International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Insulin and Adjunctive Treatments in Children and Adolescents with Diabetes

Abstract The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the principles of intensive insulin regimens, including more intensive forms of multiple daily injections with new-generation faster-acting and ultra-long-acting insulins; a summary of adjunctive medications used alongside insulin treatment that includes details on pramlintide, metformin, glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA) and sodium-glucose cotransporter inhibitors; and key considerations with regard to access to insulin and affordability to ensure that all persons with diabetes who need insulin can obtain it without financial hardship.

• Publication year

  2025

• Venue

  Hormone Research in Paediatrics

• Publication date

  2025-01-30

• Fields of study

  Medicine

• Identifiers
  DOI 10.1159/000543169PMID 39884261
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study: Continuing to Build on 40 Years of Diabetes Research.

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• Automated Insulin Delivery: A Milestone on the Road to Insulin Independence in Type 1 Diabetes.

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• International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Diabetes Technologies – Insulin Delivery

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• Automated Insulin Delivery Systems in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-analysis of Outpatient Randomized Controlled Trials

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• Once-weekly insulin icodec versus once-daily insulin degludec as part of a basal-bolus regimen in individuals with type 1 diabetes (ONWARDS 6): a phase 3a, randomised, open-label, treat-to-target trial.

  2023influential reference
• Novel Once-Weekly Basal Insulin Fc Achieved Similar Glycemic Control With a Safety Profile Comparable to Insulin Degludec in Patients With Type 1 Diabetes

  2023cited by this paper
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  2023cited by this paper
• Efficacy and safety of co-administered once-weekly cagrilintide 2·4 mg with once-weekly semaglutide 2·4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial.

  2023cited by this paper
• Insulin thermostability in a real-world setting.

  2023cited by this paper
• A co‐formulation of pramlintide and insulin A21G (ADO09) improves postprandial glucose and short‐term control of mean glucose, time in range, and body weight versus insulin aspart in adults with type 1 diabetes

  2023cited by this paper
• Time–Action Profile of Technosphere Insulin in Children with Type 1 Diabetes

  2023cited by this paper
• Closed-Loop Therapy and Preservation of C-Peptide Secretion in Type 1 Diabetes.

  2022influential reference
• ISPAD Clinical Practice Consensus Guidelines 2022: Management of the child, adolescent, and young adult with diabetes in limited resource settings

  2022cited by this paper
• ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes

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• ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes

  2022cited by this paper
• ISPAD Clinical Practice Consensus Guidelines 2022: Managing diabetes in preschoolers

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• Comparison of Insulin Glargine 300 U/mL and Insulin Degludec 100 U/mL Around Spontaneous Exercise Sessions in Adults with Type 1 Diabetes: A Randomized Cross-Over Trial (ULTRAFLEXI-1 Study)

  2022cited by this paper
• ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes

  2022cited by this paper
• Treatment of diabetic ketoacidosis with subcutaneous regular insulin in a non-ICU setting is effective and economical: A single-center experience

  2022cited by this paper
• Continuous glucose monitoring‐based time‐in‐range using insulin glargine 300 units/ml versus insulin degludec 100 units/ml in type 1 diabetes: The head‐to‐head randomized controlled InRange trial

  2022cited by this paper
• ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state

  2022cited by this paper
• Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children

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• Efficacy and safety of ultra‐rapid lispro versus lispro in children and adolescents with type 1 diabetes: The PRONTO‐Peds trial

  2022cited by this paper
• Insulin Replacement Across the Menstrual Cycle in Women with Type 1 Diabetes: An In Silico Assessment of the Need for Ad Hoc Technology

  2022cited by this paper
• Thermal stability and storage of human insulin.

  2022cited by this paper
• Molecular and pharmacological characterization of insulin icodec: a new basal insulin analog designed for once-weekly dosing

  2021cited by this paper
• Adjunctive Therapies to Optimize Closed-loop Glucose Control

  2021cited by this paper
• Molecular Engineering of Insulin Icodec, the First Acylated Insulin Analog for Once-Weekly Administration in Humans.

