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; Australian JDRF Closed-Loop Research Group

doi:10.1016/j.diabres.2021.109000

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

Diabetes Res Clin Pract. 2021 Sep:179:109000. doi: 10.1016/j.diabres.2021.109000. Epub 2021 Aug 26.

Authors

Jean C Lu¹, Sara Vogrin², Sybil A McAuley¹, Melissa H Lee¹, Barbora Paldus¹, Leon A Bach³, Morton G Burt⁴, Philip M Clarke⁵, Neale D Cohen⁶, Peter G Colman⁷, Martin I de Bock⁸, D Jane Holmes-Walker⁹, Alicia J Jenkins¹⁰, Joey Kaye¹¹, Anthony C Keech¹², Kavita Kumareswaran³, Richard J MacIsaac¹, Roland W McCallum¹³, Kerryn Roem², Catriona Sims², Stephen N Stranks⁴, Steven Trawley¹⁴, Glenn M Ward¹⁵, Vijaya Sundararajan¹⁶, Timothy W Jones¹⁷, David N O'Neal¹⁸; Australian JDRF Closed-Loop Research Group

Affiliations

¹ Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia.
² Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia.
³ Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia.
⁴ Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Adelaide, South Australia, Australia.
⁵ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
⁶ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
⁷ Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁸ Department of Paediatrics, University of Otago, Christchurch, New Zealand.
⁹ Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁰ Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
¹¹ Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
¹² NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
¹³ Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
¹⁴ Cairnmillar Institute, Melbourne, Victoria, Australia.
¹⁵ Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; Department of Pathology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
¹⁶ Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; Department of Public Health, La Trobe University, Australia.
¹⁷ Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
¹⁸ Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia. Electronic address: dno@unimelb.edu.au.

PMID: 34455185
DOI: 10.1016/j.diabres.2021.109000

Abstract

Aims: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

MeSH terms

Adult
Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 1* / drug therapy
Glycated Hemoglobin / analysis
Humans
Hypoglycemic Agents / therapeutic use
Insulin / therapeutic use
Insulin Infusion Systems
Meals

Substances

Blood Glucose
Glycated Hemoglobin A
Hypoglycemic Agents
Insulin