Diurnal Variation of Real-Life Insulin Sensitivity Factor Among Children and Adolescents With Type 1 Diabetes Using Ultra-Long-Acting Basal Insulin Analogs

Ahmed M Hegab

doi:10.3389/fped.2022.854972

Abstract

BackgroundEstimation of insulin sensitivity factor (ISF) is essential for correction insulin doses calculation. This study aimed to assess real-life ISF among children and adolescents with type 1 diabetes using ultra-long-acting basal insulin analogs and to detect factors associated with ISF among those patients.MethodsThis prospective observational study was conducted at Sohag University Hospital, Egypt, and included 93 participants aged 6–18 years, diagnosed with T1DM for at least 1 year and using insulin glargine 300 Units/mL or insulin degludec 100 Units/mL as basal insulin. The ISF, insulin-to-carbohydrate ratio (ICR) and insulin doses were initially assessed then adjusted as required. The participants were regularly contacted throughout the follow-up period. Glycemic control parameters were assessed after 3 months.ResultsThe ISF showed diurnal variation with higher correction dose requirements for the morning than for the rest of the day (p < 0.001). This pattern of diurnal variation was found in participants with different pubertal stages and in participants using either type of ultra-long acting basal insulin analogs. There was no significant difference between the ISF calculated according to the 1800 rule [1800/Total daily insulin dose (TDD)] and the morning ISF (p = 0.25). The 1800 rule-calculated ISF was significantly lower than the actual ISF for the afternoon (p < 0.001) and the evening (p < 0.001). ISF at different times of the day were significantly correlated with age, body mass index, pubertal stage, diabetes duration, TDD, and ICR. Multiple regression analysis revealed that ICR was the most significant factor associated with ISF. Linear regression analysis revealed that the ISF (in mg/dL) for any time of the day could be estimated as 5.14 × ICR for the same time of the day (coefficient = 5.14, 95% confidence interval: 5.10–5.19, R2 = 0.95, p < 0.001).ConclusionDiurnal variation of ISF that had to be considered for proper calculation of correction doses. This diurnal variation was found in children and adolescents with different pubertal stages. The 1800 rule was appropriate for the morning correction doses but not in the afternoon or the evening. The TDD and the ICR could be used for ISF estimation.

Highlights

Appropriate estimations of insulin sensitivity factor (ISF) and insulin-to-carbohydrate ratio (ICR) in children and adolescents with type 1 diabetes mellitus (T1DM) using intensive insulin therapy are essential for proper calculation of bolus insulin doses [1]
Correction doses are calculated as the difference between the current blood glucose level and the target blood glucose level divided by the ISF which is defined as the amount of reduction of blood glucose levels that can be achieved by 1 unit of insulin [3, 4]
A similar pattern of diurnal variation of ISF and ICR among prepubertal children with T1DM using insulin pumps was reported by Hanas et al, who found that higher bolus insulin requirements both as pre-meal doses and as correction doses were needed for the morning than for the rest of the day [9]

Summary

Introduction

Appropriate estimations of insulin sensitivity factor (ISF) and insulin-to-carbohydrate ratio (ICR) in children and adolescents with type 1 diabetes mellitus (T1DM) using intensive insulin therapy are essential for proper calculation of bolus insulin doses [1]. The pre-meal dose is calculated as the amount of carbohydrate in grams of a certain meal divided by the ICR for that meal. Calculation of ICR is essential to give the patients the flexibility of eating different meal sizes and adjusting the pre-meal bolus doses according to the amount of carbohydrate in each meal [2]. Correction doses are calculated as the difference between the current blood glucose level and the target blood glucose level divided by the ISF which is defined as the amount of reduction of blood glucose levels (in mg/dL or mmol/L) that can be achieved by 1 unit of insulin [3, 4]. This study aimed to assess real-life ISF among children and adolescents with type 1 diabetes using ultra-long-acting basal insulin analogs and to detect factors associated with ISF among those patients

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