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Endocr Pract. 2017 Jul 13. doi: 10.4158/EP171813.OR. [Epub ahead of print]

POSTPRANDIAL DOSING OF BOLUS INSULIN IN PATIENTS WITH TYPE 1 DIABETES: A CROSS-SECTIONAL STUDY USING DATA FROM THE T1D EXCHANGE REGISTRY.

Author information

1
From: 1Keck School of Medicine, University of Southern California, Los Angeles, CA, US.
2
Department of Pediatrics, Yale University School of Medicine, New Haven, CT, US.
3
Novo Nordisk A/S, Bagsværd, Denmark.

Abstract

OBJECTIVE:

To assess the prevalence and characteristics of patients with type 1 diabetes who dose bolus insulin postprandial (PostP) versus preprandial (PreP).

METHODS:

Data for this cross-sectional study were obtained from 21,533 participants in the T1D Exchange registry. Data were drawn from the enrollment questionnaire. Patients who dosed 'immediately before meal' or 'several minutes before meal' were classified as PreP. Patients who dosed 'during meal' or 'after meal' were classified as PostP. Data reported (PostP vs. PreP) are mean±SD and percentage, as appropriate.

RESULTS:

After exclusion of patients who did not answer the dose-timing question, or who selected 'not given regularly' or 'depends on glucose level prior to meal', (4229 of 25,762), 21,533 patients were included in the study. Ninety-nine percent of patients used rapid-acting insulin analogs; 32% dosed insulin PostP. Compared to PreP, children <18 years of age dosing PostP were characterized by higher HbA1c (8.7±1.5% [72±16.4 mmol/mol] vs. 8.4±1.7% [68±18.6 mmol/mol]), larger insulin dose (1.2±0.7 vs. 1.1±0.7 IU/Kg/d), greater prevalence of history of hypoglycemia, and diabetic ketoacidosis. Adults who dosed PostP were characterized by younger age (33.0±15.3 vs. 39.5±16.6 years), higher HbA1c (8.3±1.5% [67±16.4 mmol/mol] vs. 7.8±1.5% [62±16.4 mmol/mol), and larger insulin dose (1.0±0.6 vs. 0.9±0.5 IU/Kg/d) than PreP.

CONCLUSIONS:

This study reveals that a large proportion of patients dose bolus insulin PostP. Despite the use of current rapid-acting insulin analogs, patients who dose PostP are characterized by poorer glycemic control in all patients, and a greater prevalence of history of severe hypoglycemia and diabetic ketoacidosis in children.

KEYWORDS:

Bolus; dose; insulin; postprandial; timing

PMID:
28704103
DOI:
10.4158/EP171813.OR
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