Real-World Total Daily Insulin Dose in over 14,000 Young Individuals with Type 1 Diabetes in the United States

OBJECTIVE: Insulin requirements for people with type 1 diabetes (T1D) may vary with changes in age, pubertal status, and weight. There are limited data to assess insulin requirements based on age, sex, and body mass index (BMI) with modern treatment paradigms, especially among those using advanced technologies for the treatment and management of T1D. This study estimated total daily insulin dose (TDD) in children, adolescents, and young adults with T1D. MATERIALS AND METHODS: This retrospective study analyzed electronic health records of people with T1D aged 2-25 years from the T1D Exchange Quality Improvement Collaborative. TDD (IU/kg/day) was reported and stratified by age, sex, BMI, glycated hemoglobin (HbA1c), and insulin delivery method. RESULTS: This study included 14,358 people with T1D. Mean (SD) age of 16.2 (4.3) years, 48% were females, 74.6% were White, and 80% used a continuous glucose monitor. Mean HbA1c was 8.4%, and 80.2% of participants had an HbA1c ≥7%. TDD increased from age 2-13 years, with the steepest increase from 9-13 years. In females, the peak TDD was at age 12 years compared to age 14 years for males. Higher TDD was observed among those within higher BMI and HbA1c categories and in multiple daily injections (MDI) users compared to insulin pump (non-hybrid closed loop system [HCLS]) and HCLS users. CONCLUSIONS: Dynamic insulin requirements across age, sex, BMI, HbA1c, and insulin delivery methods, along with difficulty in achieving glycemic targets, highlight the need for frequent reassessment of TDD, especially during puberty.