Supplementary Material for: ISPAD Clinical Practice Consensus Guidelines 2024: Insulin and adjunctive treatments in children and adolescents with diabetes

1. WHAT IS NEW OR DIFFERENT • Updated insulin treatment sections including new bolus and basal insulin formulations • Updated recommendations on principles of intensive insulin treatment regimens including more intensive form of multiple daily injections with new generation faster acting insulins and ultra-long acting insulins, to achieve a high level of treatment personalization, better glycemia and empowerment for people with diabetes • Review of the roles and rationales for new insulin analogs, biosimilars, and diabetes technology devices for insulin therapy in pediatric diabetology • Summary of adjunctive medications used alongside insulin treatment that includes details on pramlintide, metformin, GLP-1 Receptor Agonists (GLP-1RA) and SGLT inhibitors. • Key considerations with regards to access to insulin and affordability specifically innovative, multi-faceted approaches involving governments, healthcare providers, pharmaceutical companies, and advocacy groups to ensure that all persons with diabetes who need insulin can obtain it without financial hardship.