Possible Ways to Improve Postprandial Glucose Control in Type 1 Diabetes

Aktürk, Halis Kaan; Rewers, Amanda; Joseph, Hal; Schneider, Nicole; Garg, Satish K.

doi:10.1089/dia.2018.0114

Cited by 27 publications

(18 citation statements)

References 110 publications

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“…In healthy subjects, PP glycemia rises and reaches the peak at 60 min, hardly exceeds 140 mg/dL, and usually returns to basal values within 2–3 h. Simultaneously, there is a rapid increase in insulin concentration and action, within the first 30–120 min. This synchronized glucose-insulin response is lost in people with T1DM [66]. Thus, a major goal of insulin therapy is to rely on a premeal insulin that better mimics the kinetic of endogenous prandial insulin profile to effectively control PP glucose excursions.…”

Section: Other Factors Influencing Postprandial Glucose Controlmentioning

confidence: 99%

Postprandial Glucose Control in Type 1 Diabetes: Importance of the Gastric Emptying Rate

2019

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The achievement of optimal post-prandial (PP) glucose control in patients with type 1 diabetes (T1DM) remains a great challenge. This review summarizes the main factors contributing to PP glucose response and discusses the likely reasons why PP glucose control is rarely achieved in T1DM patients. The macronutrient composition of the meal, the rate of gastric emptying and premeal insulin administration are key factors affecting the PP glucose response in T1DM. Although the use of continuous insulin infusion systems has improved PP glucose control compared to conventional insulin therapy, there is still need for further ameliorations. T1DM patients frequently present a delayed gastric emptying (GE) that produces a lower but more prolonged PP hyperglycemia. In addition, delayed GE is associated with a longer time to reach the glycemic peak, with a consequent mismatch between PP glucose elevation and the timing of premeal insulin action. On this basis, including GE time and meal composition in the algorithms for insulin bolus calculation of the insulin delivery systems could be an important step forward for optimization of PP glucose control in T1DM.

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Section: Other Factors Influencing Postprandial Glucose Controlmentioning

confidence: 99%

Postprandial Glucose Control in Type 1 Diabetes: Importance of the Gastric Emptying Rate

2019

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“…A missed meal bolus results in higher postprandial glucose values. 12,82 We understand that this metric relies on the patients' entry of meal information in the HCL system and may be inaccurate.…”

Section: B Hypoglycemiamentioning

confidence: 99%

“…Changes to the clinical practice of diabetes management are needed to increase the use of diabetes technologies such as insulin pumps, CGMs, and hybrid closed-loop (HCL) systems to improve glycemic control, reduce hypoglycemia, and quality of life among insulin-requiring patients with diabetes. 11,12 Despite all the advances in therapeutics and technologies in the past decade, diabetes outcomes have not improved significantly and only about one-third of patients with diabetes are able to achieve optimal glycemic control. [13][14][15][16] In addition, unfortunately, there are racial and socioeconomic inequalities to accessing newer technologies.…”

Section: Introductionmentioning

confidence: 99%

Standardized Hybrid Closed-Loop System Reporting

Shah

Garg

2021

Diabetes Technology & Therapeutics

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“…Faster-acting insulins, new noninsulin drug classes, more flexible insulin-delivery systems, and improved continuous glucose monitoring (CGM) devices offer unprecedented opportunities to improve PPG management and overall care for people with insulin-treated diabetes, as well as new opportunities to understand and target PPG excursions specifically [10]. For these reasons, the Endocrine Society convened a working panel of diabetes experts in Washington, DC on 15 December 2018 to assess the state of PPG management, align best practices to current and emerging treatment and monitoring options, and identify innovative ways to address PPG management to improve self-management and QOL for the ∼200 million adults worldwide with insulin-requiring diabetes [11].…”

mentioning

confidence: 99%

Optimizing Postprandial Glucose Management in Adults With Insulin-Requiring Diabetes: Report and Recommendations

Leahy

Fonseca

Garg

et al. 2019

Journal of the Endocrine Society

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Faster-acting insulins, new noninsulin drug classes, more flexible insulin-delivery systems, and improved continuous glucose monitoring devices offer unprecedented opportunities to improve postprandial glucose (PPG) management and overall care for adults with insulin-treated diabetes. These developments led the Endocrine Society to convene a working panel of diabetes experts in December 2018 to assess the current state of PPG management, identify innovative ways to improve self-management and quality of life, and align best practices to current and emerging treatment and monitoring options. Drawing on current research and collective clinical experience, we considered the following issues for the ∼200 million adults worldwide with type 1 and insulin-requiring type 2 diabetes: (i) the role of PPG management in reducing the risk of diabetes complications; (ii) barriers preventing effective PPG management; (iii) strategies to reduce PPG excursions and improve patient quality of life; and (iv) education and clinical tools to support endocrinologists in improving PPG management. We concluded that managing PPG to minimize or prevent diabetes-related complications will require elucidating fundamental questions about optimal ways to quantify and clinically assess the metabolic dysregulation and consequences of the abnormal postprandial state in diabetes and recommend research strategies to address these questions. We also identified practical strategies and tools that are already available to reduce barriers to effective PPG management, optimize use of new and emerging clinical tools, and improve patient self-management and quality of life.

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Possible Ways to Improve Postprandial Glucose Control in Type 1 Diabetes

Cited by 27 publications

References 110 publications

Postprandial Glucose Control in Type 1 Diabetes: Importance of the Gastric Emptying Rate

Postprandial Glucose Control in Type 1 Diabetes: Importance of the Gastric Emptying Rate

Standardized Hybrid Closed-Loop System Reporting

Optimizing Postprandial Glucose Management in Adults With Insulin-Requiring Diabetes: Report and Recommendations

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