A new proposal for a second insulin bolus to optimize postprandial glucose profile in adolescents with type 1 diabetes.
Adolescents
Carbohydrate
Fat
Postprandial glucose
Protein
Type 1 diabetes
Journal
Acta diabetologica
ISSN: 1432-5233
Titre abrégé: Acta Diabetol
Pays: Germany
ID NLM: 9200299
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
received:
20
09
2022
accepted:
12
12
2022
medline:
3
4
2023
pubmed:
28
1
2023
entrez:
27
1
2023
Statut:
ppublish
Résumé
To evaluate whether a second insulin bolus, calculated with a new approach, could improve postprandial glucose (PPG) after the intake of real-life high-fat (HF) and high-protein (HP) mixed meals. Fifteen adolescents with T1D treated with non-automated insulin pumps and CGM were enrolled. Patients received standard, HF and HP mixed meals treated with one pre-meal insulin bolus; based on differences in PPG between standard, HF and HP meals, correction boluses were calculated (30% and 60% of pre-meal bolus for HF and HP meals, respectively). Then patients received the same HF or HP meal treated with pre-meal bolus plus second insulin bolus after 3 h. Differences between postprandial variables after HF and HP meals treated with one or two insulin boluses were assessed by paired Student's t-test. Treating HF and HP meals with two insulin boluses significantly reduced the postprandial BG-AUC (21% and 26% respectively, p < 0.05), increased %TIR (from 52.5 to 78.3% for HF meal; from 32.7 to 57.1% for HP meal; p < 0.01), and reduced mean BG and %TAR (p < 0.01), with no differences in %TBR. The new way to calculate and administer correction boluses 3 h after HF and HP meals is effective and safe in reducing PPG and the hypoglycemia risk.
Identifiants
pubmed: 36705740
doi: 10.1007/s00592-022-02019-2
pii: 10.1007/s00592-022-02019-2
doi:
Substances chimiques
Insulin
0
Glucose
IY9XDZ35W2
Blood Glucose
0
Hypoglycemic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
609-618Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. Springer-Verlag Italia S.r.l., part of Springer Nature.
Références
Diabetes Control and Complications Trial Research Group (1994) Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: diabetes control and complications trial. J Pediatr 125(2):177–188. https://doi.org/10.1016/s0022-3476(94)70190-3
doi: 10.1016/s0022-3476(94)70190-3
Danne T, Phillip M, Buckingham BA et al. (2018) ISPAD clinical practice consensus guidelines 2018: insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 19(Suppl 27):115–135. https://doi.org/10.1111/pedi.12718
doi: 10.1111/pedi.12718
pubmed: 29999222
Danne T, Cariou B, Buse JB et al. (2019) Improved time in range and glycemic variability with Sotagliflozin in combination with insulin in adults with type 1 diabetes: a pooled analysis of 24-week continuous glucose monitoring data from the inTandem program. Diabetes Care 42(5):919–930. https://doi.org/10.2337/dc18-2149
doi: 10.2337/dc18-2149
pubmed: 30833371
pmcid: 6905498
Owens DR, Bolli GB (2020) The continuing quest for better subcutaneously administered prandial insulins: a review of recent developments and potential clinical implications. Diabetes Obes Metab 22(5):743–754. https://doi.org/10.1111/dom.13963
doi: 10.1111/dom.13963
pubmed: 31930670
pmcid: 7187182
Gordin D, Rönnback M, Forsblom C, Heikkilä O, Saraheimo M, Groop PH (2007) Acute hyperglycaemia rapidly increases arterial stiffness in young patients with type 1 diabetes. Diabetologia 50(9):1808–1814. https://doi.org/10.1007/s00125-007-0730-0
doi: 10.1007/s00125-007-0730-0
pubmed: 17611734
Madsbad S (2016) Impact of post-prandial glucose control on diabetes-related complications: how is the evidence evolving? J Diabetes Complicat 30(2):374–385. https://doi.org/10.1016/j.jdiacomp.2015.09.019
doi: 10.1016/j.jdiacomp.2015.09.019
Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL (2018) ISPAD clinical practice consensus guidelines 2018: nutritional management in children and adolescents with diabetes. Pediatr Diabetes 19(Suppl 27):136–154. https://doi.org/10.1111/pedi.12738
doi: 10.1111/pedi.12738
pubmed: 30062718
Cardona-Hernandez R, Schwandt A, Alkandari H et al. (2021) Glycemic outcome associated with insulin pump and glucose sensor use in children and adolescents with type 1 diabetes. Data from the international pediatric registry SWEET. Diabetes Care 44(5):1176–1184. https://doi.org/10.2337/dc20-1674
doi: 10.2337/dc20-1674
pubmed: 33653821
Marigliano M, Eckert AJ, Guness PK, et al. (2021) Association of the use of diabetes technology with HbA1c and BMI-SDS in an international cohort of children and adolescents with type 1 diabetes: the SWEET project experience. Pediatr Diabetes 22(8):1120–1128. https://doi.org/10.1111/pedi.13274
doi: 10.1111/pedi.13274
pubmed: 34716736
Prigge R, McKnight JA, Wild SH, Scottish Diabetes Research Network Epidemiology Group (2021) International comparison of glycaemic control in people with type 1 diabetes: an update and extension. Diabet Med. https://doi.org/10.1111/dme.14766
doi: 10.1111/dme.14766
pubmed: 34890078
Sawyer A, Sobczak M, Forlenza GP, Alonso GT (2022) Glycemic control in relation to technology use in a single center cohort of children with type 1 diabetes. Diabetes Technol Ther. https://doi.org/10.1089/dia.2021.0471
doi: 10.1089/dia.2021.0471
pubmed: 35167376
Bell KJ, Barclay AW, Petocz P, Colagiuri S, Brand-Miller JC (2014) Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2(2):133–140. https://doi.org/10.1016/S2213-8587(13)70144-X
doi: 10.1016/S2213-8587(13)70144-X
pubmed: 24622717
Marigliano M, Morandi A, Maschio M, Sabbion A, Contreas G, Tomasselli F, Tommasi M, Maffeis C (2013) Nutritional education and carbohydrate counting in children with type 1 diabetes treated with continuous subcutaneous insulin infusion: the effects on dietary habits, body composition and glycometabolic control. Acta Diabetol 50(6):959–964. https://doi.org/10.1007/s00592-013-0491-9
doi: 10.1007/s00592-013-0491-9
pubmed: 23778883
Smart CE, Ross K, Edge JA, King BR, McElduff P, Collins CE (2010) Can chil- dren with type 1 diabetes and their caregivers estimate the carbohy- drate content of meals and snacks? Diabet Med 27(3):348–353
doi: 10.1111/j.1464-5491.2010.02945.x
pubmed: 20536499
Smart CE, Ross K, Edge JA, Collins CE, Colyvas K, King BR (2009) Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting. Diabet Med 26:279–285
doi: 10.1111/j.1464-5491.2009.02669.x
pubmed: 19317823
Marran KJ, Davey B, Lang A, Segal DG (2013) Exponential increase in post-prandial blood-glucose exposure with increasing carbohydrate loads using a linear carbohydrate-to-insulin ratio. S Afr Med J 103(7):461–463. https://doi.org/10.7196/samj.6382
doi: 10.7196/samj.6382
pubmed: 23802208
Davison KA, Negrato CA, Cobas R et al. (2014) Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil. Nutr J 13:19. https://doi.org/10.1186/1475-2891-13-19
doi: 10.1186/1475-2891-13-19
pubmed: 24607084
pmcid: 3995939
Nansel TR, Haynie DL, Lipsky LM, Laffel LM, Mehta SN (2012) Multiple indicators of poor diet quality in children and adolescents with type 1 diabetes are associated with higher body mass index percentile but not glycemic control. J Acad Nutr Diet 112(11):1728–1735. https://doi.org/10.1016/j.jand.2012.08.029
doi: 10.1016/j.jand.2012.08.029
pubmed: 23102173
pmcid: 3985553
Evert AB, Dennison M, Gardner CD et al. (2019) Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 42(5):731–754. https://doi.org/10.2337/dci19-0014
doi: 10.2337/dci19-0014
pubmed: 31000505
pmcid: 7011201
Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HA (2015) Impact of fat, protein, and glycemic index on post-prandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care 38(6):1008–1015. https://doi.org/10.2337/dc15-0100
doi: 10.2337/dc15-0100
pubmed: 25998293
