Background: Over the last two decades, treatment of type 1 diabetes became more intensified and changes in the type of insulin used were reported.
Objective and hypotheses: We hypothesised that there are also changes in insulin dosage and in the ratio of prandial to basal insulin. Our aim was to analyse potential trends in paediatric subjects with type 1 diabetes from Austria and Germany between 2000 and 2014.
Method: 50 861 subjects (<20 years of age) with type 1 diabetes from the Diabetes-Patienten-Verlaufsdokumentation (DPV) database documented between 2000 and 2014 were included. Regression models were applied for insulin dosage/kg body weight in patients on intensified conventional insulin therapy (ICT) and in patients on continuous s.c. insulin infusion (CSII) as well as for the ratio of prandial to basal insulin in patients on ICT. Additionally, sex- and age-specific analyses (05; 5<10; 10<15; 15<20 years of age) were conducted. Confounders: sex, age, BMI, and diabetes duration. P values for trend (SAS 9.4).
Results: Insulin dosage increased in ICT from 0.88 IU/kg per day in 2000 to 0.94 IU/kg per day in 2014 and in CSII from 0.71 IU/kg per day to 0.80 IU/kg per day (both P<0.0001). Stratification by sex and age-groups revealed a significant increase in ICT and CSII (all P<0.01). Only in 510 year old subjects on CSII, insulin dosage decreased from 0.71 IU/kg per day to 0.68 IU/kg per day (P<0.0001). The ratio of prandial to basal insulin in ICT rose from 1.25 in 2000 tov 1.37 in 2014 (P=0.0056). In girls and in younger age-groups (05; 5<10), an increase was present (all P<0.0001). In other subgroups, this trend was lacking (P>0.05, respectively).
Conclusion: Insulin dosage and ratio of prandial to basal insulin both increased over the last 15 years. Possibly, these findings might be explained by an increase in sedentary lifestyle or by changes in the quantity/quality of nutrition.
Funding information: The work was supported by the German Competence Network Diabetes mellitus funded by the Federal Ministry of Education and Research (FKZ 01GI1106), now integrated into the German Center for Diabetes Research (DZD). Further financial support was provided by the European Foundation for the Study of Diabetes (EFSD).
01 - 03 Oct 2015
European Society for Paediatric Endocrinology