Basal rates and circadian profiles in continuous subcutaneous insulin infusion (CSII) differ for preschool children, prepubertal children, adolescents and young adults.

Abstract

OBJECTIVE:

Initiation of continuous subcutaneous insulin therapy (CSII) requires an appropriate basal rate profile. Different approaches exist; however, there is a lack of evidence-based recommendations, especially in young children.

STUDY DESIGN:

In this large multicenter survey, 5941 CSII patients from the German/Austrian prospective documentation system (DPV) were analyzed. Patients were divided into four age groups: <6 yr (n = 837), 6 to <12 yr (n = 1739), 12 to <18 yr (n = 2985) and 18 to <25 yr (n = 380). Basal insulin requirement and diurnal distribution were evaluated based on the most recent documentation for each patient.

RESULTS:

Basal insulin requirement differed significantly between the four age groups (<6: 0.25 ± 0.12; 6 to <12: 0.33 ± 0.12; 12 to <18: 0.43 ± 0.15; 18 to <25: 0.35 ± 0.13 U/kg; p < 0.001). Circadian insulin profiles were markedly different between the younger and older age groups. In addition to age, longer diabetes duration, female gender, higher HbA1c and lower body mass index standard deviation score (BMI-SDS) were related to higher basal insulin requirement per kilogram of body weight.

CONCLUSIONS:

Age of the patient is the primary factor that influences both total daily requirement and circadian distribution of basal insulin in CSII. Experience from a large database may therefore facilitate the initiation of pump therapy in pediatric patients.

• Authors: Rainer Bachran, Peter Beyer, Christof Klinkert, Bettina Heidtmann, Joachim Rosenbauer, Reinhard W Holl, German/Austrian DPV Initiative, German Pediatric CSII Working Group, BMBF Competence Network Diabetes
• Journal: Pediatric diabetes (Pediatr Diabetes) Vol. 13 Issue 1 Pg. 1-5 (Feb 2012) ISSN: 1399-5448 [Electronic] Denmark
• PMID: 21545675 (Publication Type: Evaluation Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 John Wiley & Sons A/S.

Topics

• Adolescent
• Adult
• Age Factors
• Basal Metabolism (drug effects, physiology)
• Child
• Child, Preschool
• Circadian Rhythm (drug effects, physiology)
• Data Collection
• Databases, Factual
• Diabetes Mellitus (drug therapy, metabolism, physiopathology)
• Dose-Response Relationship, Drug
• Drug Dosage Calculations
• Female
• Humans
• Infusions, Subcutaneous
• Insulin Infusion Systems (statistics & numerical data)
• Male
• Puberty (drug effects, metabolism, physiology)
• Young Adult