Aims

Automated insulin delivery systems improve blood glucose control in patients with type 1 diabetes (T1D). However, optimizing their performance requires patient's proper compliance to meal insulin bolus administration. We explored real-life prevalence of delayed prandial boluses (DBs) in adults with T1D on advanced technologies, and their association with glycemic control and fear of hypoglycemia (FH).

Methods

In the last two-week web-based reports of 152 adults with T1D on Hybrid Closed Loop Systems (HCLS) or Sensor Augmented Pump (SAP), DBs were identified when a steep increase in blood glucose occurred at CGM before the prandial bolus, and CGM metrics were evaluated. All participants completed an online questionnaire on FH.

Results

Mean DBs over two weeks were 10.2 ± 4.7 (M ± SD, range 1–23) and more frequent in women than men (11.0 ± 4.6 vs. 9.4 ± 4.7, p = 0.036). Participants with more DBs (>12) showed significantly lower Time-In-Range (62.4 ± 13.8 vs. 76.6 ± 9.0 %) than those with less DBs (<7.7), along with higher Time-Above-Range, GMI, and Coefficient-of-Variation (ANOVA, p < 0.001 for all). Participants with higher FH score showed more DBs (11.6 ± 5.0) than those in lower tertiles (9.57 ± 4.59 and 9.47 ± 4.45, ANOVA p = 0.045).

Conclusions

In patients on advanced technologies, delayed boluses are extremely common, and associate with significantly worse glycemic control. Utmost attention is needed to bolus timing, mainly tackling fear of hypoglycemia.

中文翻译：

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延迟餐时胰岛素注射是血糖控制的重要决定因素，并且与采用先进技术的 1 型糖尿病患者对低血糖的恐惧有关

目标

自动胰岛素输送系统可改善 1 型糖尿病 (T1D) 患者的血糖控制。然而，优化其性能需要患者正确遵守膳食胰岛素推注给药。我们利用先进技术探讨了成人 T1D 患者中延迟餐时推注 (DB) 的现实生活患病率，及其与血糖控制和对低血糖 (FH) 的恐惧的关系。

方法

在过去两周基于网络的 152 名成人 T1D 患者使用混合闭环系统 (HCLS) 或传感器增强泵 (SAP) 的报告中，当膳食推注前 CGM 发生血糖急剧升高时，确定了 DB；评估 CGM 指标。所有参与者都完成了有关 FH 的在线调查问卷。

结果

两周内的平均 DB 为 10.2 ± 4.7（M ± SD，范围 1-23），并且女性比男性更常见（11.0 ± 4.6 对比 9.4 ± 4.7，p = 0.036）。DB 较多 (>12) 的参与者比 DB 较少 (<7.7) 的参与者表现出显着较低的范围内时间 (62.4 ± 13.8 vs. 76.6 ± 9.0 %)，并且范围之上时间、GMI 和系数较高变异（方差分析，p < 0.001）。FH 分数较高的参与者比三分位数较低的参与者（9.57 ± 4.59 和 9.47 ± 4.45，方差分析 p = 0.045）显示出更多的 DB（11.6 ± 5.0）。

结论

在采用先进技术的患者中，延迟推注极为常见，并且与血糖控制明显较差相关。需要特别注意推注时间，主要是解决对低血糖的恐惧。