937-P: Mealtime Insulin in New-Onset Type 1 Diabetes Mellitus: Fixed Dose vs. Insulin:Carbohydrate Ratio

Abstract

Over the past 20 years, advances in diabetes technology and along with carbohydrate counting (CC) to determine insulin dose, has provided an opportunity for improvement in glycemic control and quality of life for children and adolescents with type 1 diabetes (T1D). These advances, however, have not translated into improved outcomes. This may be due to the stress and anxiety the child and family experience with the large amount of information taught during diabetes education sessions at diagnosis. A simplified teaching approach may reduce stress for the child and family. This study assessed the effects of two approaches to mealtime insulin delivery on parental stress. In the fixed dose (FD) regimen, the same dose of insulin is delivered for a set range of carbohydrates. In the insulin:carbohydrate ratio (ICR) regimen, insulin delivery varies based on the exact number of carbohydrates. Twenty-four subjects (8-15-yrs) with new-onset T1D were randomized to the FD or ICR group. The primary endpoint was parental stress using the Parental Stress Survey, at 1-month and 4-months after diagnosis. Secondary endpoints included glycemic variability (% of values within target range) and HbA1C (%), at 1-month and 4-months after diagnosis. The FD group experienced less stress than the ICR group at 1-month (27 ± 2.29 vs. 37.28 ± 2.57)and 4-months (27.62 ± 2.34vs. 35.14 ± 2.57) (interactive p = 0.04). The FD group had similar glycemic variability and HbA1C levels as the ICR group at 1-month (67.5% vs. 63.2% and 9.76 ± 0.53vs. 9.2 ± 0.58) and 4-months (63.3% vs. 69.0% and 7.27 ± 0.55 vs. 7.71 ± 0.58). Complications (severe hypoglycemia or DKA) did not occur in either group during the study. The additional stress associated with learning CC at the onset of T1D education may be reduced with a simple mealtime insulin and carbohydrate regimen. A simple insulin regimen that does not adversely affect glycemic control may alleviate the stress that many patients and families experience when a child is diagnosed with new-onset T1D. Disclosure J. V. Reyes diaz: None. E. Felner: None.