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Serum insulin profiles in consecutive children 2 years after the diagnosis of IDDM
T Simell1, J Mäenpää, E A Kaprio
1I Department of Paediatrics, Children's Hospital, University of Helsinki, Finland.
Insights
This study reveals that 24-hour serum insulin profiles in children with insulin-dependent diabetes mellitus (IDDM) vary with age and correlate with insulin dose and blood glucose levels, highlighting potential nocturnal hypoinsulinaemia in younger children.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Understanding insulin profiles is crucial for managing insulin-dependent diabetes mellitus (IDDM) in children.
- Age-related differences in insulin pharmacokinetics and dynamics may impact glycemic control.
Purpose of the Study:
- To investigate the associations between 24-hour serum insulin profiles and various clinical parameters in children with IDDM.
- To explore age-specific variations in insulin profiles and their relationship with insulin dosage, glycemic control, and endogenous insulin production.
Main Methods:
- Studied 77 children with IDDM (aged 2-17 years) two years post-diagnosis.
- Analyzed 24-hour serum insulin profiles, insulin dose, HbA1c, C-peptide, and blood glucose levels.
- Compared insulin concentrations across four age groups.
Main Results:
- Mean weight-based insulin doses were similar across age groups, but body surface-area-based doses differed.
- Serum insulin concentrations increased significantly with age.
- 24-hour mean serum insulin, along with HbA1c, predicted 32% of the variation in mean blood glucose.
- Younger children (<9 years) frequently exhibited low nocturnal insulin levels, with some experiencing hypoglycemia and hypoinsulinaemia.
Conclusions:
- Insulin profiles in children with IDDM are age-dependent and correlate with insulin dosage and glycemic control.
- Nocturnal hypoinsulinaemia and potential hypoglycemia are concerns in younger children with IDDM.
- Insulin profiles showed a weak correlation with HbA1c and peak C-peptide values.
Abstract:
We studied associations of 24-h serum insulin profiles with insulin dose, age, gender, haemoglobin A1c (HbA1c) and C-peptide values, as well as blood glucose profiles in 77 consecutive children-nine aged 2-4, 14 aged 5-8, 26 aged 9-12, and 28 aged 13-17 years--2 years after the onset of insulin-dependent diabetes mellitus (IDDM). Mean weight-based insulin doses in the four age groups were similar (0.7 +/- 0.2 U.kg-1.day-1 in all); body surface-area-based doses differed. Insulin doses correlated significantly with the 24-h mean and area-under-the-curve (AUC) values, and with mean values at 03.00 hours of serum insulin in the children aged 5-8 and 13-17 years. The mean insulin concentrations of the age groups (95% confidence intervals) increased with age [6.1 (3.8, 9.7), 7.6 (5.9, 9.8), 10.4 (8.6, 12.4), and 14.0 (11.6, 16.8) mU/l; p < 0.0002]. The 24-h mean of serum insulin together with HbA1c concentration predicted 32% of the variation of mean blood glucose concentrations. Of children aged less than 9 years, 50% had insulin values less than 5 mU/l (healthy subjects' lower reference limit), and 14% were of less than 2 mU/l (detection limit of the assay) at 03.00 hours. At 07.00 hours, 82% had insulin values of less than 5 mU/l, and 36% were of less than 2 mU/l, respectively. Some young children had night-time hypoglycaemia with simultaneous hypoinsulinaemia. Insulin profiles correlated poorly with the HbA1c and peak C-peptide values.(ABSTRACT TRUNCATED AT 250 WORDS)