High variability in insulin needs complicates diabetes management in young children
medwireNews: Children with type 1 diabetes who are aged 6 years or younger have significantly more variability in their insulin needs than adolescents or adults, shows an analysis of closed-loop data.
“Our observations may help to explain why, despite frequent insulin dose adjustments, dysglycemia and a higher risk of nocturnal hypoglycemia are common and contribute to a lower quality of life for young children with type 1 diabetes and their families,” write Roman Hovorka (University of Cambridge, UK) and co-researchers.
The highly variable insulin needs in young children were particularly apparent at night, when the coefficient of variation in insulin delivery was 10.2 percentage points greater than in adolescents and 10.7 percentage points greater than in adults.
“The night-by-night variability of insulin needs might be difficult to overcome with conventional therapeutic tools, multiple daily injections, and insulin pumps,” writes the team in Diabetes Care.
“[T]herefore, our results emphasize the importance of advanced technologies, such as closed-loop systems, to manage diabetes in the vulnerable group of young children.”
The increased variability of daytime insulin needs amounted to 7.0 and 6.4 percentage points for young children versus adolescents and adults, respectively, both of which were statistically significant.
The findings are based on 2365 nights and 2367 days of data obtained from closed-loop insulin delivery clinical trials involving 20 children aged 1–6 years, 21 aged 7–12 years, 18 adolescents aged 13–18 years, and 58 adults.
The variability of insulin needs for children in the older age category (7–12 years) fell between that of the younger children and the adolescents. All age groups spent similar amounts of time (around 70%) within their target blood glucose range.
Insulin needs were more variable between nights than between days for all age groups, but among those older than 12 years there was no difference according to age at diagnosis. This led the team to suggest that “unpredictable activity levels, varying meal intake, and lower insulin needs” are the likely underlying factors, rather than pathophysiologic factors.
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