# An Altered Lipid Profile Is Indicative of Increased Insulin Requirement in Children and Adolescents at the Onset of Type 1 Diabetes

## TL;DR

High triglyceride levels in children with newly diagnosed Type 1 Diabetes predict higher insulin needs, which could help improve treatment and reduce hospital stays.

## Contribution

Identifies serum triglyceride levels as a strong independent predictor of insulin requirement at Type 1 Diabetes onset.

## Key findings

- Serum triglyceride levels were the strongest independent predictor of increased insulin requirement.
- The association remained significant regardless of diabetic ketoacidosis severity.
- The model had an adjusted R2 of 0.37 and an AUC of approximately 0.70.

## Abstract

Background: At the onset of Type 1 Diabetes (T1D), international guidelines recommend initiating subcutaneous insulin therapy within a wide dosage range (0.5–1 IU/kg/day), as insulin requirement (IR) varies greatly based on several factors, including age, pubertal status, and the presence of diabetic ketoacidosis (DKA). In clinical practice, some individuals require higher-than-expected IR, leading to prolonged hospitalization. This study aimed to identify predictive factors for elevated IR at T1D onset. Methods: We conducted a retrospective observational study including 218 children and adolescents diagnosed with T1D between January 2010 and September 2020. Clinical and laboratory parameters were collected. IR was defined as the highest daily subcutaneous insulin dose (IU/kg/day) during hospitalization, after resolution of DKA. Results: As expected, DKA severity and HbA1c levels were associated with increased IR. However, the strongest independent predictor in the multivariate model was serum triglyceride level (β = 0.27, p < 0.001), with an adjusted R2 of 0.37. No evidence of multicollinearity was detected, and ROC analysis yielded an AUC of approximately 0.70. Conclusions: Hypertriglyceridemia at T1D onset is independently associated with higher IR, regardless of DKA severity. Early recognition of this marker could help optimize insulin dosing, improve metabolic stabilization, and potentially shorten hospital stays.