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Daily insulin requirement of children and adolescents with type 1 diabetes: effect of age, gender, body mass index and mode of therapy.

Department of Pediatric Endocrinology and Diabetology, Charité Children's Hospital, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany¹ Department of Pediatric Endocrinology and Diabetology, Vestische Hospital for Children and Adolescents, University of Witten-Herdecke, Datteln, Germany² Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria³ Department of Pediatric Endocrinology and Diabetology, University of Dresden, Dresden, Germany⁴ Department of Pediatric Endocrinology and Diabetology, TU München, München, Germany⁵ Department of Epidemiology, University of Ulm, Ulm, Germany

(Correspondence should be addressed to S Wiegand; Email: susanna.wiegand{at}charite.de)

Design: The purpose of this study was to generate insulin dose (ID) percentiles for children and adolescents with type 1 diabetes mellitus (DM1) having the opportunity to assess this important parameter in relation to age and sex.

Methods: Daily IDs per weight (ID/kg) were recorded in 22 177 patients with DM1 (3–25 years of age, DM1 duration of more than 2 years, 48% female) and ID percentiles (ID-Perc) were created statistically. The ID-Perc were compared between male and female, and between multiple insulin injection therapy (MIT) and continuous s.c. insulin infusion (CSII). A multivariate regression analysis was performed for ID in the third year of DM1 with ID/kg, body weight, age, gender, and insulin delivery regimen as variables.

Results: The 50th ID-Perc (P50) varied among 0.67 IU/kg (age 3 years), 0.93 IU/kg (13 years), and 0.70 IU/kg (23 years) increasing from early childhood to adolescence and decreasing toward adulthood. Highest P50 ID was found at 12 years in females (0.94 IU/kg) and at 14 years in males (0.92 IU/kg). Using ICT, the ID was significantly higher compared with CSII (P50: 0.94 IU/kg versus 0.79 IU/kg at 13 years). In multivariate regression analysis, ID was significantly (P>0.001) associated with age, gender, and insulin delivery regime.

Conclusion: The ID-Perc were significantly different during various periods of childhood and were influenced by gender, body weight, and insulin injection regimes. Therefore, the presented data 1) provide evidence to interpret individual ID in children and adolescents with DM1 and 2) more specifically identify children with unusually high (insulin resistance and non-compliance) or low (MODY and persistent remission) insulin requirement.