(C-093) Treatment patterns in pediatric type 1 diabetes mellitus patients in Taiwan

Background: Type 1 diabetes mellitus (T1DM) is a life-threatening disease in childhood, which may lead to multiple complications. Lifelong insulin replacement is the core treatment for T1DM. However, the information of treatment patterns in pediatric T1DM patients remains insufficient in Taiwan.

Objectives: To analyze the prescription patterns and the factors related to treatment decisions of pediatric T1DM in Taiwan.

Methods: This is a retrospective cohort study. Patients under 20 years old and diagnosed with T1DM between January 2015 and December 2021 were identified from the National Health Insurance Database. Baseline characteristics from one year before the diagnosis date were collected. Patients were stratified into three groups based on their initial outpatient insulin prescriptions: the insulin analogues group (long-acting insulins, rapid-acting insulins, premixed insulins), the human insulin group (regular insulin and NPH insulin) and the combination group (using insulin analogue plus the human insulin). Categorical variables were expressed in terms of frequency and percentage (%), while continuous variables were expressed as mean ± standard deviation. The standardized mean difference (SMD) was used to assess imbalance between groups, with a SMD above 0.1 indicating imbalance.

Results: During the observation periods, 1454 pediatrics with T1DM were identified. The annual incidence rate was stable, with a mean annual incidence rate of 4.8 per 100,000 children. Most of the patients (59.4%) received insulin analogues as their initial treatment, followed by human insulin (26.8%). Patients receiving insulin analogues were older (mean age 10.7) than those with human insulin (mean age 8, SMD 0.58) and combination (mean age 5.6, SMD 1.34). The days from the diagnosis of T1DM to the first insulin treatment were shorter in human insulin group (mean 8.9, median 0) than insulin analogues group (mean 20.2, median 14) and combination group (mean 18, median 15). Psychotic disorder is the most common comorbidity, with similar prevalence of 5.0% to 6.2% (SMD < 0.1) among three groups. Thyroid disease (5.2%, SMD 0.12/0.33) and lipid disorder (2.8%, SMD 0.13/0.24) were more prevalent in the insulin analogues group.

Conclusions: For children newly diagnosed with T1DM, their baseline characteristics show significant differences across the three initial insulin treatment groups. In the future, we will conduct further causal relationship testing on the factors that may influence insulin treatment choices in children with T1DM.