Insulin delivery patterns required to maintain postprandial euglycemia in type 1 diabetes following consumption of traditional Egyptian Ramadan Iftar meal using insulin pump therapy: A randomized crossover trial.

Autor:	Elbarbary NS; Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt., Elhenawy YI; Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt., Ali ARR; Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt., Smart CE; School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia.; Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.
Jazyk:	angličtina
Zdroj:	Pediatric diabetes [Pediatr Diabetes] 2022 Dec; Vol. 23 (8), pp. 1628-1634. Date of Electronic Publication: 2022 Nov 04.
DOI:	10.1111/pedi.13439
Abstrakt:	Objectives: During Ramadan, traditional Egyptian Iftar meals have large amounts of high-glycemic index carbohydrate and fat. The efficacy of different bolus regimens on optimizing post prandial glucose (PPG) excursion following this Iftar meal was assessed. Methods: A randomized controlled trial evaluating 4-h PPG measured by continuous glucose-monitoring was conducted. A total of 25 youth with T1DM using insulin pumps were given the same Iftar meal (fat [45 g], protein [28 g], CHO [95 g]) on seven consecutive days. Insulin to carbohydrate ratio (ICR) was individualized, and all boluses were given upfront 20 min before Iftar. Participants were randomized to receive a standard bolus and six different split boluses delivered over 4 h in the following splits: dual wave (DW) 50/50; DW 50/50 with 20% increment (120% ICR); DW60/40; DW 60/40 with 20% increment; DW 70/30 and DW 70/30 with 20% increment. Results: Standard bolus and split 70/30 with 20% increment resulted in significantly lower early glucose excursions (120 min) with mean excursions of less than 40 mg/dL (2.2 mmol/L) compared to other conditions (p < 0.01). The split 70/30 with 20% increment significantly optimized late PPG excursion (240 min) in comparison to standard bolus (p < 0.01), as well as resulting in a significantly lower post meal glucose area under the curve compared with all other conditions (p < 0.01), with no late hypoglycemia. Conclusion: To achieve physiologic PPG profile in traditional Iftar meal, a DW bolus with 20% increment given 20 min preprandial as split bolus 70/30 over 4 h, optimized both early and delayed PPG excursions. (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze:	MEDLINE
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