Abstract



Introduction: Insulin requirements in pediatric type 1 diabetes mellitus (T1DM) vary according to age, pubertal status, and metabolic factors; however, the relationship between insulin dose and glycemic control remains complex.



Objective: This study aimed to evaluate the association between total daily insulin dose and metabolic control in children and adolescents with T1DM.



Methods: In this cross-sectional study, 471 children and adolescents with T1DM attending an endocrine clinic were evaluated. HbA1c was measured on two separate occasions at a three-month interval. Insulin dose was recorded at each monthly visit over the three-month observation period. Associations between total daily insulin dose (U/kg/day), HbA1c, body mass index (BMI), diabetes duration, and pubertal stage were analyzed.



Results: The mean age was 12.37 ± 3.95 years (range, 2.25–17.8 years), and the mean duration of diabetes was 4.69 ± 3.36 years. A significant positive correlation was observed between total daily insulin dose and HbA1c (r = 0.18, p < 0.001). Insulin requirements increased significantly across pubertal stages (p < 0.001). BMI showed a positive correlation with insulin dose among male participants (r = 0.20, p = 0.008). In multivariable regression analysis, total insulin dose was significantly associated with HbA1c (β = 0.74, 95% CI: 0.22–1.26, p = 0.006), whereas age, sex, diabetes duration, and pubertal stage were not significant predictors.



Conclusion: Higher insulin doses were associated with poorer glycemic control, likely reflecting compensatory dose escalation rather than improved metabolic regulation. Pubertal status and BMI significantly influenced insulin requirements in children and adolescents with T1DM.