Determinants of Insulin Requirement in Children With Type 1 Diabetes Mellitus: Experience From a Tertiary Care Center in North-Western India

Objectives Insulin, the main drug used in the treatment of Type 1 Diabetes Mellitus (T1DM), has a variable dose requirement and often needs individualized titration in pediatric patients. This individualization of treatment can be time-consuming and challenging. We conducted this study to analyze insulin requirement in children with T1DM and its correlation with various patient variables. Methods The cross-sectional ambispective study included pediatric patients with T1DM aged <18 years who were admitted to the department of pediatrics at our hospital from November 2022 to October 2023. Insulin titration was tailored to individual needs during admission. Maximum insulin requirement during admission (IU/kg/day) and insulin requirement at discharge (IU/kg/day) were recorded along with relevant demographic and clinical details in a pre-prepared proforma. A total of 64 patients were included, with a male-to-female ratio of 1.55:1. Ten patients were studied retrospectively, and 54 patients were analyzed prospectively. Results The maximum insulin requirement in terms of IU/kg/day during hospitalization was significantly higher among children below 5 years of age, female patients, and those presenting with celiac disease or diabetic ketoacidosis (DKA) (p < 0.05). Insulin requirements at discharge were notably higher in children with celiac disease (P = 0.031), while no significant disparities were observed based on age, sex, presence of DKA, or hypothyroidism. Linear regression analysis identified age, sex, presence of DKA, and maximum insulin dose required during hospitalization as significant predictors of insulin dose at discharge (R2 = 0.92, p < 0.001). Conclusions These findings may provide valuable insights for refining insulin titration and discharge planning. Further studies are imperative in developing nations due to limited data on pediatric insulin requirements.