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Delayed Prandial Insulin Boluses Are an Important Determinant of Blood Glucose Control and Relate to Fear of Hypoglycemia in People with Type 1 Diabetes on Advanced Technologies

Journal of diabetes and its complications(2024)

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摘要
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.
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关键词
Type 1 diabetes,HCLS,Prandial insulin bolus,Late meal bolus,Fear of hypoglycemia
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