Meal-time glycaemia in adults with type 1 diabetes using multiple daily injections vs insulin pump therapy following carbohydrate-counting education and bolus calculator provision.

Abstract

AIMS:

To compare meal-time glycaemia in adults with type 1 diabetes mellitus (T1D) managed with multiple daily injections (MDI) vs. insulin pump therapy (IPT), using self-monitoring blood glucose (SMBG), following diabetes education.

METHODS:

Adults with T1D received carbohydrate-counting education and a bolus calculator: MDI (Roche Aviva Expert) and IPT (pump bolus calculator). All then wore 3-weeks of masked-CGM (Enlite, Medtronic). Meal-times were assessed by two approaches: 1) Set time-blocks (breakfast 06:00-10:00hrs; lunch 11:00-15:00hrs; dinner 17:00-21:00hrs) and 2) Bolus-calculator carbohydrate entries signalling meal commencement. Post-meal masked-CGM time-in-range (TIR) 3.9-10.0 mmol/L was the primary outcome.

RESULTS:

MDI(n = 61) and IPT (n = 59) participants were equivalent in age, sex, diabetes duration and HbA1c. Median (IQR) education time provided did not differ (MDI: 1.1 h (0.75, 1.5) vs. IPT: 1.1 h (1.0, 2.0); p = 0.86). Overall, daytime (06:00-24:00hrs), lunch and dinner TIR did not differ for MDI vs. IPT participants but was greater for breakfast with IPT in both analyses with a mean difference of 12.8%, (95 CI 4.8, 20.9); p = 0.002 (time-block analysis).

CONCLUSION:

After diabetes education, MDI and IPT use were associated with similar day-time glycemia, though IPT users had significantly greater TIR during the breakfast period. With education, meal-time glucose levels are comparable with use of MDI vs. pumps.

• Authors: Jean C Lu, Sara Vogrin, Sybil A McAuley, Melissa H Lee, Barbora Paldus, Leon A Bach, Morton G Burt, Philip M Clarke, Neale D Cohen, Peter G Colman, Martin I de Bock, D Jane Holmes-Walker, Alicia J Jenkins, Joey Kaye, Anthony C Keech, Kavita Kumareswaran, Richard J MacIsaac, Roland W McCallum, Kerryn Roem, Catriona Sims, Stephen N Stranks, Steven Trawley, Glenn M Ward, Vijaya Sundararajan, Timothy W Jones, David N O'Neal, Australian JDRF Closed-Loop Research Group
• Journal: Diabetes research and clinical practice (Diabetes Res Clin Pract) Vol. 179 Pg. 109000 (Sep 2021) ISSN: 1872-8227 [Electronic] Ireland
• PMID: 34455185 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier B.V. All rights reserved.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin

Topics

• Adult
• Blood Glucose
• Blood Glucose Self-Monitoring
• Diabetes Mellitus, Type 1 (drug therapy)
• Glycated Hemoglobin (analysis)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Insulin Infusion Systems
• Meals