From the Guidelines
The recommended treatment for a child diagnosed with type 1 diabetes is insulin therapy, which must be continued lifelong, typically involving multiple daily injections or an insulin pump to deliver both basal and bolus insulin, with dosing individualized based on the child's weight, age, and insulin sensitivity, often starting at 0.5-1.0 units/kg/day, as supported by the most recent evidence from 1.
Key Components of Treatment
- Insulin therapy: multiple daily injections or an insulin pump to deliver basal (background) insulin, such as insulin glargine (Lantus), insulin detemir (Levemir), or insulin degludec (Tresiba), and bolus (mealtime) insulin, such as insulin lispro (Humalog), insulin aspart (NovoLog), or insulin glulisine (Apidra) 1.
- Dosing: individualized based on the child's weight, age, and insulin sensitivity, often starting at 0.5-1.0 units/kg/day, with adjustments made as the child grows and insulin needs change 1.
- Blood glucose monitoring: regular monitoring 4-10 times daily or continuous glucose monitoring (CGM) to track blood glucose levels and adjust insulin doses accordingly 1.
- Carbohydrate counting: children and caregivers must learn to match insulin doses to food intake, using insulin-to-carbohydrate ratios (typically 1 unit per 10-15 grams of carbs) 1.
- Regular medical follow-up: every 3 months to adjust insulin doses as the child grows and to monitor for potential complications 1.
- Multidisciplinary approach: involving an endocrinologist, diabetes educator, dietitian, and mental health professional to provide comprehensive care and support 1.
Importance of Individualized Care
The treatment of type 1 diabetes in children requires an individualized approach, taking into account the child's unique needs, lifestyle, and circumstances, as emphasized in 1 and 1. This includes considering factors such as the child's age, weight, and insulin sensitivity, as well as their dietary habits, physical activity level, and overall health status. By providing individualized care and support, healthcare providers can help children with type 1 diabetes achieve optimal blood glucose control, prevent complications, and improve their overall quality of life.
From the FDA Drug Label
The efficacy of TOUJEO was evaluated in a 26-week, randomized, open-label, multicenter trial (Study B) in 463 pediatric patients with type 1 diabetes mellitus Patients were randomized to basal-bolus treatment with TOUJEO or LANTUS and treated for 26 weeks. TOUJEO and LANTUS were administered once daily in the morning or in the evening. A mealtime insulin analogue was administered before each meal.
The recommended treatment for a child diagnosed with type 1 diabetes is basal-bolus therapy, which includes a basal insulin (such as TOUJEO or LANTUS) administered once daily, and a mealtime insulin analogue (such as insulin glulisine, insulin lispro, or insulin aspart) administered before each meal.
- The dosage of basal insulin should be adjusted to achieve optimal glycemic control.
- The choice of basal insulin (TOUJEO or LANTUS) and mealtime insulin analogue should be individualized based on the child's specific needs and response to treatment.
- The treatment regimen should be monitored and adjusted regularly to ensure optimal glycemic control and minimize the risk of hypoglycemia and other adverse effects 2.
From the Research
Treatment Overview
The recommended treatment for a child diagnosed with type 1 diabetes involves lifelong administration of exogenous insulin, with the primary goal of maintaining near-normoglycemia through intensive insulin therapy, avoiding acute complications, and preventing long-term microvascular and macrovascular complications 3.
Insulin Therapy
Effective insulin therapy must be provided based on the needs, preferences, and resources of the individual and the family for optimal management of type 1 diabetes. The best therapeutic option for patients with type 1 diabetes is basal-bolus therapy, either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) 3.
Management Strategies
Management of type 1 diabetes in children and young people includes insulin replacement therapy and dietary management, with an emphasis on regular and ongoing monitoring of blood glucose levels, quarterly measurement of glycated haemoglobin, and the management of hyperglycaemia and hypoglycaemia 4.
Goals of Treatment
The goals of treatment are the near-normalization of glucose metabolism, the avoidance of acute complications, the reduction of diabetes-specific sequelae, unrestricted participation in age-appropriate everyday activities, and normal physical and psychosocial development 5.
Factors Affecting Glycemic Control
Glycemic control can be affected by many factors, including younger age, longer disease duration, and urban residence, which were found to be significant predictors of good glycemic control in a study of children with type 1 diabetes 6.
Insulin-Delivery Methods
Alternative routes for delivering insulin are being investigated, including the hybrid closed-loop 'artificial pancreas' system, oral, inhalation, intranasal routes, and others, to address the needs of children and adolescents in the treatment of type 1 diabetes 7.
Key Considerations
- Comprehensive education is necessary for the individual needs of the patient and family before and after initiation of insulin therapy 3.
- Self-monitoring of blood glucose and/or a continuous glucose monitoring system is crucial to avoid critical hypoglycemia and glucose variability 3.
- Doses of insulin should be adapted based on the daily pattern of blood glucose, through regular review and reassessment, and patient factors such as exercise and pubertal status 3.