Initial Subcutaneous Insulin Requirement in Children With Newly Diagnosed Type 1 Diabetes

Area of Science:

• Pediatrics
• Endocrinology
• Metabolic Disorders

Background:

• Type 1 Diabetes (T1D) is an autoimmune condition requiring lifelong insulin therapy.
• Initial management of new-onset T1D in children often involves hospitalization and careful insulin dose titration.
• Understanding factors influencing initial insulin requirements is crucial for effective treatment and patient outcomes.

Purpose of the Study:

• To identify factors influencing the total daily subcutaneous insulin dose (TDD) in children newly diagnosed with T1D.
• To analyze changes in TDD during hospitalization for new-onset T1D.
• To correlate initial presentation severity with insulin requirements.

Main Methods:

• Retrospective file review of 85 children (≤18 years) hospitalized for new-onset T1D between 2020 and 2023.
• Analysis of TDD on the first and last days of hospitalization.
• Comparison of TDD across different initial presentation groups (DKA, ketosis with hyperglycemia).
• Multiple linear regression analysis to identify influencing parameters.

Main Results:

• Initial TDD was significantly higher in patients with diabetic ketoacidosis (DKA) compared to those with ketosis and hyperglycemia (1.41 ± 0.14 u/kg/day vs. 1.19 ± 0.18 u/kg/day).
• TDD decreased significantly from the first day (1.3 ± 0.16 u/kg/day) to the last day (0.81 ± 0.28 u/kg/day) of hospitalization.
• pH at admission and body weight were identified as significant predictors of TDD.
• TDD on the last day of hospitalization was similar across all presentation groups.

Conclusions:

• Children with newly diagnosed T1D, particularly those with DKA, exhibit high initial insulin requirements.
• Insulin needs decrease during hospitalization, but the initial severity of acidosis impacts the dose.
• Subcutaneous insulin dosage should be individualized based on clinical presentation, including acidosis severity and body weight.