Aims. New-onset type 1 diabetes mellitus (T1D) in pediatric patients represents a clinical challenge for initial total daily insulin dosing (TIDD) due to substantial heterogeneity in practice and lack of consensus on the optimal starting dose. Our INSENODIAB (INsulin SEnsitivity in New Onset type 1 DIABetes) study is aimed at (1) exploring the influence of patient-specific characteristics on insulin requirements in pediatric patients with new-onset T1D; (2) constructing a predictive model for the recommended TIDD tailored to individual patient profiles; and (3) assessing potential associations between TIDD and patient outcomes at follow-up intervals of 3 and 12 months. Methods. We conducted a comprehensive analysis of medical records for children aged 6 months to 18 years, hospitalized for new-onset T1D from 2013 to 2022. The study initially involved multivariable regression analysis on a retrospective cohort (rINSENODIAB), incorporating baseline variables. Subsequently, we validated the model robustness on a prospective cohort (pINSENODIAB) with a significance threshold of 5%. The model accuracy was assessed by Pearson’s correlation. Results. Our study encompassed 103 patients in the retrospective cohort and 80 in the prospective cohort, with median TIDD at diagnosis of 1.1 IU/kg BW/day (IQR 0.5). The predictive model for optimal TIDD was established using baseline characteristics, resulting in the following formula: . Validation of the model using the pINSENODIAB cohort demonstrated a significant Pearson correlation coefficient of 0.74. Notably, no significant correlation was observed between TIDD at diagnosis and partial remission markers (IDAA1C, C-peptide) at 3- and 12-months postdiagnosis time points. Conclusions. In the context of new-onset T1D in pediatric patients, we identified key influencing factors for determining optimal TIDD, including age, percentage of weight loss, weight, veinous pH, and bicarbonates. These findings have paved the way for the development of a dosing algorithm to potentially expedite glycemic control stabilization and facilitate a more individualized approach to treatment regimens.

中文翻译：

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新发 1 型糖尿病儿童和青少年胰岛素剂量需求的决定因素和特征：INSENODIAB 研究的见解

目标。由于实践中存在很大的异质性并且对最佳起始剂量缺乏共识，儿科患者新发 1 型糖尿病 (T1D) 对初始每日总胰岛素剂量 (TIDD) 提出了临床挑战。我们的 INSENODIAB（新发 1 型糖尿病中的胰岛素敏感度）研究旨在 (1) 探索患者特异性特征对新发 T1D 儿科患者胰岛素需求的影响；(2) 根据患者个体情况构建推荐的 TIDD 预测模型；(3) 在 3 个月和 12 个月的随访间隔内评估 TIDD 与患者结果之间的潜在关联。方法。我们对 2013 年至 2022 年因新发 T1D 住院的 6 个月至 18 岁儿童的病历进行了全面分析。该研究最初涉及回顾性队列 (rINSENODIAB) 的多变量回归分析，纳入基线变量。随后，我们在前瞻性队列 (pINSENODIAB) 上验证了模型的稳健性，显着性阈值为 5%。模型的准确性通过 Pearson 相关性进行评估。结果。我们的研究涵盖了回顾性队列中的 103 名患者和前瞻性队列中的 80 名患者，诊断时的中位 TIDD 为 1.1 IU/kg BW/天 (IQR 0.5)。使用基线特征建立了最佳 TIDD 的预测模型，得出以下公式：。使用 pINSENODIAB 队列验证模型显示显着的 Pearson 相关系数为 0.74。值得注意的是，诊断时的 TIDD 与诊断后 3 个月和 12 个月的部分缓解标志物（IDAA1C、C 肽）之间没有观察到显着相关性。结论。在儿科患者新发 T1D 的背景下，我们确定了确定最佳 TIDD 的关键影响因素，包括年龄、体重减轻百分比、体重、静脉 pH 值和碳酸氢盐。这些发现为开发剂量算法铺平了道路，该算法有可能加快血糖控制稳定并促进更加个体化的治疗方案。