The Use of a Smart Bolus Calculator Informed by Real-time Insulin Sensitivity Assessments Reduces Postprandial Hypoglycemia Following an Aerobic Exercise Session in Individuals With Type 1 Diabetes.
Autor: | Fabris C; Center for Diabetes Technology, University of Virginia, Charlottesville, VA cf9qe@virginia.edu., Nass RM; Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA., Pinnata J; Center for Diabetes Technology, University of Virginia, Charlottesville, VA., Carr KA; Center for Diabetes Technology, University of Virginia, Charlottesville, VA., Koravi CLK; Center for Diabetes Technology, University of Virginia, Charlottesville, VA., Barnett CL; Center for Diabetes Technology, University of Virginia, Charlottesville, VA., Oliveri MC; Center for Diabetes Technology, University of Virginia, Charlottesville, VA., Anderson SM; Center for Diabetes Technology, University of Virginia, Charlottesville, VA., Chernavvsky DR; Center for Diabetes Technology, University of Virginia, Charlottesville, VA.; Dexcom, Inc., Charlottesville, VA., Breton MD; Center for Diabetes Technology, University of Virginia, Charlottesville, VA. |
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Jazyk: | angličtina |
Zdroj: | Diabetes care [Diabetes Care] 2020 Apr; Vol. 43 (4), pp. 799-805. Date of Electronic Publication: 2020 Mar 06. |
DOI: | 10.2337/dc19-1675 |
Abstrakt: | Objective: Insulin dosing in type 1 diabetes (T1D) is oftentimes complicated by fluctuating insulin requirements driven by metabolic and psychobehavioral factors impacting individuals' insulin sensitivity (IS). In this context, smart bolus calculators that automatically tailor prandial insulin dosing to the metabolic state of a person can improve glucose management in T1D. Research Design and Methods: Fifteen adults with T1D using continuous glucose monitors (CGMs) and insulin pumps completed two 24-h admissions in a hotel setting. During the admissions, participants engaged in an early afternoon 45-min aerobic exercise session, after which they received a standardized dinner meal. The dinner bolus was computed using a standard bolus calculator or smart bolus calculator informed by real-time IS estimates. Glucose control was assessed in the 4 h following dinner using CGMs and was compared between the two admissions. Results: The IS-informed bolus calculator allowed for a reduction in postprandial hypoglycemia as quantified by the low blood glucose index (2.02 vs. 3.31, P = 0.006) and percent time <70 mg/dL (8.48% vs. 15.18%, P = 0.049), without increasing hyperglycemia (high blood glucose index: 3.13 vs. 2.09, P = 0.075; percent time >180 mg/dL: 13.24% vs. 10.42%, P = 0.5; percent time >250 mg/dL: 2.08% vs. 1.19%, P = 0.317). In addition, the number of hypoglycemia rescue treatments was reduced from 12 to 7 with the use of the system. Conclusions: The study shows that the proposed IS-informed bolus calculator is safe and feasible in adults with T1D, appropriately reducing postprandial hypoglycemia following an exercise-induced IS increase. (© 2020 by the American Diabetes Association.) |
Databáze: | MEDLINE |
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