Estimating insulin requirements in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) remains challenging because insulin needs can change substantially during growth and adolescence. A retrospective study published in Diabetes Technology & Therapeutics examined how total daily insulin dose (TDD) varied across age groups, metabolic profiles, and insulin delivery methods in individuals with T1DM.
The analysis included 14,358 individuals aged 2 to 25 years from the T1DM Exchange Quality Improvement Collaborative. Mean age was 16.2 years, 48% were female, and nearly 80% used continuous glucose monitoring (CGM). Mean glycated hemoglobin (HbA1c) was 8.4%, with more than 80% of participants having HbA1c levels ≥7%. The study evaluated differences in TDD according to age, sex, body mass index (BMI), glycemic control, and insulin delivery approach.
Findings
- TDD increased progressively from ages 2 to 13 years, with the steepest rise observed between ages 9 and 13 years.
- Peak TDD occurred earlier in females than males, at age 12 years versus 14 years, respectively.
- Higher TDD was observed among participants in higher BMI and HbA1c categories.
- Participants using multiple daily injections (MDI) required higher TDD than those using insulin pumps without hybrid closed-loop systems (HCLS) and HCLS users.
The findings support regular reassessment of insulin dosing during childhood and adolescence, particularly during puberty when insulin requirements change rapidly.
