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 SimsStephen N. Stranks, Steven Trawley, Glenn M. Ward, Vijaya Sundararajan, Timothy W. Jones, David N. O'Neal, Australian JDRF Closed-Loop Research Group

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2 Citations (Scopus)

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.

Original languageEnglish
Article number109000
Number of pages9
JournalDiabetes Research and Clinical Practice
Volume179
DOIs
Publication statusPublished - Sept 2021

Keywords

  • Diabetes Mellitus
  • Glycaemia
  • Insulin pumps
  • insulin

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