Cargando…

Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents

OBJECTIVE: Pump-treated children with type 1 diabetes (T1DM) have widely differing basal insulin (BI) infusion profiles for specific periods of the day. The pattern of BI requirements depends on the timing and magnitude of cortisol and growth hormone secretion within each age group. In adolescents a...

Descripción completa

Detalles Bibliográficos
Autores principales: Demir, Günay, Atik Altınok, Yasemin, Özen, Samim, Darcan, Şükran, Gökşen, Damla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Galenos Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186333/
https://www.ncbi.nlm.nih.gov/pubmed/33374094
http://dx.doi.org/10.4274/jcrpe.galenos.2020.2020.0171
_version_ 1783704934068256768
author Demir, Günay
Atik Altınok, Yasemin
Özen, Samim
Darcan, Şükran
Gökşen, Damla
author_facet Demir, Günay
Atik Altınok, Yasemin
Özen, Samim
Darcan, Şükran
Gökşen, Damla
author_sort Demir, Günay
collection PubMed
description OBJECTIVE: Pump-treated children with type 1 diabetes (T1DM) have widely differing basal insulin (BI) infusion profiles for specific periods of the day. The pattern of BI requirements depends on the timing and magnitude of cortisol and growth hormone secretion within each age group. In adolescents and young adults, a decreased insulin sensitivity is seen, particularly in the early morning (dawn phenomenon) and to a lesser extent, in the late afternoon (dusk phenomenon). Different approaches exist for the inititation of basal rates. However, there is a lack of evidence-based recommendation, especially in young children. Usually the basal rates are set equally throughout day and night or the day is divided into tertiles. The aim of this study was to analyze the change of the initial, equally distributed, BI rates over the first year of standard insulin pump therapy. METHODS: A total of 154 patients with T1DM, aged between 0 and <21 years at diagnosis, from a single center were documented. Patients were divided into five age groups according to age at pump initiation: group 1, <5 years (n=36); group 2, 5-8 years (n=20); group 3, 8-15 years (n=74); group 4, 15-18 years, (n=19); and group 5, >18 years, (n=5). Distribution of hourly basal rates at the initiation of the pump and at the end of first year were evaluated. RESULTS: Median (range) age and diabetes duration was 14.46 (1.91-26.15) and 7.89 (1.16-17.15) years, respectively. Forty-four percent were male, 56% were female. Mean total insulin dose/kg in the whole cohort at the initiation and after one year of pump therapy was 0.86±0.23 U/kg and 0.78±0.19 U/kg, respectively and differed significantly between each age group (p<0.001; p<0.001). Mean daily basal rate/kg showed significant differences between the five groups (p<0.001). Circadian distribution of BI differed markedly among the five age groups. CONCLUSION: At the initiation of insulin pump therapy, circadian profiles by age group should be taken into account in pediatric patients to optimize basal rate faster and more easily.
format Online
Article
Text
id pubmed-8186333
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Galenos Publishing
record_format MEDLINE/PubMed
spelling pubmed-81863332021-06-17 Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents Demir, Günay Atik Altınok, Yasemin Özen, Samim Darcan, Şükran Gökşen, Damla J Clin Res Pediatr Endocrinol Original Article OBJECTIVE: Pump-treated children with type 1 diabetes (T1DM) have widely differing basal insulin (BI) infusion profiles for specific periods of the day. The pattern of BI requirements depends on the timing and magnitude of cortisol and growth hormone secretion within each age group. In adolescents and young adults, a decreased insulin sensitivity is seen, particularly in the early morning (dawn phenomenon) and to a lesser extent, in the late afternoon (dusk phenomenon). Different approaches exist for the inititation of basal rates. However, there is a lack of evidence-based recommendation, especially in young children. Usually the basal rates are set equally throughout day and night or the day is divided into tertiles. The aim of this study was to analyze the change of the initial, equally distributed, BI rates over the first year of standard insulin pump therapy. METHODS: A total of 154 patients with T1DM, aged between 0 and <21 years at diagnosis, from a single center were documented. Patients were divided into five age groups according to age at pump initiation: group 1, <5 years (n=36); group 2, 5-8 years (n=20); group 3, 8-15 years (n=74); group 4, 15-18 years, (n=19); and group 5, >18 years, (n=5). Distribution of hourly basal rates at the initiation of the pump and at the end of first year were evaluated. RESULTS: Median (range) age and diabetes duration was 14.46 (1.91-26.15) and 7.89 (1.16-17.15) years, respectively. Forty-four percent were male, 56% were female. Mean total insulin dose/kg in the whole cohort at the initiation and after one year of pump therapy was 0.86±0.23 U/kg and 0.78±0.19 U/kg, respectively and differed significantly between each age group (p<0.001; p<0.001). Mean daily basal rate/kg showed significant differences between the five groups (p<0.001). Circadian distribution of BI differed markedly among the five age groups. CONCLUSION: At the initiation of insulin pump therapy, circadian profiles by age group should be taken into account in pediatric patients to optimize basal rate faster and more easily. Galenos Publishing 2021-06 2021-06-02 /pmc/articles/PMC8186333/ /pubmed/33374094 http://dx.doi.org/10.4274/jcrpe.galenos.2020.2020.0171 Text en ©Copyright 2021 by Turkish Pediatric Endocrinology and Diabetes Society | The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Demir, Günay
Atik Altınok, Yasemin
Özen, Samim
Darcan, Şükran
Gökşen, Damla
Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents
title Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents
title_full Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents
title_fullStr Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents
title_full_unstemmed Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents
title_short Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents
title_sort initial basal and bolus rates and basal rate variability during pump treatment in children and adolescents
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186333/
https://www.ncbi.nlm.nih.gov/pubmed/33374094
http://dx.doi.org/10.4274/jcrpe.galenos.2020.2020.0171
work_keys_str_mv AT demirgunay initialbasalandbolusratesandbasalratevariabilityduringpumptreatmentinchildrenandadolescents
AT atikaltınokyasemin initialbasalandbolusratesandbasalratevariabilityduringpumptreatmentinchildrenandadolescents
AT ozensamim initialbasalandbolusratesandbasalratevariabilityduringpumptreatmentinchildrenandadolescents
AT darcansukran initialbasalandbolusratesandbasalratevariabilityduringpumptreatmentinchildrenandadolescents
AT goksendamla initialbasalandbolusratesandbasalratevariabilityduringpumptreatmentinchildrenandadolescents