Optimal prandial timing of bolus insulin in diabetes management: a review

Slattery, David; Amiel, Stephanie A.; Choudhary, Pratik

doi:10.1111/dme.13525

“…Because of the delay in onset of action of subcutaneously administered rapid-acting insulin, most closed-loop systems require a hybrid approach, characterized by manual administration of prandial boluses, ideally at 15-20 minutes pre-meal. [79][80][81][82] These systems can adapt to day-to-day variations in insulin requirements and, doing so, can reduce GV, especially overnight.…”

Section: Continuous Subcutaneous Insulin Infusionmentioning

confidence: 99%

Glycaemic variability: The under‐recognized therapeutic target in type 1 diabetes care

Wilmot

¹

,

Choudhary

²

,

Leelarathna

³

et al. 2019

Diabetes Obesity Metabolism

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Type 1 diabetes mellitus (T1DM) remains one of the most challenging long‐term conditions to manage. Despite robust evidence to demonstrate that near normoglycaemia minimizes, but does not completely eliminate, the risk of complications, its achievement has proved almost impossible in a real‐world setting. HbA1c to date has been used as the gold standard marker of glucose control and has been shown to reflect directly the risk of diabetes complications. However, it has been recognized that HbA1c is a crude marker of glucose control. Continuous glucose monitoring (CGM) provides the ability to measure and observe inter‐ and intraday glycaemic variability (GV), a more meaningful measure of glycaemic control, more relevant to daily living for those with T1DM. This paper reviews the relationship between GV and hypoglycaemia, and micro‐ and macrovascular complications. It also explores the impact on GV of CGM, insulin pumps, closed‐loop technologies, and newer insulins and adjunctive therapies. Looking to the future, there is an argument that GV should become a key determinant of therapeutic success. Further studies are required to investigate the pathological and psychological benefits of reducing GV.

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“…Insulin is essential for blood glucose control in T1D. Both the dose and timing of bolus injections are key factors in controlling post-prandial glucose [19]. However, it is not easy for the patients to understand how different types of insulin work.…”

Section: [P5]mentioning

confidence: 99%

Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: Type 1 Diabetes Education in Lifestyle and Self Adjustment (TELSA)

Xie

¹

,

Liu

²

,

Huang

³

et al. 2020

Preprint

0

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Background: Various guidelines recommend that all adults diagnosed with type 1 diabetes (T1D) should be offered an evidence based, structured education programme (SEP) to optimize selfmanagement care. China has a 13,000 annual increase in newly diagnosed T1D cases, of which 65% are adults. However, there is yet no validated SEP targeted to T1D patients in China. The purpose of this study is to establish a structured T1D self-management education programme-'Type 1 Diabetes Education in Lifestyle and Self Adjustment' (TELSA) that is adapted to medical and cultural practices in China.Methods: TELSA programme was developed based on the ADDIE model, following three steps: i) Semistructured interviews were administered to 10 healthcare professionals (HCPs) and 13 T1D patients.Different topic guides, focusing on 4 dimensions including goals, contents, format of delivery, and quality assurance, were designed for either HCPs or patients. The interviews were recorded and analysed with thematic analysis. ii) Extracted themes were modified according to Delphi consultation.iii) Preliminary courses were conducted as pilot study to evaluate the effects of TELSA and optimization of the curriculum was finalized accordingly.

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“…Both the dose and timing of bolus injections are key factors in controlling post-prandial glucose. The optimal time to administer mealtime insulin may differ between patients or even between meals [19]. However, it is not easy for the patients to understand all by their own how different insulin works.…”

Section: Theme 4: Insulinmentioning

confidence: 99%

Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: Type 1 Diabetes Education in Lifestyle and Self Adjustment (TELSA)

Xie

¹

,

Liu

²

,

Huang

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Various guidelines recommend that all adults diagnosed with type 1 diabetes (T1D) should be offered an evidence based, structured education programme (SEP) to optimize selfmanagement care. China has a 13,000 annual increase in newly diagnosed T1D cases and is now the fourth largest country in the number of new T1D cases per year. However, there is yet no validated SEP targeted to T1D patients in China. The purpose of this study is to establish a structured T1D selfmanagement education programme-'Type 1 Diabetes Education in Lifestyle and Self Adjustment' (TELSA) that is adapted to medical and cultural practices in China. Methods: TELSA programme was developed based on the ADDIE model, following three steps: i) Semi-structured interviews were administered to 10 healthcare professionals (HCPs) and 13 T1D patients. Different topic guides, focusing on 4 dimensions including goals, contents, format of delivery, and quality assurance, were designed for either HCPs or patients. The interviews were recorded and analysed with thematic analysis. ii) Extracted themes were modified according to Delphi consultation. iii) Preliminary courses were conducted as pilot study to evaluate the effects of TELSA and optimization of the curriculum was finalized accordingly. Results: A total of 18 themes in 4 dimensions of the programme design were identified in the final version: i) goals: 'behaviour modification' and 'outcome improvement'; ii) contents: 'living with T1D', 'self-monitoring of blood glucose', 'knowing insulin', 'insulin dose adjustment', 'carbohydrates and carbohydrate counting ', 'hypoglycaemia', 'complications', 'managing psychological issues', 'physical activities', and 'question-and-answer'; iii) format: 'multidisciplinary team combined with peer support', 'face-to-face education followed with distal learning', and '2-day programme held on weekends'; and iv) quality assurance: 'after-class quiz', 'patients' feedback', and 'long-term evaluation on effectiveness'. Conclusions: A type 1 diabetes structured education programme in China was set up and shown to be applicable under local medical, social, and cultural environment. BackgroundType 1 diabetes (T1D) patients suffer from continuous loss of pancreatic β-cell function and needs life-long exogenous insulin treatment. Since insulin requirements are affected by various internal and 4 external factors, maintaining glycaemic control in target with a flexible daily routine remains an enormous challenge in T1D management. Diabetes self-management education (DSME) is critical for patients to achieve HbA1c targets, minimise hypoglycaemia, and optimise quality of life. Selfmanagement training courses such as dose adjustment for normal eating (DAFNE) and the diabetes teaching and treatment programmes (DTTP) have consistently demonstrated positive outcomes in diabetes control as well as quality of life in multiple studies [1][2][3][4]. Therefore, consensus has been reached across various guidelines that all adults diagnosed with T1D should be offered an evidence...

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Optimal prandial timing of bolus insulin in diabetes management: a review

Cited by 98 publications

References 49 publications

Glycaemic variability: The under‐recognized therapeutic target in type 1 diabetes care

Glycaemic variability: The under‐recognized therapeutic target in type 1 diabetes care

Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: Type 1 Diabetes Education in Lifestyle and Self Adjustment (TELSA)

Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: Type 1 Diabetes Education in Lifestyle and Self Adjustment (TELSA)

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