ESPE Abstracts (2019) 92 P2-92

An Impaired Lipid Profile is a Sign of Reduced Insulin Sensitivity in Children and Adolescents at Type 1 Diabetes Onset

Giulio Maltoni1, Stefano Zucchini1, Maximiliano Zioutas1, Valeria Di Natale1, Alessandra Cassio2


1AOU S.Orsola-Malpighi, Bologna, Italy. 2AOU S. Orsola-Malpighi, Bologna, Italy


At type 1 diabetes (T1D) onset, international guidelines reccommend a starting subcutaneous insulin dose widely ranging from 0,5 to 1 u/kg/day. In fact, many factors such as age, pubertal stage and the severity of ketoacidosis, may influence insulin sensitivity. However, it is a common experience that many subjects may require a higher insulin daily dose than expected, with the subsequent need of longer time to achieve stable blood glucose values and the extension of days of hospitalization. The aim of this study was to find possible predictive factors related to insulin total daily dose at T1D onset. This is a retrospective study of 95 consecutive subjects at T1D onset, occurred between April 2014 and March 2018. Clinical and laboratory data were analyzed. Insulin requirement was expressed as the maximum amount of insulin administered subcutaneously during hospitalization per kg in 24 hours. Parameters analyzed are showed in table. Insulin requirement was strongly correlated to lipid assessment, in particular to triglyceridemia (P=0.0001). Though, as already reported, the severity of ketoacidosis and HbA1c at onset negatively affected insulin sensibility (P<0,015), at multiple regression the significant variable was triglyceremia. As expected, the duration of hospitalization increased proportionally to the units of insulin/kg (P=0.0013). At 12 months after diagnosis, the average insulin dose was directly related to that at the onset, both in the total sample of subjects (P=0.0006) and in the subsample with HbA1c at 12 months <54 mmol/mol (P=0.0001). No correlation with symptoms duration and reported weight loss. Conclusions: triglyceridemia at the diagnosis of T1D is suggestive of increased insulin requirement, regardless of the severity of the acidosis. This could potentially reduce the time to reach stable blood glucose values and decrease the days and costs of hospitalization.

Mean age (yrs)8,7 ± 4,4
HbA1c (mmol/mol)103 ± 27
First blood glucose value (mg/dl)481 ± 295
Total Cholesterol (mg/dl)188,8 ± 55,6
HDL cholesterol (mg/dl)45,5 ± 15,3
Triglycerides (mg/dl)225,7 ± 242,0
Symptoms duration (days)38 ± 49
Hospitalization duration (days)9,4 ± 3,4
Intravenous Hydration duration (hours)18,0 ± 25,3
PH7,3 ± 0,1
HCO3 (mmol/L)18,8 ± 7,6
Weight loss reported (kg)2,4 ± 2,5
C-peptide at onset (ng/ml)0,018 ± 0,01
Insulin requirement at onset (U/kg/day)0,96 ± 0,45
Insulin requirement at 12 months (U/kg/day)0,58 ± 0,23

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