INSENODIAB Study : Determinants and characteristics of insulin dose requirements in children and adolescent with new-onset type 1 diabetes.

Beckers, Maude [UCL] Bernard, Noémie [UCL] Gallo, Paola [UCL] Bugli, Céline [UCL] Lysy, Philippe [UCL]

BEST ORAL PRESENTATION Aims In children with newly diagnosed type 1 diabetes (T1D), insulin dose regimens vary substantially. According to current ISPAD recommendations, the initial total daily dose should range from 0.7 to 1 UI/kg body weight/day. Adjusting and stabilizing this dose to achieve normal blood glucose concentration can take several days. The goals of this study were (1) to assess how patient characteristics influence insulin dose requirements and (2) to establish predictive models of those insulin requirements in newly diagnosed children with T1D. Methods INSENODIAB is a monocentric, retrospective observational study over a 7-year period from January 2013 to February 2020. Chart review was conducted for children (6 months-18 years) admitted in Cliniques universitaires Saint-Luc for a new diagnosis of T1D during the observational period. Demographics, clinical and laboratory data, including insulin dosage were collected for all patients. Univariate and multivariable linear regression models were used to examine the impact of patient variables on insulin total daily dose, using a nominal Type I error of 5% as threshold. Results Complete clinical records were available for 103 patients with median body weight of 27 kg (Q1-Q3: 18.2-39.1, Mean: 30.0 kg). Median Insulin total daily dose was 26.8 units (Q1-Q3: 18.8-48.3 units, n=103) during hospitalization and 24.5 units (Q1-Q3: 17.0-45.3 units, n=94) on the day of discharge. Median duration of hospitalization was 5 days (range 1-10 days). In multivariable analysis, the main variables found to impact optimal insulin total daily dose were age, veinous bicarbonates levels at admission, body mass index and percentage of weight loss at diagnosis. The same factors remained after adjusting the model to insulin dose per day per kilogram body weight. Conclusions In newly diagnosed children with T1D, percentage of weight loss and veinous bicarbonates levels at admission, in addition to age and body mass index, influence the Insulin total daily dose necessary to reach glycemic control. Those results helped us developing a dosing algorithm which could potentially reduce the number of days currently needed to stabilize glycemic control in children and adolescents with new-onset T1D.