in the 3 age groups differed significantly (0-6 years 0.20 IU/kg body weight; >6-12 years 0.34 IU/kg body weight; >12-18 years 0.41 IU/kg body weight p<0.0001). The amount of basal insulin in 24 hours in each group correlates with body weight, age and duration of diabetes. The circadian distribution of the basal rate shows different profiles in each age group.

Conclusion: Pediatric patients on CSII have age specific characteristics in total amount and circadian distribution of basal rates.

diabetes mellitus type 1 - children - adolescents - insulin pump therapy - insulin basal rate

References

• 1 Ahern J, Boland EA, Doane R, Ahern JJ, Rose P, Vincent M, Tamborlane W. Insulin pump therapy in pediatrics: a therapeutic alternative to safely lower HbA1c levels across all age groups.  Pediatric Diabetes. 2002;  3 10-15
• 2 Bode BW, Sabbah HT, Gross TM, Fredrickson L, Davidson PC. Diabetes management in the new millennium using insulin pump therapy.  Diabetes Metabolism Research and Reviews. 2002a;  18 ((Suppl. 1)) S14-S20
• 3 Bode BW, Tamborlane W, Davidson P. Insulin pump therapy in the 21st century.  Postgraduate Medicine. 2002b;  111 69-77
• 4 Boland EA, Grey M, Oesterle A, Fredrickson L, Tamborlane W. Continuous subcutaneous insulin infudion. A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes.  Diabetes Care. 1999;  22 1779-1784
• 5 Boland EA, Ahern J, Grey M. A primer on the use of insulin pumps in adolescents.  Diabetes Educator. 1998;  24 78-86
• 6 Conrad S, MacGrath M, Gitelman S. Transition from multiple daily injections to continuous subcutaneous insulin infusion in type 1 diabetes mellitus.  Journal of Pediatrics. 2002;  140 235-240
• 7 Costin G, Kaufman FR, Brasel JA. Growth hormone secretory dynamics in subjects with normal stature.  J Pediatr. 1989;  115 537-544
• 8 Danne T, Battelino T. et al . A cross-sectional international survey of continuous subcutaneous insulin infusion in 377 children and adolescents with type 1 diabetes mellitus from 10 countries.  Pediatric Diabetes. 2005;  6 193-198
• 9 DiMeglio LA, Boyd SR. et al . Preschoolers are not miniature adolescents: a comparison of insulin pump dosis in two groups of children with type 1 diabetes mellitus.  J Pediatr Enocrinol Metab. 2004;  17 865-870
• 10 Dost A, Herbst A. et al . Shorter remission period in young versus older children with diabetes mellitus type 1.  Exp Clin Endocrinol Diabetes. 2007;  115 33-37
• 11 Grabert M, Schweiggert F, Holl RW. A framework for diabetes documentation and quality management in Germany: 10 years of experience with DPV.  Computer Methods and Programs in Biomedicine. 2002;  69 115-121
• 12 Holterhus PM, Odendahl R. et al . Classification of distinct baseline insulin infusion patterns in children and adolescents with type 1 diabettes on continuous subcutaneous insulin infusion therapy.  Diabetes Care. 2007;  30 568-573
• 13 Kaufman FR, Halvorson M, Miller D, MacKenzie M, Fisher LK, Pitukcheewanont P. Insulin pump therapy in type 1 pediatric patients: now and into the year 2000.  Diabetes Metabolism Research and Reviews. 1999;  15 338-352
• 14 Kromeyer-Hauschild K, Wabitsch M. et al . Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben.  Monatsschrift Kinderheilkunde. 2001;  149 807-818
• 15 Lenhard MJ, Reeves GD. Continuous subcutaneous insulin infusion.  Archives of Internal Medicine. 2001;  161 2293-2300
• 16 Litton J, Rice A, Friedman N, Oden J, Lee M, Freemark M. Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus.  Journal of Pediatrics. 2002;  141 490-495
• 17 MacMahon SK, Airey FL. et al . Insulin pump therapy in children and adolescents: improvements in key parameters of diabetes management including quality of life.  Diabet Med. 2005;  22 92-96
• 18 Plotnick L, Clark L, Brancati F, Erlinger T. Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes.  Diabetes Care. 2003;  26 1142-1146
• 19 Reaven GM, Chen YDI. et al . Plasma insulin, C-Peptide, and proinsulin concentration in obese and nonobese indiviuals with varying degrees of glucose tolerance.  J Clin Endocrinol Metab. 1993;  76 44-48
• 20 Reinehr T, Holl RW. et al . Insulin resistance in children and adolescents with type 1 diabetes mellitus: relation to obesity.  Pediatr Diabetes. 2005;  6 5-12
• 21 Sinha R, Fisch G. et al . Prevalence of impaired glucose tolerance among children and adolescents with marked obesity.  N Engl J Med. 2002;  346 802-810
• 22 Weinzimer SA, Ahern JH. et al . Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: a follow-up report.  Pediatrics. 2004;  114 1601-1605
• 23 Wilson DM, Buckingham BA. et al . A two-center randomized controlled feasibility trial of insulin pump therapy in young children with diabetes.  Diabetes Care. 2005;  28 15-19

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