Sian Rilstone, United Kingdom
Imperial College Healthcare NHS Trust Nutrition and DieteticsPresenter of 2 Presentations
A SURVEY OF UK DIETITIANS ON CURRENT ADVICE TO PEOPLE WITH TYPE 1 DIABETES USING INSULIN PUMP THERAPY IN 2019
Abstract
Background and Aims
Continuous Subcutaneous Insulin Infusion (CSII) enables food freedom in type 1 diabetes (T1DM). Evidence supporting advanced insulin bolus options with CSII is lacking or conflicting, and clinical guidelines are absent. The aim of this national survey was to establish current practice among T1DM specialist dietitians.
Methods
A 19 question survey was sent to the British Dietetic Association’s Diabetes Specialist Group, which consists of approximately 600 Dietitians with a special interest in Diabetes.
Results
78 people completed the questionnaire. 97% always or mostly recommended using bolus advisor on their pumps. 78% said their patients mostly used it. 61% recommended bolusing insulin before their meal. 97% recommended their patients use extended boluses in some form. The most recommended option was the 50:50 combination bolus. Extended boluses were recommended by 91% of respondents for high fat meals, and for foods high in protein and fat (78%), when eating high-fat home-cooked meals (77%) and foods containing significant soluble fibre (60%). 36% of respondents recommend that patients bolus additional insulin for protein or fat and protein. 45% recommended superbolusing.
Conclusions
Bolus advisors are generally used widely, allowing consistent calculation and tracking of insulin. The range of bolus types recommended by dietitians varied reflecting the conflicting evidence, but initial bolus and duration may be insufficient to inhibit hepatic glucose production and cover delayed macronutrient absorption. Extended bolusing was recommended, mostly appropriately. Relatively small numbers advise protein and fat counting. Superbolusing is under-utilised, reflecting the lack of published data, and inconvenience.
A SURVEY OF UK DIETITIANS ON CURRENT ADVICE TO PEOPLE WITH TYPE 1 DIABETES USING INSULIN PUMP THERAPY IN 2019 COMPARED WITH 2015
Abstract
Background and Aims
Continuous Subcutaneous Insulin Infusion (CSII) enables greater food freedom for people with type 1 diabetes (T1DM). Evidence supporting advanced insulin bolus options with CSII is poor, with no clinical guidelines. This national survey establishes current practice among type 1 diabetes (T1DM) specialist dietitians.
Methods
A 10 question survey was sent out electronically to the British Dietetic Association’s Diabetes Specialist Group in 2015 and in 2019.
Results
101 dietitians responded in 2015, 78 in 2019. The most popular extended bolus format in both 2019 and 2015 was the 50:50 dual wave, which 85% recommended (89% in 2015). Square wave boluses were the second most popular bolus in 2015 with 80% recommending it’s use, falling to 59% in 2019. In 2015 the 30:70 dual wave was third most popular with 75% recommending, falling to 49% in 2019. Extending over 2-3 hours was most commonly recommended in 2019 (43%), with 1-2 hours most common in 2015 (39%). The maximum duration recommended was 5-6 hours (36%) in 2019 (23% in 2015). 36% of 2019 respondents recommend that patients bolus additional insulin for protein or fat and protein (compared with 9% in 2015). 45% of respondents recommended superbolusing, an increase from 2015 (25%).
Conclusions
Bolus advice from specialist dietitians has improved over 4 years with longer combination boluses, superboluses and protein and fat counting advocated. This reflects improved education and suggest improved tools to support total macronutrient and superbolusing may be required.