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Timing of bolus in children with type 1 diabetes using continuous subcutaneous insulin infusion (TiBoDi Study)
Andrea E Scaramuzza1, Dario Iafusco, Laura Santoro
1Department of Paediatrics, University of Milano, Ospedale Luigi Sacco, 20154 Milan, Italy. scaramuzza.andrea@hsacco.it
Insights
Administering insulin boluses 15 minutes before meals significantly improves glycemic control in children with type 1 diabetes. This timing helps maintain blood glucose levels closer to the therapeutic target after eating.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Continuous subcutaneous insulin infusion (CSII) is a safe and effective method for insulin delivery in children with type 1 diabetes (T1D).
- Achieving stable glycemic control in pediatric T1D patients using CSII remains challenging.
- Optimizing basal rates and bolus timing are critical factors for effective diabetes management.
Purpose of the Study:
- To evaluate the optimal timing for a preprandial bolus dose delivered via insulin pump in pediatric patients with type 1 diabetes.
- To determine if bolus timing impacts postprandial glycemic control in children with T1D.
Main Methods:
- The study involved 30 children diagnosed with type 1 diabetes.
- Participants received a standard meal following different timing strategies for their insulin bolus dose.
- Postprandial glucose levels were monitored to assess the impact of bolus timing.
Main Results:
- Postprandial glucose levels were lower when bolus doses were administered 15 minutes or immediately before meals compared to after meals.
- A statistically significant difference was observed at the 1-hour postprandial time point, with pre-meal boluses yielding better glucose control.
- While the overall area under the curve (AUC) did not differ significantly, the standard deviation of the AUC was lowest with a 15-minute pre-meal bolus, indicating more consistent glucose responses.
Conclusions:
- The findings support administering preprandial insulin boluses before, rather than after, meals in pediatric patients with type 1 diabetes.
- This timing strategy can be beneficial even in cases where patients experience pre-meal hypoglycemia.
- Optimizing bolus timing is a key strategy for improving glycemic control in children managed with insulin pumps.
Background:
Continuous subcutaneous insulin infusion is considered a safe and effective way to administer insulin in pediatric patients with type 1 diabetes, but achieving satisfactory and stable glycemic control is difficult. Several factors contribute to control, including fine-tuning the basal infusion rate and bolus timing. We evaluated the most effective timing of a pump-delivered, preprandial bolus in children with type 1 diabetes.
Methods:
We assessed the response of 30 children with type 1 diabetes to a standard meal after different timing of a bolus dose.
Results:
The glucose levels for 3 h after the meal were lower (i.e., closer to the therapeutic target of <140 mg/dL) when the bolus doses were administered 15 min or immediately before the meal, rather than after the meal. However, these differences were not statistically significant, except at the 1-h postprandial time point: bolus just after meal, 177 +/- 71 mg/dL (9.83 +/- 3.94 mmol/L); 15 min before meal, 136 +/- 52 mg/dL (7.55 +/- 2.89 mmol/L) (P = 0.044); and just before meal, 130 +/- 54 mg/dL (7.22 +/- 3.00 mmol/L) (P = 0.024). The area under the curve (AUC) (in mg/min) did not differ significantly with different bolus times, but the SD of the AUC was the lowest with the bolus given 15 min before the meal.
Conclusions:
These data support injection of the bolus before, rather than after, eating, even if the patient is hypoglycemic before meals.
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