Wolpert HA, Atakov-Castillo A, Smith SA, Steil GM (2013) Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care 36(4):810–816. https://doi.org/10.2337/dc12-0092
doi: 10.2337/dc12-0092
pubmed: 23193216
pmcid: 3609492
Pańkowska E, Błazik M, Groele L (2012) Does the fat-protein meal increase post-prandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther 14(1):16–22. https://doi.org/10.1089/dia.2011.0083
doi: 10.1089/dia.2011.0083
pubmed: 22013887
Smart CE, Evans M, O’Connell SM et al. (2013) Both dietary protein and fat increase post-prandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care 36(12):3897–3902. https://doi.org/10.2337/dc13-1195
doi: 10.2337/dc13-1195
pubmed: 24170749
pmcid: 3836096
Paterson M, Bell KJ, O’Connell SM, Smart CE, Shafat A, King B (2015) The role of dietary protein and fat in glycaemic control in type 1 diabetes: implications for intensive diabetes management. Curr Diab Rep 15(9):61. https://doi.org/10.1007/s11892-015-0630-5
doi: 10.1007/s11892-015-0630-5
pubmed: 26202844
pmcid: 4512569
Paterson MA, Smart CE, Lopez PE et al. (2016) Influence of dietary protein on post-prandial blood glucose levels in individuals with type 1 diabetes mellitus using intensive insulin therapy. Diabet Med 33(5):592–598. https://doi.org/10.1111/dme.13011
doi: 10.1111/dme.13011
pubmed: 26499756
Wolever TM, Mullan YM (2011) Sugars and fat have different effects on postprandial glucose responses in normal and type 1 diabetic subjects. Nutr Metab Cardiovasc Dis 21(9):719–725. https://doi.org/10.1016/j.numecd.2010.12.005
doi: 10.1016/j.numecd.2010.12.005
pubmed: 21330118
Neu A, Behret F, Braun R et al. (2015) Higher glucose concentrations following protein: and fat-rich meals—the Tuebingen grill study: a pilot study in adolescents with type 1 diabetes. Pediatr Diabetes 16(8):587–591. https://doi.org/10.1111/pedi.12224
doi: 10.1111/pedi.12224
pubmed: 25330823
Paterson MA, King BR, Smart CEM, Smith T, Rafferty J, Lopez PE (2019) Impact of dietary protein on post-prandial glycaemic control and insulin requirements in type 1 diabetes: a systematic review. Diabet Med 36(12):1585–1599. https://doi.org/10.1111/dme.14119
doi: 10.1111/dme.14119
pubmed: 31454430
Kordonouri O, Hartmann R, Remus K, Bläsig S, Sadeghian E, Danne T (2012) Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy. Pediatr Diabetes 13(7):540–544. https://doi.org/10.1111/j.1399-5448.2012.00880.x
doi: 10.1111/j.1399-5448.2012.00880.x
pubmed: 22765260
Pańkowska E, Szypowska A, Lipka M, Szpotańska M, Błazik M, Groele L (2009) Application of novel dual wave meal bolus and its impact on glycated hemoglobin A1c level in children with type 1 diabetes. Pediatr Diabetes 10(5):298–303. https://doi.org/10.1111/j.1399-5448.2008.00471.x
doi: 10.1111/j.1399-5448.2008.00471.x
pubmed: 19175902
Metwally M, Cheung TO, Smith R, Bell KJ (2021) Insulin pump dosing strategies for meals varying in fat, protein or glycaemic index or grazing-style meals in type 1 diabetes: a systematic review. Diabetes Res Clin Pract 172:108516. https://doi.org/10.1016/j.diabres.2020.108516
doi: 10.1016/j.diabres.2020.108516
pubmed: 33096184
Lopez PE, Smart CE, McElduff P et al. (2017) Optimizing the combination insulin bolus split for a high-fat, high-protein meal in children and adolescents using insulin pump therapy. Diabet Med 34(10):1380–1384. https://doi.org/10.1111/dme.13392
doi: 10.1111/dme.13392
pubmed: 28574182
Bell KJ, Toschi E, Steil GM, Wolpert HA (2016) Optimized mealtime insulin dosing for fat and protein in type 1 diabetes: application of a model-based approach to derive insulin doses for open-loop diabetes management. Diabetes Care 39(9):1631–1634. https://doi.org/10.2337/dc15-2855
doi: 10.2337/dc15-2855
pubmed: 27388474
Lopez PE, Evans M, King BR et al. (2018) A randomized comparison of three prandial insulin dosing algorithms for children and adolescents with type 1 diabetes. Diabet Med 35(10):1440–1447. https://doi.org/10.1111/dme.13703
