Surprising variation in insulin treatment for kids

There is significant geographical variation in the type of insulin, dose and device given to kids with type 1 diabetes, a survey of Australian and New Zealand clinicians reveals.

The online survey of 110 paediatric endocrinologists and paediatricians providing care for children and adolescents with diabetes, found Australian clinicians largely favoured multiple daily injections (MDI) for all paediatric age groups whereas in New Zealand, MDI was only favoured from 10 years of age.

Dr Benjamin Wheeler, from the Department of Women’s and Children’s Health at the University of Otago, told the limbic that even the starting dose ranged from less than 0.5 U/kg/day to more than 1 U/kg/day.

“It’s quite fascinating how much variation there is. We think we are all doing the same thing but instead we found quite a bit of variation depending on postcode.”

The study found 38% of Australian clinicians considered early introduction of insulin pump therapy in their youngest patients (<2 years) whereas it was never considered in New Zealand.

Dr Wheeler said there was also variation between country and clinician group in the choice of long-acting insulin and methods for determining insulin bolus.

Australian clinicians and New Zealand pediatric endocrinologists were more likely to use carbohydrate counting (63%) while pediatricians in New Zealand preferred fixed doses.

Dr Wheeler said a number of factors were at play including where doctors trained, the dominant philosophy in major centres and inconsistency in guidelines.

“It is fair to say there is no firm direction from the main guidelines in pediatric endocrinology.”

However there was also a question about the influence of pharmaceutical companies.

“Endocrinologists appear to be creatures of habit. The vast majority of clinicians (77%) only used one manufacturer’s product when there is no science supporting that over two other products on the market.”

Dr Wheeler said although the variation in practice was a concern, it was unclear whether it ultimately affected long-term outcomes.

“We place a lot of emphasis on technology and new insulins but we don’t want to lose sight of the impact of strong education and strong support for patients in this lifelong journey with a difficult, complex disease.”