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The influence of patient variables on insulin total daily dose in paediatric inpatients with new onset type 1 diabetes mellitus

Journal of Diabetes & Metabolic Disorders volume 17, pages 159–163 (2018)Cite this article

Abstract

Purpose

Insulin dose requirements at new diagnosis of type 1 diabetes mellitus (T1DM) vary widely. Current guidelines recommend an initial total daily dose (TDD) ranging from 0.5 to 1.0 IU/kg/day. It often takes several days of frequent dose adjustments before an optimal insulin dose is achieved. The aim of this study was to identify the influence of patient variables on the dose-requirement of insulin in newly diagnosed children with T1DM.

Methods

A retrospective chart review of children (≤ 18 years old) admitted to hospital between 2010 and 2016 due to new onset T1DM was undertaken. Demographic, clinical, insulin dosing, and laboratory data were recorded. The influence of patient characteristics on insulin TDD was analysed statistically by performing univariate and multivariate linear regression analyses.

Results

Complete clinical records for 70 patients were available for analysis. The median insulin TDD on first day of admission was 21 (4.5 to 75 units) and that on the day before discharge was 27 (5.5 to 124 units). In the multivariate regression analysis, body size (total body weight and fat-free mass), glycated haemoglobin (HbA1C), and blood ketone concentration were found to be significant predictors of optimal insulin TDD (p < 0.05).

Conclusion

In addition to body size, HbA1c and ketone concentrations are useful in calculating initial TDD in newly diagnosed children with T1DM. This could potentially decrease the number of days needed to reach a stable dose and result in improved early glycaemic control.

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Affiliations

  1. School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand

    Marion Muller, Mathilde Colas, Natalie J. Medlicott & Hesham S. Al-Sallami

  2. Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand

    Benjamin J. Wheeler, Miranda Blackwell & David M. Reith

Authors
  1. Marion Muller
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  2. Benjamin J. Wheeler
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  3. Miranda Blackwell
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  4. Mathilde Colas
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  6. Natalie J. Medlicott
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  7. Hesham S. Al-Sallami
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Correspondence to Hesham S. Al-Sallami.

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Muller, M., Wheeler, B.J., Blackwell, M. et al. The influence of patient variables on insulin total daily dose in paediatric inpatients with new onset type 1 diabetes mellitus. J Diabetes Metab Disord 17, 159–163 (2018). https://doi.org/10.1007/s40200-018-0355-5

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  • DOI: https://doi.org/10.1007/s40200-018-0355-5

Keywords

  • Insulin dose
  • Covariates
  • Paediatrics
  • Blood glucose