MISSED PRANDIAL INSULIN BOLUSES REDUCE TIME IN RANGE (TIR) AND INCREASE TIME ABOVE RANGE (TAR): NEW METHODS OF ANALYSIS
- David Rodbard, United States of America
- David Rodbard, United States of America
- Jie Xue, United States of America
- Xuanyao He, United States of America
- Jennal Johnson, United States of America
- Howard Wolpert, United States of America
Abstract
Background and Aims
Insulin nonadherence leads to poor glycaemic control. Several methods have been proposed for identifying missed and suboptimal meal-related insulin bolus. To improve the analysis of results from clinical studies, we compared a new method based on the Mean Amplitude of Glycaemic Excursion (MAGE) concept (Method 1) and Kovatchev-Breton method (Method 2).
Methods
Method 1 uses Baghurst’s algorithm for MAGE to identify prandial glucose peaks utilising upstrokes which exceed a prespecified amplitude rather than the standard deviation of continuous glucose monitoring (CGM). Method 2 uses a >70 mg/dL increase within 2 hours of glucose increase. Missed bolus dose was defined as no injection within 2 hours prior to onset of the glucose excursion. The methods were compared using data from a 12-week study with two 21-day periods (period 1: masked CGM, 68 subjects; period 2: real-time CGM, 65 subjects; using Dexcom G5) in subjects with type 1 diabetes or type 2 diabetes using a basal-bolus regimen with prandial insulin lispro U-100 injected using a connected pen.
Results
In both periods, days with no missed bolus had lower mean glucose, higher TIR and lower TAR compared to days with ≥1 missed bolus (Table).
Conclusions
Methods 1 and 2 have excellent concurrence; both identify the effects of missed bolus on TIR and TAR. This study highlights the utility of connected insulin pens to identify suboptimal diabetes self-management and points to the need for development of consensus in the clinical community about the reporting of insulin dosing metrics.
