Pediatric Diabetes

 Beta Cell Function after Intensive Subcutaneous Insulin Therapy or Intravenous Insulin Infusion at Onset of T1D in Children without ketoacidosis
Background Our aim was to see if IV insulin therapy at diagnosis preserves beta-cell function better than multiple subcutaneous injections (SC). Methods 54 children 9.9±3.5 years (range 2.8-14.9) without ketoacidosis were included in a 2 year, randomized multicenter study with insulin SC or 48-72 hours IV initially. 33 (61%) were boys, 22 (41%) were pubertal. 48 subjects completed 12 months follow-up and 43 completed 24 months. At 1, 6, 12 and 24 months, HbA1c, C-peptide and insulin/kg/24h were measured. At 24 months, a mixed-meal tolerance test (MMTT) was performed. Results HbA1c at diagnosis was 10.7%, (93 mmol/mol) for IV, 10.7%, (94 mmol/mol) for SC. During the first two full days of insulin therapy, mean plasma glucose was 8.2 mmol/l for IV, 9.5 for SC (p=0.025). Mean insulin dose was 1.5 U/kg/day for IV vs. 1.0 for SC (p=0.001). 16 (7 in IV, 9 in SC group) started with insulin pumps during the follow-up. At 24 months we saw no significant differences: HbA1c (7.5%, 58 mmol/mol, for IV, 7.2%, 55 mmol/mol, for SC; ns), insulin doses (0.79 vs. 0.88 U/kg/day; ns), fasting C-peptide (0.08 vs. 0.12 nmol/l; ns), maximal MMTT response (0.19 vs. 0.25 nmol/l; ns) and AUC (18.26 vs. 23.9 nmol/l*min; ns). Peak C-peptide > 0.2 nmol/l in the combined IV and SC groups correlated significantly with HbA1c and C-peptide at onset in a multiple regression. Conclusion Residual beta cell function at 2 years seems to be independent from initial insulin regimens but related to HbA1c and c-peptide at onset.