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.
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;
Abstract
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.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.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).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.
| Journal | DIABETES RESEARCH AND CLINICAL PRACTICE |
| ISSN | 1872-8227 |
| Published | 01 Sep 2021 |
| Volume | 179 |
| Issue | |
| Pages | 109000 |
| DOI | 10.1016/j.diabres.2021.109000 |
| Type | Journal Article |
| Sponsorship |