Development of Optimal Kids Insulin Dosing System Formulas for Young Children with Type 1 Diabetes Mellitus

Abstract

This study was designed to develop predictive formulas for precise insulin dosing in young children with type 1 diabetes (T1DM). Consecutive 1-year data from a group of 14 young patients (eight girls, six boys) 3.9 ± 0.8 years old with diabetes duration of 2.0 ± 0.8 years, transitioned from multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII), were analyzed to identify parameters governing optimal insulin dosing. Body mass index (BMI), total daily dose (TDD), total basal dose, insulin-to-carbohydrate ratio (ICR), correction factor (CF), and mean amplitude of glycemic excursion (MAGE) by continuous glucose monitoring and hemoglobin A(1c) (HbA(1c)) level were evaluated at baseline and every 3 months. The slopes of CF versus 1/TDD, bolus versus TDD, ICR versus 1/TDD, and CF versus ICR were determined. Kids Insulin Dosing System (KIDS) slope constants at follow-up were associated with MAGE compared with baseline (P<0.0001) without significant changes in BMI (16.6 ± 1.5 vs. 16.7 ± 1.4 kg/m(2)) and HbA(1c) values (8.0 ± 0.50% vs. 7.8 ± 0.40%). The relationship between CF and TDD changed significantly during CSII compared with baseline MDI (P<0.0001), whereas the coefficients for ICR and TDD relationship remained relatively unchanged. The KIDS formulas estimated TDD=0.74×body weight, total basal dose=0.28×TDD, CF=2,800/TDD, and ICR=13.5×body weight/TDD. The interrelationships among ICR, CF, TBD, and TDD remained stable on CSII and were accompanied by decreased glycemic excursions. The KIDS formulas may yield consistent and easy estimates of insulin dosing factors in very young patients with T1DM.