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Predictors of changing insulin dose requirements and glycaemic control in children, adolescents and young adults with Type 1 diabetes
Author(s) -
Teló G. H.,
Dougher C. E.,
Volkening L. K.,
Katz M. L.,
Laffel L. M.
Publication year - 2018
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13699
Subject(s) - medicine , insulin , type 1 diabetes , diabetes mellitus , overweight , cohort , regimen , young adult , type 2 diabetes , pediatrics , endocrinology , obesity
Aims To investigate trajectories of daily insulin dose requirements and glycaemic control in children, adolescents and young adults with Type 1 diabetes and to identify factors associated with changing insulin needs and deterioration in HbA 1c . Methods The sample was a dynamic cohort of 635 children, adolescents and young adults with Type 1 diabetes from one centre. Data from clinic visits occurring over 20 years (1993–2013) were extracted from medical records. From age 7–24 years, we evaluated HbA 1c and insulin dose according to sex, insulin regimen and weight status. Results Participants provided a mean ± sd of 10.7±4.3 years of insulin dose data and 12.0±4.6 years of HbA 1c data. At first observation, the mean ± sd age was 10.0±2.6 years, diabetes duration was 2.8±2.1 years, insulin dose was 0.8±0.2 units/kg and HbA 1c was 74±18 mmol/mol (8.9±1.6%). Insulin dose was higher in girls at ages 8–13 years ( P <0.0001 to P <0.01), but higher in boys/young men at ages 16–21 years ( P <0.0001 to P =0.04). HbA 1c was higher in girls/young women at ages 16–24 years ( P <0.0001 to P =0.01). Compared with injection therapy, pump therapy was associated with lower insulin dose at ages 8–24 years ( P <0.0001 to P =0.03) and lower HbA 1c at ages 8–22 years ( P <0.0001 to P =0.005). HbA 1c did not differ between overweight/obese and normal weight individuals, but overweight/obese individuals had higher insulin dose at ages 8–13 years ( P <0.0001 to P =0.03). Conclusions This longitudinal assessment identifies clinically meaningful modifiable (e.g. insulin regimen) and non‐modifiable (e.g. sex) factors predictive of insulin requirements and HbA 1c levels in young people with Type 1 diabetes; anticipatory insulin adjustments may improve glycaemic control.