medwireNews: Delayed prandial insulin boluses are common in people using advanced technologies for the management of type 1 diabetes and are associated with adverse glycemic outcomes, suggest real-world study results from researchers at Federico II University in Naples, Italy.
Speaking at the 58th EASD Annual Meeting, Giovanni Annuzzi said that previous research – conducted before the availability of advanced technologies –demonstrated that mistiming of boluses is associated with poor glycemic control, with 20 minutes before a meal identified as the optimal time for application.
“Advanced technologies significantly improve blood glucose control,” but optimal control “may still be challenging in the postprandial period,” and mistiming of boluses could play a role, Annuzzi told delegates in Stockholm, Sweden.
To investigate this further, the team investigated the frequency and impact of delayed boluses among 152 people with type 1 diabetes using hybrid closed-loop systems or sensor-augmented pumps.
During a 2-week follow-up period, all participants experienced at least one delayed bolus, defined as occasions when a prandial bolus was preceded by a steep increase in blood glucose on continuous glucose monitoring. The average number of delayed boluses per participant during the study period was 9.2.
Therefore, delayed boluses are “very common, maybe more than we thought,” said Annuzzi.
He added that there was “a very direct and strict association between the number of delayed boluses and overall glucose.”
Specifically, participants in the highest tertile for number of delayed boluses had the lowest proportion of time spent in the target glucose range of 70–180 mg/dL (3.9–10.0 mmol/L), at approximately 63%. This increased to approximately 73% for those in the middle tertile, and rose again, to around 76%, in those in the lowest tertile.
A higher number of delayed boluses was also associated with more time spent above the target range, as well as with a higher glucose management indicator score (indicating estimated glycated hemoglobin) and greater glucose variability. All of these associations were statistically significant.
These findings highlight the need for “more attention to the timing of bolus injection” in people using advanced technologies, said the presenter.
He noted that fear of hypoglycemia may be a reason behind the delayed boluses. When participants’ scores on the FH-15 fear of hypoglycemia scale were categorized into tertiles, people in the highest tertile had significantly more delayed boluses than those in the middle and lowest tertiles.
Therefore, “we should have structured educational programs” to improve mealtime bolus timing, concluded Annuzzi.
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