Timing of Meal Insulin and Its Relation to Adherence to Therapy in Type 1 Diabetes

Abstract

The purpose of this study is to examine timing of meal insulin and further determine whether an association exists between timing of meal insulin and missed meal insulin doses. The cohort included 4768 T1D Exchange clinic registry participants <26 years with type 1 diabetes ≥1 year. Chi-square tests, t-tests, and regression were used to assess the relationship between participant characteristics and timing of meal insulin and missed meal doses, respectively. Timing of meal insulin and association with missed meal doses was analyzed using logistic regression. In all, 21% reported administering insulin several minutes before, 44% immediately before, 10% during, and 24% after meal. Participants who gave insulin prior to a meal had significantly lower HbA1c than those who gave insulin during or after meal (8.4% ± 1.5% vs 8.8% ± 1.6%, adjusted P < .001), but no significant association was observed regarding DKA events. Those who reported missing ≥1 insulin dose per week had higher HbA1c (9.8% ± 1.9% vs 8.3% ± 1.3%, adjusted P < .001) and were more likely to experience at least one DKA event (9% vs 5%, adjusted P = .001) compared with those who rarely missed a meal insulin dose. Participants who reported administering insulin during or after a meal were more likely to report missing ≥1 meal insulin dose per week compared with those who administered insulin before a meal (28% vs 14%, adjusted P < .001). Premeal insulin was associated with lower HbA1c and fewer missed meal insulin doses. Providers may use this information to discuss the benefits of premeal insulin on glycemic control and adherence to therapy.

Dietary intake and eating patterns of young children with type 1 diabetes achieving glycemic targets

“…The majority of children in this cohort routinely give insulin before meals, which has been shown to be an important factor in minimizing postmeal glycemic excursions 31. In addition to a study that previously demonstrated a decrease in HbA1c by the administration of preprandial versus postprandial insulin,32 a recent study using T1D Exchange Clinic registry data reported a association between preprandial insulin dosing and lower HbA1c 33. However, as opposed to our small sample where 95% gave insulin before meals, only 61% of 419 parents/carers surveyed in the T1D Exchange gave insulin before the meal, suggesting that this may be an area of concern for health providers and parents alike.…”

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

“…As technology evolves, so must our measurement of self-management behaviors. Adherence to CGM and insulin pump use has typically been examined in the context of number of days of wear in the former [46, 47] and missed boluses in the latter [48, 49]. A comprehensive list of individual self-management tasks for CGMs (e.g., respond to alerts) and insulin pumps (e.g., carrying supplies, counting carbohydrates, administering boluses, checking blood glucose) has been described by Tanenbaum and colleagues [50].…”

Enterically delivered insulin tregopil exhibits rapid absorption characteristics and a pharmacodynamic effect similar to human insulin in conscious dogs

“…Present therapy relies on subcutaneous insulin to suppress HGP, a role it is pharmacokinetically poorly suited for, and to stimulate glucose disposal in peripheral tissues. Further, many patients wait until after eating to deliver a subcutaneous insulin bolus, which exacerbates this PK mismatch and worsens postprandial hyperglycaemia . Adding tregopil as an adjunct to rapid‐acting subcutaneous insulin could transfer the responsibility of inhibiting HGP from subcutaneous insulin to tregopil.…”

“…Further, many patients wait until after eating to deliver a subcutaneous insulin bolus, which exacerbates this PK mismatch and worsens postprandial hyperglycaemia. 29 Adding tregopil as an adjunct to rapid-acting subcutaneous insulin could transfer the responsibility of inhibiting HGP from subcutaneous insulin to tregopil. Because tregopil more closely approximates rapid, physiological insulin release, during the 5-hour postprandial period.…”