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Published on: June 11, 2012
Optimum bolus wizard settings in insulin pumps in children with Type 1 diabetes
A J B Andersen1, A Ostenfeld2, C B Pipper3
1Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark. amandabjerre@gmail.com.
Insights
Insulin pump settings for children require individualization. Standardized factors are not constant, necessitating age- and dose-dependent adjustments for optimal diabetes management in pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Diabetes Technology
Background:
- Optimizing insulin pump therapy in children with type 1 diabetes is crucial for glycemic control.
- The Bolus Wizard feature aims to simplify insulin dose calculations but requires accurate input factors.
Purpose of the Study:
- To evaluate current insulin pump settings in a well-regulated pediatric population using the Bolus Wizard.
- To identify factors influencing insulin-to-carbohydrate and insulin sensitivity factors in children on insulin pump therapy.
Main Methods:
- Retrospective analysis of data from 124 children with optimal HbA1c levels on insulin pump therapy.
- Utilized Bolus Wizard settings to derive insulin-to-carbohydrate and insulin sensitivity factors.
- Employed multiple regression analysis to identify variables associated with these calculation factors.
Main Results:
- Insulin-to-carbohydrate factor increased with age, ranging from 276 to 424.
- Insulin sensitivity factor was highest in the 6 to <12 years age group (125).
- Age, carbohydrate intake, bolus frequency, and insulin dosage per kg were significantly associated with both factors; treatment duration and basal/bolus ratio also showed associations.
Conclusions:
- Optimal insulin pump settings at initiation are influenced by individual insulin needs and pump usage patterns.
- Standardized calculation factors are inadequate for children, highlighting the need for personalized settings.
- Development of specific age- and insulin dose-dependent calculation factors is recommended for improved pediatric insulin pump management.
Aim:
To evaluate current insulin pump settings in an optimally regulated paediatric population using bolus wizard.
Methods:
We used a retrospective study design to analyse data from 124 children on insulin pump therapy who had optimum HbA1c levels [< 59 mmol/mol (< 7.5%)] and no history of severe hypoglycaemic events. Bolus wizard settings were used to calculate the insulin to carbohydrate factors and insulin sensitivity factors. Multiple regression analysis was used to analyse the variables associated with the calculation factors.
Results:
Insulin to carbohydrate factor varied from 276 in the youngest group to 424 in the oldest group, and increased according to age. Insulin sensitivity factor was highest in the group aged 6 to < 12 years, with a value of 125. Age, amount of carbohydrates, number of boluses per day and insulin per kg were all significantly associated with both calculation factors. Furthermore, duration of insulin pump treatment was significantly associated with insulin sensitivity factor and percentage bolus/basal was significantly associated with insulin to carbohydrate factor. Gender, diabetes duration and BMI were not associated with any of the calculation factors.
Conclusion:
Optimum insulin pump settings at pump initiation depend on both insulin requirements and use of the pump. Settings need to be individualized because the standardized calculation factors are not constant for children. There is a need to develop specific age- and insulin dose-dependent calculation factors.
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