The comparison of two mealtime insulin dosing algorithms for high and low glycaemic index meals in adolescents with type 1 diabetes

Abstract

Aims Postprandial glycaemic variability carries on being a clinical challenge in optimizing glucose control in type 1 diabetes. The aim of this study was to compare the postprandial glycaemic effects of carbohydrate counting and food insulin index algorithms following the consumption of protein‐rich, high‐fat meals with different glycaemic index (GI) in adolescents with type 1 diabetes. Methods A randomized, single‐blind and crossover trial included 15 adolescents aged 14–18 years with type 1 diabetes. Participants consumed two different test meals with similar energy, macronutrients and food insulin index but the approximately twofold difference in GI, in random order on four consecutive mornings at their home. Insulin dose for high‐ and low‐GI test meals was determined by using the carbohydrate counting and food insulin index algorithms. Four‐hour postprandial glycaemia was assessed by the continuous glucose monitoring system. Results Compared with carbohydrate counting, the food insulin index algorithm significantly decreased peak glucose excursion (−57%, p = 0.02), incremental area under the curve (−65%, p = 0.02) and coefficient variation of blood glucose (−37%, p = 0.03) in the high‐GI meal, though there was no difference between the two algorithms in the low‐GI meal. The occurrence of hypoglycaemia did not significantly differ between insulin dosing algorithms for the high‐GI (p = 0.58) and low‐GI (p = 0.20) meals. Conclusions The food insulin index algorithm may be beneficial for postprandial glycaemic control after the consumption of high‐GI meals in adolescents with type 1 diabetes.

The Application of the Food Insulin Index in the Prevention and Management of Insulin Resistance and Diabetes: A Scoping Review

“…Full-text screening was performed on 72 articles of which 47 were excluded. Data extraction was performed on the remaining 25 articles [ 27 , 29 , 30 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ].…”

“…Of the twenty-five included articles, eleven were cross-sectional [ 29 , 36 , 37 , 38 , 39 , 48 , 50 , 51 , 54 , 55 , 56 ], six were crossover studies [ 30 , 41 , 43 , 46 , 47 , 52 ], four were randomised controlled trials (RCTs) [ 27 , 40 , 44 ], three were prospective studies [ 49 , 53 , 57 ], and one was a regression analysis [ 45 ]. Most of the studies were conducted in Australia (n = 11) and Iran (n = 10).…”

“…Most of the articles (n = 13) were published between 2019 and 2023. The study populations of the articles included the following: four studies on type 2 diabetic individuals [ 36 , 37 , 38 , 39 ], seven studies on type 1 diabetic individuals [ 40 , 41 , 42 , 43 , 44 , 47 , 52 ], one study on obese adolescents with insulin resistance [ 46 ], eleven on healthy participants [ 27 , 29 , 45 , 48 , 49 , 51 , 53 , 54 , 55 , 56 , 57 ], one on both healthy and type 2 diabetic participants [ 30 ], and one study used healthy participants as well as participants with insulin resistance and T2DM [ 50 ]. Characteristics and findings of the included studies are summarised in Table 1 .…”

“…Five studies scored 50–75%. representing average-quality evidence [ 48 , 53 , 54 , 55 , 57 ], and 19 studies scored 76–100%, representing high-quality evidence [ 27 , 29 , 30 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 56 ].…”

A complex archetype

“…Conventional insulin dose adjustment uses the principles of carbohydrate estimation but omits the impact of protein and fat on gastric emptying, post‐prandial glucose appearance and insulin sensitivity. The food insulin index algorithm calculates insulin requirement based on the whole food energy content and, in this issue, is assessed in a randomised controlled trial against conventional carbohydrate estimation 6 . In test meals, the food insulin index algorithm led to a significantly lower post‐prandial glucose than carbohydrate estimation, without an increase in hypoglycaemia, suggesting that, for some foods the food insulin index algorithm may be preferable.…”