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Insulin requirements differ for infants with type 1, neonatal diabetes using pump therapy
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Infants with type 1 and neonatal diabetes treated with continuous subcutaneous insulin infusion have differing basal and prandial insulin requirements that change over time, according to research in Diabetes Technology & Therapeutics.
Thomas M. Kapellen, MD, of the Hospital for Children and Adolescents and the University of Leipzig in Germany, and colleagues analyzed data from 168 infants with diabetes treated with insulin pump therapy (58.9% boys) participating in the Prospective Diabetes Follow-up Registry (DPV) in Germany and Austria. Within the cohort, 58 infants had type 1 diabetes (mean age at diagnosis, 45.7 weeks); 67 had neonatal diabetes (mean age at diagnosis, 1.8 weeks); 43 infants had diabetes with unknown antibody status (mean age at diagnosis, 45.7 weeks). Researchers compared basal rate and mealtime bolus insulin requirements.
At initiation of insulin pump therapy, researchers found that infants with type 1 diabetes required a median total insulin amount of 0.83 IU/kg of body weight vs. a median total insulin of 7.63 IU/kg of body weight for infants with antibody status unknown diabetes and a median of 0.74 IU/kg of body weight for infants with neonatal diabetes.
Basal insulin requirements at diabetes onset were found to be significantly different between infants with neonatal diabetes (median of 0.56 IU/kg of body weight) and infants with type 1 diabetes (median of 0.43 IU/kg of body weight; P = .036). The prandial insulin requirements were also significantly different between infants with neonatal diabetes (median of 0.18 IU/kg of body weight) and infants with type 1 diabetes (median of 0.39 IU/kg of body weight; P < .0025). Infants with diabetes with unknown antibody status had similar data to those with type 1 diabetes, according to researchers.
Mealtime bolus insulin patterns were not significantly different among the infant groups, according to researchers.
“Prandial doses are quite low in neonatal diabetes,” the researchers wrote. “This could be due to an almost continuous feeding with up to eight to 12 small breast feeds or formula feeds in a 24-hour period. This continuous feeding pattern could lead to an underestimated prandial rate and a basal rate that compensates for prandial requirements.”
The total daily insulin dose, prandial dose and basal rate decreased in all infant groups at follow-up, according to researchers.
“With the presented data, a more precise and safe start with a circadian basal rate and a circadian mealtime bolus treatment can be provided,” the researchers wrote. “Together with the German Working Group for Pediatric Pump Treatment, we discussed the use of these data to give instructions to pediatric diabetologists for the treatment of neonates and infants below the age of 1 year.” – by Regina Schaffer
Disclosure: Kapellen reports receiving honoraria for speaking for Accu-Chek, Roche and Medtronic.
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