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• Heat-stability study of various insulin types in tropical temperature conditions: New insights towards improving diabetes care

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• Modeling the variability of insulin sensitivity during the menstrual cycle in women with type 1 diabetes to adjust open-loop insulin therapy

  2021cited by this paper
• Travelling Across Time Zones With Type 1 Diabetes: A Pilot Study Comparing Insulin Degludec With Insulin Glargine U100.

  2021cited by this paper
• The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

  2021cited by this paper
• The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

  2021cited by this paper
• Pharmacokinetics and Glucodynamics of Ultra Rapid Lispro (URLi) versus Humalog® (Lispro) in Younger Adults and Elderly Patients with Type 1 Diabetes Mellitus: A Randomised Controlled Trial

  2020cited by this paper
• The Evolution of Insulin and How it Informs Therapy and Treatment Choices

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• ADO09, a co‐formulation of the amylin analogue pramlintide and the insulin analogue A21G, lowers postprandial blood glucose versus insulin lispro in type 1 diabetes

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• Factors Influencing Insulin Absorption Around Exercise in Type 1 Diabetes

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• Efficacy and Safety of Insulin Glargine 300 Units/mL (Gla-300) Versus Insulin Glargine 100 Units/mL (Gla-100) in Children and Adolescents (6–17 years) With Type 1 Diabetes: Results of the EDITION JUNIOR Randomized Controlled Trial

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• Ultra-Rapid Lispro Efficacy and Safety Compared to Humalog® in Japanese Patients with Type 1 Diabetes: PRONTO-T1D Subpopulation Analysis

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• Effects of Sotagliflozin Combined with Intensive Insulin Therapy in Young Adults with Poorly Controlled Type 1 Diabetes: The JDRF Sotagliflozin Study

  2020cited by this paper
• Medication-induced hyperglycemia: pediatric perspective

  2020cited by this paper
• Insulin Storage: A Critical Reappraisal

  2020cited by this paper
• Insulin Therapy: Future Perspectives.

  2020cited by this paper
• Diabetes management in Wolcott-Rallison syndrome: analysis from the German/Austrian DPV database

  2020cited by this paper
• Insulin Therapy in Hospitalized Patients.

  2019cited by this paper
• Decreasing Trends in Mean HbA1c Are Not Associated With Increasing Rates of Severe Hypoglycemia in Children: A Longitudinal Analysis of Two Contemporary Population-Based Pediatric Type 1 Diabetes Registries From Australia and Germany/Austria Between 1995 and 2016

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• Fast-Acting Insulin Aspart: A Review of its Pharmacokinetic and Pharmacodynamic Properties and the Clinical Consequences

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• Effect of Injection Site Cooling and Warming on Insulin Glargine Pharmacokinetics and Pharmacodynamics

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• Metformin Improves Peripheral Insulin Sensitivity in Youth With Type 1 Diabetes.

  2019influential reference
• Efficacy and Safety of Fast-Acting Insulin Aspart Compared With Insulin Aspart, Both in Combination With Insulin Degludec, in Children and Adolescents With Type 1 Diabetes: The onset 7 Trial

  2019cited by this paper
• Efficacy and safety of ipragliflozin add‐on therapy to insulin in Japanese patients with type 1 diabetes mellitus: A randomized, double‐blind, phase 3 trial

  2019cited by this paper
• Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy

  2018cited by this paper
• Efficacy and safety of a fixed combination of insulin degludec/insulin aspart in children and adolescents with type 1 diabetes: A randomized trial

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• ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

  2018cited by this paper
• Day-to-Day and Within-Day Variability in Glucose-Lowering Effect Between Insulin Degludec and Insulin Glargine (100 U/mL and 300 U/mL): A Comparison Across Studies

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• Carbohydrate Counting in Children and Adolescents with Type 1 Diabetes

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• Factors Affecting the Absorption of Subcutaneously Administered Insulin: Effect on Variability

  2018cited by this paper
• Insulin therapy in neonatal diabetes mellitus: a review of the literature.

