Behavioral Patterns and Associations with Glucose Control During 12-Week Randomized Free-Living Clinical Trial of Day and Night Hybrid Closed-Loop Insulin Delivery in Adults with Type 1 Diabetes

Emami, Ali; Willinska, Malgorzata E; Thabit, Hood; Leelarathna, Lalantha; Hartnell, Sara; Dellweg, Sibylle; Benesch, Carsten; Mader, Julia K.; Holzer, Manuel; Kojzar, Harald; Pieber, Thomas R.; Arnolds, Sabine; Evans, Mark L.; Hovorka, Roman

doi:10.1089/dia.2016.0307

Cited by 12 publications

(8 citation statements)

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“…A recent study evaluating the relationship between behavioural patterns and glucose control (mean glucose, glucose variability and post‐intervention HbA 1c ) during hybrid closed‐loop use in suboptimally controlled Type 1 diabetes highlighted the impact behavioural patterns, such as eating habits, have on glucose control 13. In line with the present study, no significant association was found between bolusing frequency and mean glucose.…”

Section: Discussionsupporting

confidence: 86%

Bolusing frequency and amount impacts glucose control during hybrid closed‐loop

et al. 2017

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AimTo compare bolus insulin delivery patterns during closed‐loop home studies in adults with suboptimally [HbA1c 58–86 mmol/mol (7.5%–10%)] and well‐controlled [58 mmol/mol (< 7.5%)] Type 1 diabetes.MethodsRetrospective analysis of daytime and night‐time insulin delivery during home use of closed‐loop over 4 weeks. Daytime and night‐time controller effort, defined as amount of insulin delivered by closed‐loop relative to usual basal insulin delivery, and daytime bolus effort, defined as total bolus insulin delivery relative to total daytime insulin delivery were compared between both cohorts. Correlation analysis was performed between individual bolus behaviour (bolus effort and frequency) and daytime controller efforts, and proportion of time spent within and below sensor glucose target range.ResultsIndividuals with suboptimally controlled Type 1 diabetes had significantly lower bolus effort (P = 0.038) and daily bolus frequency (P < 0.001) compared with those with well‐controlled diabetes. Controller effort during both daytime (P = 0.007) and night‐time (P = 0.005) were significantly higher for those with suboptimally controlled Type 1 diabetes. Time when glucose was within the target range (3.9–10.0 mmol/L) during daytime correlated positively with bolus effort (r = 0.37, P = 0.016) and bolus frequency (r = 0.33, P = 0.037). Time when glucose was below the target range during daytime was comparable in both groups (P = 0.36), and did not correlate significantly with bolus effort (r = 0.28, P = 0.066) or bolus frequency (r = –0.21, P = 0.19).ConclusionMore frequent bolusing and higher proportion of insulin delivered as bolus during hybrid closed‐loop use correlated positively with time glucose was in target range. This emphasises the need for user input and educational support to benefit from this novel therapeutic modality.

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Section: Discussionsupporting

confidence: 86%

Bolusing frequency and amount impacts glucose control during hybrid closed‐loop

et al. 2017

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“…The use of high carbohydrate, low fat diet to prevent hypoglycaemias could, however, be counterintuitive as a change from a standard diet to a low-carbohydrate diet rather has the potential to reduce the incidence of hypoglycaemias 13 , 14 . Importantly, while increased carbohydrate intake and the associated higher insulin doses give rise to larger variations in blood glucose concentrations 13 , 15 , marked reductions in glycaemic variability have been reported in studies of low-carbohydrate diets 14 , 16 . High variability of the blood glucose levels, on the other hand, is a well-known risk factor for hypoglycaemia 5 , 17 , a phenomenon that could also explain the current observations.…”

Section: Discussionmentioning

confidence: 99%

Dietary intake and hospitalisation due to diabetic ketoacidosis and hypoglycaemia in individuals with type 1 diabetes

Ahola

Harjutsalo

Thomas

et al. 2021

Sci Rep

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We investigated the association between diet and risk of hospitalisation for diabetic ketoacidosis (DKA) or hypoglycaemia in type 1 diabetes. Food records were used to assess dietary intake. Data on DKA and hypoglycaemia hospitalisations, within two years of dietary assessments, were obtained from registries. Analyses were conducted with and without macronutrient substitution. Data were available from 1391 participants, 28 (2.0%) and 55 (4.0%) of whom were hospitalised due to DKA or hypoglycaemia, respectively. In the adjusted model, self-reported alcohol intake was associated with increased (per 10 g: B = 1.463, 95% CI = 1.114–1.922, p = 0.006; per E%: B = 1.113, 95% CI = 1.027–1.206, p = 0.009), and fibre intake with reduced (per g/MJ: B = 0.934, 95% CI = 0.878–0.995, p = 0.034) risk of DKA hospitalisation. Substituting carbohydrates for fats was associated with increased risk for hypoglycaemia hospitalisation (B = 1.361, 95% CI = 1.031–1.795, p = 0.029), while substituting alcohol for carbohydrates (B = 1.644, 95% CI = 1.006–2.685, p = 0.047) or proteins (B = 2.278, 95% CI = 1.038–4.999, p = 0.040) increased the risk for DKA hospitalisation. In conclusion, refraining from alcohol intake is a preventable risk factor for DKA, while higher fibre intake seems rather protective. Increasing carbohydrate intake while decreasing that of fats, is associated with higher hypoglycaemia risk. Whether this is a cause or effect of hypoglycaemia remains to be established.

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“…Third, we consciously enrolled a broad patient population for thisstudy,including (22). The frequency of premeal bolusing also is important, emphasizing the need for ongoing diabetes education and support with the closed-loop system (23).…”

Section: Discussionmentioning

confidence: 99%