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

Abstract

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.

Day-and-Night Closed-Loop Insulin Delivery in a Broad Population of Pregnant Women With Type 1 Diabetes: A Randomized Controlled Crossover Trial

“…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). Others have commented that closed-loop insulin delivery may have unintended effects on dietary intake and proposed that education tooptimize healthyeating patterns be incorporated into closed-loop training (24).…”

Integrated Insulin Pump and Continuous Glucose Monitoring Technology in Diabetes Care Today: A Perspective of Real-Life Experience With the Minimed™ 670G Hybrid Closed-Loop System

“…The percentage of daytime euglycemia is strongly linked to the time spent in Auto Mode, optimal ICRs, and proper patient behavior. Bally et al (41) recently reported that bolusing behavior and frequency during HCL use correlated positively with time spent in target glucose range.…”

A Systematic Review of Commercial Hybrid Closed-Loop Automated Insulin Delivery Systems

“…A total of 14 studies were included (Table 5 in the Supplementary Information): 11 trials, two analyses of trial data, and one real-world study [10,[72][73][74][75][76][77][78][79][80][81][82][83][84]. Four of the studies included participants under 18 years old, one included only participants over 60 years old, and two of the studies included pregnant women.…”