Age-Dependent Bolus Settings: Insulin-to-Carbohydrate Ratios and Insulin Sensitivity Factors in Pediatric Patients with Type 1 Diabetes on Conventional CSII in the DPV Registry
Authors' conclusion
Our real-world findings on CSII settings in a large cohort of children with sufficient metabolic control highlight the inadequacy of a single TDD-based calculation formula, as insulin requirements varied by age, time of day, sex, and BMI.
Study context
- Population
- Patients aged 1 to <18 years with T1D, postremission (diabetes duration >1 year, insulin dose ≥0.5 IU/kg/d), HbA1c ≤7.5%, on insulin pumps with short-acting analog insulin in 2023, DPV registry (Germany, Austria, Switzerland, Luxembourg); AID users excluded
- Participants
- 7,697 patients
- Exposure
- Insulin pump bolus settings by age group, time of day, sex and body mass index (BMI)
- Outcome
- Morning ICR (g carbs/IU) and ISF (mg/dL)
- Follow-up
- Morning
Methodological detailsmultinational registry (DPV), real-world
- Multinational registry (DPV)
- Real-world
Main finding
As reported in the abstract
morning
| Group | Value | ISF |
|---|---|---|
| <6 years | median 11.2 (IQR 9.1–14.0) g carbs/IU | 1:150 mg/dL (70-228) |
| 6 to <12 years | median 8.7 (IQR 7.0–10.7) g carbs/IU | 1:90 (50-140) |
| 12 to <18 years | median 6.1 (IQR 5.0–7.7) g carbs/IU | 1:50 (40-80) |
Value
<6 yearsmedian 11.2 (IQR 9.1–14.0) g carbs/IU
6 to <12 yearsmedian 8.7 (IQR 7.0–10.7) g carbs/IU
12 to <18 yearsmedian 6.1 (IQR 5.0–7.7) g carbs/IU
ISF
<6 years1:150 mg/dL (70-228)
6 to <12 years1:90 (50-140)
12 to <18 years1:50 (40-80)
Observational data: associations, not effects.
Further findings
ISF by time of day
- ISF highest in the late evening in all age groups
BMI and ISF
- Higher BMI-SDS associated with lower ISF
Sex
- Girls above 6 years had lower ICR but similar ISF to boys
ISF × TDD factor
- Comparable in all age groups and BMI categories
Original publication
Age-Dependent Bolus Settings: Insulin-to-Carbohydrate Ratios and Insulin Sensitivity Factors in Pediatric Patients with Type 1 Diabetes on Conventional CSII in the DPV Registry. Diabetes Technol Ther. Published 6 February 2025. doi:10.
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