Predicting the optimal Basal insulin infusion pattern in children and adolescents on insulin pumps

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Item Type:	Article
Title:	Predicting the optimal Basal insulin infusion pattern in children and adolescents on insulin pumps
Creators Name:	Holterhus, P.M., Bokelmann, J., Riepe, F., Heidtmann, B., Wagner, V., Rami-Merhar, B., Kapellen, T., Raile, K., Quester, W. and Holl, R.W.
Abstract:	OBJECTIVE: We aimed at developing and cross-validating a mathematical prediction model for an optimal basal insulin infusion pattern for children with type 1 diabetes on continuous subcutaneous insulin infusion therapy (CSII). RESEARCH DESIGN AND METHODS: We used the German/Austrian DPV-Wiss database for quality control and scientific surveys in pediatric diabetology and retrieved all CSII patients <20 years of age (November 2009). A total of 1,248 individuals from our previous study were excluded (dataset 1), resulting in 6,063 CSII patients (dataset 2) (mean age 10.6 +/- 4.3 years). Only the most recent basal insulin infusion rates (BRs) were considered. BR patterns were identified and corresponding patients sorted by unsupervised clustering. Logistic regression analysis was applied to calculate the probabilities for each BR pattern. Equations were based on both independent datasets separately, and probabilities for BR patterns were cross-validated using typical test patients. RESULTS: Of the 6,063 children, 5,903 clustered in one of four major circadian BR patterns, confirming our previous study. The oldest age-group (mean age 12.8 years) was represented by 2,490 patients (42.18%) with a biphasic dawn-dusk pattern (BC). A broad single insulin maximum at 9-10 p.m. (F) was unveiled by 853 patients (14.45%) (mean age 6.3 years). Logistic regression analysis revealed that age, to a lesser extent duration of diabetes, and partly sex predicted BR patterns. Cross-validation revealed almost identical probabilities for BR patterns BC and F in the two datasets but some variation in the remaining two BR patterns. CONCLUSIONS: Reconfirmation of four key BR patterns in two very large independent cohorts supports that these patterns are realistic approximations of the circadian distribution of insulin needs in children with type 1 diabetes. Prediction of an optimal pattern a priori can improve initiation and clinical follow-up of CSII in children and adolescents. In addition, these BR patterns represent valuable information for insulin-infusion algorithms in closed-loop CSII.
Keywords:	Insulin, Insulin Infusion Systems, Regression Analysis, Theoretical Models, Type 1 Diabetes Mellitus
Source:	Diabetes Care
ISSN:	0149-5992
Publisher:	American Diabetes Association
Volume:	36
Number:	6
Page Range:	1507-1511
Date:	June 2013
Official Publication:	https://doi.org/10.2337/dc12-1705
PubMed:	View item in PubMed

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