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Age-Dependent Bolus Settings: Insulin-to-Carbohydrate Ratios and Insulin Sensitivity Factors in Pediatric Patients

Christina Reinauer1, Alena Welters1, Mareike Niemeyer2

  • 1Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.

Diabetes Technology & Therapeutics
|February 6, 2025
PubMed

Insights

Insulin pump settings for pediatric type 1 diabetes vary significantly by age, time of day, sex, and BMI, indicating standard formulas are insufficient. Data-driven recommendations are needed for effective insulin-to-carbohydrate ratios and insulin sensitivity factors.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Technology

Background:

  • Optimizing insulin pump settings, specifically insulin-to-carbohydrate ratios (ICRs) and insulin sensitivity factors (ISFs), is critical for managing type 1 diabetes in children.
  • Traditional methods for calculating these parameters based on total daily insulin dose (TDD) are often inadequate for pediatric populations.

Purpose of the Study:

  • To analyze real-world insulin pump settings (ICR and ISF) in a large cohort of pediatric patients with type 1 diabetes.
  • To identify variations in these settings based on age, diurnal patterns, sex, and body mass index (BMI).
  • To provide data-driven insights for establishing initial continuous subcutaneous insulin infusion (CSII) settings.

Main Methods:

  • Analysis of data from 7697 pediatric patients with type 1 diabetes using insulin pumps, sourced from the DPV registry.
  • Inclusion criteria: age 1 to <18 years, postremission, HbA1c ≤7.5%, using short-acting analog insulin.
  • Exclusion of automated insulin delivery system users; stratification by age, BMI percentiles, and sex.

Main Results:

  • Insulin requirements increased with age, correlating with lower ICRs and ISFs.
  • Insulin needs peaked in the morning, with lowest ICR and ISF values observed across all age groups.
  • Insulin sensitivity factor (ISF) was highest in the late evening; higher BMI-SDS was linked to lower ISF; girls over 6 had lower ICRs than boys.

Conclusions:

  • Real-world data demonstrate that a single TDD-based formula is insufficient for calculating CSII settings in children with type 1 diabetes.
  • Insulin needs exhibit significant variability influenced by age, time of day, sex, and BMI.
  • Findings offer a valuable reference for clinicians to establish initial, individualized CSII settings for pediatric patients.

Keywords:
bolus insulincorrection factorinsulin pumpinsulin sensitivity factorinsulin-to-carbohydrate ratiopediatric diabetes

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