Continuous Subcutaneous Insulin Infusion in Neonates and Infants Below 1 Year: Analysis of Initial Bolus and Basal Rate Based on the Experiences from the German Working Group for Pediatric Pump Treatment.
BACKGROUND
Diabetes mellitus is rare in young infants and neonates. Continuous subcutaneous insulin infusion (CSII) is used most frequently for insulin treatment in this age group. However, the individual doctor's experience is scarce because of the low prevalence of diabetes in this age. For this study patients treated with CSII with an age below 1 year were selected from the German/Austrian DPV (Diabetes-Patienten-Verlaufsdokumentation) database, and basal rate and bolus calculation were described.


METHODS
For all patients less than 1 year of age, basal rate and mealtime boluses were compared among infants with type 1 diabetes mellitus (T1DM), infants with neonatal diabetes mellitus (NDM), and infants with antibody status unknown diabetes mellitus (AUDM).


RESULTS
Fifty-eight patients with T1DM, 67 neonates with NDM, and 43 infants with early diabetes development after 6 months and negative β-cell antibodies (AUDM) could be analyzed. T1DM patients at onset required a median total insulin amount of 0.83 IU/kg of body weight, whereas NDM patients required 0.74 IU/kg of body weight (P = 0.63). Basal insulin requirement however, was different between the two groups (0.56 IU/kg of body weight in NDM vs. 0.43 IU/kg in T1DM) (P = 0.036). The percentage basal profile of NDM and T1DM patients was quite similar to children at the age of 1-5 years. The proportion of prandial insulin at onset was significantly different (32% in NDM vs. 53% in T1DM) (P < 0.00001). AUDM patients showed almost similar data to T1DM patients. The pattern of mealtime bolus insulin was not different among the groups.


CONCLUSIONS
The presented data can be used as an initial guide value to start CSII treatment in neonates and infants. To be on the safe side we recommend the lower quartile for the dosage as the starting value in nonketotic patients.
1 Hospital for Children and Adolescents, University of Leipzig , Leipzig, Germany .
Thomas M
TM
Kapellen
2 Catholic Children's Hospital Wilhelmstift , Hamburg, Germany .
Bettina
B
Heidtmann
3 Hospital for Children and Adolescents, University of Bochum , Bochum, Germany .
Eggert
E
Lilienthal
4 Department of Pediatrics, Medical University of Vienna , Vienna, Austria .
Birgit
B
Rami-Merhar
5 Childrens Hospital , Worms, Germany .
Charlotte
C
Engler-Schmidt
6 Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm , Ulm, Germany .
Reinhard W
RW
Holl
D003920:Diabetes Mellitus / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D054796:Drug Dosage Calculations; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D062407:Meals; D017410:Practice Guidelines as Topic; D012042:Registries
D007004:Hypoglycemic Agents; D007328:Insulin