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• Conventional insulin pump therapy in two neonatal diabetes patients harboring the homozygous PTF1A enhancer mutation: Need for a novel approach for the management of neonatal diabetes.

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• Clinical outcomes in youth beyond the first year of type 1 diabetes: Results of the Pediatric Diabetes Consortium (PDC) type 1 diabetes new onset (NeOn) study

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• Subcutaneous regular insulin for the treatment of diabetic ketoacidosis in children

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• Growth hormone and insulin-like growth factor-I axis in type 1 diabetes.

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• Comparison of Insulin Glargine 300 Units/mL and 100 Units/mL in Adults With Type 1 Diabetes: Continuous Glucose Monitoring Profiles and Variability Using Morning or Evening Injections

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• Faster‐acting insulin aspart provides faster onset and greater early exposure vs insulin aspart in children and adolescents with type 1 diabetes mellitus

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• Association of HbA1c to BOLUS Scores Among Youths with Type 1 Diabetes

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• Worldwide Injection Technique Questionnaire Study: Injecting Complications and the Role of the Professional.

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• Insulin storage in hot climates without refrigeration: temperature reduction efficacy of clay pots and other techniques

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• Sustained glycaemic control and less nocturnal hypoglycaemia with insulin glargine 300U/mL compared with glargine 100U/mL in Japanese adults with type 1 diabetes (EDITION JP 1 randomised 12-month trial including 6-month extension).

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• The efficacy and safety of DPP4 inhibitors in patients with type 1 diabetes: A systematic review and meta-analysis.

  2016cited by this paper
• Moving toward the ideal insulin for insulin pumps

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• Efficacy and Safety of Liraglutide Added to Capped Insulin Treatment in Subjects With Type 1 Diabetes: The ADJUNCT TWO Randomized Trial

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• Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach

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• Classifying insulin regimens – difficulties and proposal for comprehensive new definitions

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• Influence of dietary protein on postprandial blood glucose levels in individuals with Type 1 diabetes mellitus using intensive insulin therapy

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• Insulin degludec in combination with bolus insulin aspart is safe and effective in children and adolescents with type 1 diabetes

  2015cited by this paper
• Puberty and type 1 diabetes

  2015influential reference
• Pharmacokinetics and Pharmacodynamics of NPH Insulin in Type 1 Diabetes: The Importance of Appropriate Resuspension Before Subcutaneous Injection

  2015influential reference
• Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes

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• Higher insulin detemir doses are required for the similar glycemic control: comparison of insulin detemir and glargine in children with type 1 diabetes mellitus

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• Pharmacokinetics of diluted (U20) insulin aspart compared with standard (U100) in children aged 3–6 years with type 1 diabetes during closed-loop insulin delivery: a randomised clinical trial

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• Pediatric diabetes consortium T1D New Onset (NeOn) study: clinical outcomes during the first year following diagnosis

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• Faster In and Faster Out: Accelerating Insulin Absorption and Action by Insulin Infusion Site Warming

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• Feasibility of overnight closed-loop therapy in young children with type 1 diabetes aged 3–6 years: comparison between diluted and standard insulin strength

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  2014cited by this paper
• New Insulin Glargine 300 Units·mL−1 Provides a More Even Activity Profile and Prolonged Glycemic Control at Steady State Compared With Insulin Glargine 100 Units·mL−1

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• Digital Interventions for Adolescents with Diabetes: A Systematic Review

  2026cites this paper
• Fast-acting insulin aspart in children with diabetes type 1: efficacy of different insulin administration methods in real-world clinical practice

  2026cites this paper
• How to Safely Use Diluted Insulin in an Automated Insulin Delivery System in Very Young Children: An Educator Perspective.

  2025cites this paper
• Development and Methodology of the 2024 and 2026 ISPAD Clinical Practice Guidelines.

  2025cites this paper
• Incretin‐Based Adjunct to Background Insulin Treatment for Managing Body Weight Excess in Type 1 Diabetes: An Expert Opinion Viewpoint From the Italian Association of Clinical Endocrinologists

  2025cites this paper
• The future of type 1 diabetes therapy.

  2025cites this paper