Endocrine Abstracts

Introduction: National guidance from the Association of Children’s Diabetes Clinicians (ACDC) recommends starting children with newly diagnosed type 1 diabetes mellitus on a total daily insulin dose of 0.5–0.75 iU per kilo per day (kg/d). This equates to a basal insulin dose of between 0.25–0.375 iU/kg per day. Local practice suggested many patients required a significantly smaller starting dose of basal insulin.

Aim: To evaluate the dose of Levemir at first clinic review with that recommended by ACDC guidelines.

Method: A retrospective service evaluation collecting data of paediatric patients presenting to 3 district general hospitals between 2020 and 2022. Basal insulin prescription recommended at diagnosis was compared against the dose at first clinic review. Data were obtained from patients with a new diagnosis of type 1 diabetes. Data collection included: Patient demographics, Levemir dosage at diagnosis, Levemir dosage at first clinic visit and weights.

Results: We collected data on 142 patients. 34 patients were excluded for incomplete data or alternative basal insulin.(DKA: Diabetic Ketoacidosis)Mean dose of Levemir at first clinic All ages 0.224 iU/kg/d (95%CI±0.022)

Conclusion: The median doses of Levemir at first clinic review are below the ACDC recommended starting doses of basal insulin. There was a mean reduction in Levemir at first clinic review in all ages, except for those children aged 1 to 3 in DKA. These data suggest the current ACDC recommended starting dose of basal insulin may be too high. More research is required to establish a personalised appropriate starting dose of long-acting insulin.