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Bolusing frequency and amount impacts glucose control during hybrid closed-loop.

L Bally1,2,3, H Thabit1,2, Y Ruan1,4

  • 1Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.

Diabetic Medicine : a Journal of the British Diabetic Association
|July 30, 2017
PubMed
Summary
This summary is machine-generated.

Individuals with suboptimally controlled Type 1 diabetes used less bolus insulin and had lower glucose control during closed-loop therapy. More frequent bolusing improved time in target glucose range, highlighting the need for user education.

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Biomedical Engineering

Background:

  • Type 1 diabetes management requires precise insulin delivery.
  • Hybrid closed-loop systems offer automated glucose control but user input remains crucial.
  • Suboptimal glycemic control in Type 1 diabetes is linked to altered insulin dosing patterns.

Purpose of the Study:

  • To compare bolus insulin delivery patterns in adults with suboptimally versus well-controlled Type 1 diabetes using closed-loop systems at home.
  • To investigate the relationship between bolus insulin behavior and glycemic control within a closed-loop setting.

Main Methods:

  • Retrospective analysis of 4-week home-based hybrid closed-loop data in adults with Type 1 diabetes.
  • Comparison of daytime and night-time controller effort and bolus effort between suboptimally controlled (HbA1c 58-86 mmol/mol) and well-controlled (HbA1c < 58 mmol/mol) groups.
  • Correlation analysis of bolus behavior (effort, frequency) with glucose metrics (time in range, time below range).

Main Results:

  • Suboptimally controlled individuals exhibited significantly lower bolus effort and daily bolus frequency compared to well-controlled individuals.
  • Higher controller effort was observed during both daytime and night-time in the suboptimally controlled group.
  • Increased daytime bolus effort and frequency positively correlated with more time spent within the target glucose range (3.9-10.0 mmol/L).

Conclusions:

  • More frequent bolus insulin administration and a higher proportion of bolus insulin delivery are associated with improved time in target glucose range during hybrid closed-loop use.
  • These findings underscore the importance of user engagement, including appropriate bolus insulin strategies and educational support, for optimizing outcomes with closed-loop therapy.
  • Personalized adjustments in bolus insulin delivery patterns may be necessary to maximize the benefits of automated insulin delivery systems in Type 1 diabetes.