Evin Ferda, Tittel Sascha R, Piccini Barbara, Cardona-Hernandez Roque, Mul Dick, Sheanon Nicole, von dem Berge Thekla, Neuman Vit, Tauschmann Martin, Gökşen Damla
Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Ege University, Izmir, Turkey.
Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Ulm, Germany.
Pediatr Diabetes. 2023 Aug 9;2023:8837506. doi: 10.1155/2023/8837506. eCollection 2023.
The optimal basal and bolus insulin distribution in type 1 diabetes (T1D) is still controversial. Herein, we aimed to determine the variability of basal to total daily insulin dose according to treatment modality and diabetes technologies from the Better Control in Pediatric and Adolescent Diabetes: () . The study cohort was generated by using the SWEET database. Patients with T1D for at least 2 years, aged between 2.5 and 18 years, with at least one clinic visit between June 2010 and June 2021, were included in the study. Four groups were composed according to treatment modality as follows: multiple daily injections (MDI) without continuous glucose monitoring (CGM); MDI with CGM; subcutaneous insulin infusion (CSII) without CGM; and CSII with CGM. Data of the participants were analyzed and compared for each treatment modality separately.
A total of 38,956 children and adolescents were included in the study. Of the study sample, 48.6% were female, the median (range) age was 15.2 (11.9-17.2) years, and the median diabetes duration was 6.0 (3.8-9.0) years. The distribution of treatment modality was as follows: MDI without CGM, 32.9%; MDI with CGM, 18.0%; CSII without CGM, 11.7%; and CSII with CGM, 37.3%. In unadjusted data, regardless of treatment modality, all the analyses revealed a significant association between basal dose to total daily insulin dose (BD/TDD) with male gender, younger age group, and lower HbA1c, which were all related to a decreased ratio of BD/TDD (all < 0.05). There was no association between BD/TDD and different diabetes technologies after the age, gender, and diabetes duration were adjusted.
Herein, we showed that there was an association between lower proportions of basal to total insulin and lower hemoglobin A1c in a large cross-sectional cohort of children who had T1D. There was also an association between lower BD/TDD and younger age. There was no significant difference between BD/TDD ratios under different diabetes technologies (CGM and/or CSII).
1型糖尿病（T1D）中基础胰岛素与餐时胰岛素的最佳分配仍存在争议。在此，我们旨在根据“儿童与青少年糖尿病更佳控制研究”（）中的治疗方式和糖尿病技术，确定基础胰岛素剂量占每日总胰岛素剂量的变异性。研究队列通过使用SWEET数据库生成。纳入研究的患者为患有T1D至少2年、年龄在2.5至18岁之间、在2010年6月至2021年6月期间至少有一次门诊就诊经历的患者。根据治疗方式分为四组，如下：无持续葡萄糖监测（CGM）的多次皮下注射（MDI）；有CGM的MDI；无CGM的皮下胰岛素输注（CSII）；有CGM的CSII。分别对每种治疗方式的参与者数据进行分析和比较。
共有38956名儿童和青少年纳入研究。在研究样本中，48.6%为女性，年龄中位数（范围）为15.2（11.9 - 17.2）岁，糖尿病病程中位数为6.0（3.8 - 9.0）年。治疗方式分布如下：无CGM的MDI，32.9%；有CGM的MDI，18.0%；无CGM的CSII，11.7%；有CGM的CSII，37.3%。在未经调整的数据中，无论治疗方式如何，所有分析均显示基础剂量占每日总胰岛素剂量（BD/TDD）与男性性别、较年轻年龄组以及较低的糖化血红蛋白（HbA1c）之间存在显著关联，这些均与BD/TDD比值降低相关（均P < 0.05）。在调整年龄、性别和糖尿病病程后，BD/TDD与不同糖尿病技术之间无关联。
在此，我们表明在一大群患有T1D的儿童横断面队列中，基础胰岛素占总胰岛素比例较低与较低的糖化血红蛋白之间存在关联。较低的BD/TDD与较年轻年龄之间也存在关联。不同糖尿病技术（CGM和/或CSII）下的BD/TDD比值无显著差异。
