Esben Thyssen Vestergaard

Proportion of Basal to Total Insulin Dose Is Associated with Metabolic Control, Body Mass Index, and Treatment Modality in Children with Type 1 Diabetes-A Cross-Sectional Study with Data from the International SWEET Registry

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  • Vinni Faber Rasmussen
  • Esben Thyssen Vestergaard
  • Anke Schwandt, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
  • ,
  • Jacques Beltrand, Department of Pediatrics, Hospital Necker Enfants Malades, Paris, France.
  • ,
  • Birgit Rami-Merhar, Department of Pediatrics, St Anna Children's Hospital, Medical University Vienna, Vienna, Austria.
  • ,
  • Stephen M P O'Riordan, Department of Pediatrics and Endocrinology, Cork University Hospital, Cork, Ireland.
  • ,
  • Przemyslawa Jarosz-Chobot, Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland.
  • ,
  • Cintia Castro-Correia, Department of Pediatrics, Hospital S João, Porto, Portugal.
  • ,
  • Evelien F Gevers, Department of Pediatric Endocrinology and Diabetes, Barts Heath NHS Trust - Royal London Children's Hospital, London, United Kingdom; Center for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary University London, London, United Kingdom.
  • ,
  • Niels H Birkebæk

OBJECTIVES: To investigate in a large population the proportion of daily basal insulin dose (BD) to daily total insulin dose (TD) (BD/TD) and its association with glycated hemoglobin A1c (HbA1c), body mass index (BMI)- SDS, and treatment modality in children with type 1 diabetes.

STUDY DESIGN: Cross-sectional study in subjects with type 1 diabetes, age ≤18 years, and ≥2 years of diabetes duration, registered in the international multicenter Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference registry in March 2018. Variables included region, sex, age, diabetes duration, treatment modality (multiple daily injections [MDI] or continuous subcutaneous insulin infusion [CSII]), self-monitoring blood glucose, HbA1c, BD/TD, and BMI-SDS. BMI was converted to BMI-SDS using World Health Organization charts as reference. Hierarchic linear regression models were applied with adjustment for age, sex, and diabetes duration.

RESULTS: A total of 19 687 children with type 1 diabetes (49% female, 49% CSII users) with median age 14.8 (11.5; 17.2) years and diabetes duration 6.0 (3.9; 9.0) years were included. HbA1c was 63 (55; 74) mmol/mol (7.9 [7.2; 8.9]%), and BMI-SDS 0.55 (-0.13; 1.21). Unadjusted, a lower BD/TD was associated with lower HbA1c, male sex, younger age, shorter diabetes duration, lower BMI-SDS, higher numbers of self-monitoring blood glucose and CSII (all P < .01). After adjustment for confounders, lower BD/TD was associated with lower HbA1c (P < .01) and lower BMI-SDS (P < .01) in children on CSII, but not on MDI.

CONCLUSIONS: Lower BD/TD is positively associated with lower HbA1c and lower BMI-SDS in children with type 1 diabetes on CSII. It remains to be investigated in a prospective study whether reducing BD/TD insulin will improve metabolic control and normalize body weight in children with type 1 diabetes.

Original languageEnglish
JournalThe Journal of Pediatrics
Volume215
Pages (from-to)216-222.e1
Number of pages8
ISSN0022-3476
DOIs
Publication statusPublished - Dec 2019

    Research areas

  • BMI-SDS, HbA1c, adolescents, continuous subcutaneous insulin infusion, multiple daily injections

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