doi: 10.1111/dme.13703
pubmed: 29873107
Frohock AM, Oke J, Yaliwal C, Edge J, Besser REJ (2022) Additional insulin dosing for fat and protein in children with type 1 diabetes using multiple daily injections. Pediatr Diabetes 23(6):742–748. https://doi.org/10.1111/pedi.13372
doi: 10.1111/pedi.13372
pubmed: 35645222
Walsh J, Roberts R, Heinemann L (2014) Confusion regarding duration of insulin action: a potential source for major insulin dose errors by bolus calculators. J Diabetes Sci Technol 8(1):170–178. https://doi.org/10.1177/1932296813514319
doi: 10.1177/1932296813514319
pubmed: 24876553
pmcid: 4454113
Piechowiak K, Dżygało K, Szypowska A (2017) The additional dose of insulin for high-protein mixed meal provides better glycemic control in children with type 1 diabetes on insulin pumps: randomized cross-over study. Pediatr Diabetes 18(8):861–868. https://doi.org/10.1111/pedi.12500
doi: 10.1111/pedi.12500
pubmed: 28117542
Campbell MD, Walker M, King D et al. (2016) Carbohydrate counting at meal time followed by a small secondary post-prandial bolus injection at 3 h prevents late hyperglycemia, without hypoglycemia, after a high-carbohydrate, high-fat meal in type 1 diabetes. Diabetes Care 39(9):e141–e142. https://doi.org/10.2337/dc16-0709
doi: 10.2337/dc16-0709
pubmed: 27352952
Cacciari E, Milani S, Balsamo A et al. (2006) Italian cross-sectional growth charts for height, weight and BMI (2–20 year). J Endocrinol Invest 29(7):581–593. https://doi.org/10.1007/BF03344156
doi: 10.1007/BF03344156
pubmed: 16957405
Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 51(3):170–179. https://doi.org/10.1136/adc.51.3.170
doi: 10.1136/adc.51.3.170
pubmed: 952550
pmcid: 1545912
Scavone G, Manto A, Pitocco D et al. (2010) Effect of carbohydrate counting and medical nutritional therapy on glycaemic control in type 1 diabetic subjects: a pilot study. Diabet Med 27(4):477–479. https://doi.org/10.1111/j.1464-5491.2010.02963.x
doi: 10.1111/j.1464-5491.2010.02963.x
pubmed: 20536522
Evans M, Smart CEM, Paramalingam N et al. (2019) Dietary protein affects both the dose and pattern of insulin delivery required to achieve post-prandial euglycaemia in type 1 diabetes: a randomized trial. Diabet Med 36(4):499–504. https://doi.org/10.1111/dme.13875
doi: 10.1111/dme.13875
pubmed: 30537305
Paterson MA, Smart CEM, Howley P, Price DA, Foskett DC, King BR (2020) High-protein meals require 30% additional insulin to prevent delayed post-prandial hyperglycaemia. Diabet Med 37(7):1185–1191. https://doi.org/10.1111/dme.14308
doi: 10.1111/dme.14308
pubmed: 32298501
Bell KJ, Fio CZ, Twigg S et al. (2020) Amount and type of dietary fat, post-prandial glycemia, and insulin requirements in type 1 diabetes: a randomized within-subject trial. Diabetes Care 43(1):59–66. https://doi.org/10.2337/dc19-0687
doi: 10.2337/dc19-0687
pubmed: 31455688
Smith TA, Smart CE, Fuery MEJ et al. (2021) In children and young people with type 1 diabetes using pump therapy, an additional 40% of the insulin dose for a high-fat, high-protein breakfast improves post-prandial glycaemic excursions: a cross-over trial. Diabet Med 6:e14511. https://doi.org/10.1111/dme.14511
doi: 10.1111/dme.14511
Smith TA, Smart CE, Howley PP, Lopez PE, King BR (2021) For a high fat, high protein breakfast, preprandial administration of 125% of the insulin dose improves post-prandial glycaemic excursions in people with type 1 diabetes using multiple daily injections: a cross-over trial. Diabet Med 9:e14512. https://doi.org/10.1111/dme.14512
doi: 10.1111/dme.14512
Keating B, Smart CEM, Harray AJ et al. (2021) Additional insulin is required in both the early and late post-prandial periods for meals high in protein and fat: a randomised trial. J Clin Endocrinol Metab 6:dgab318. https://doi.org/10.1210/clinem/dgab318
doi: 10.1210/clinem/dgab318