David Rodbard, United States of America
Biomedical Informatics Consultants LLC Clinical Research and BiostatisticsPresenter of 1 Presentation
USE OF CONNECTED INSULIN PEN TO EVALUATE THE EFFECTS OF PRE-MEAL, DELAYED, MISSED, AND CORRECTION BOLUSES ON PRANDIAL GLUCOSE CONTROL IN T1D AND T2D
Abstract
Background and Aims
Connected insulin pens have the potential to objectively assess the impact of insulin dosing behaviors on postprandial glucose control.
Methods
This observational study enrolled 68 people with T1D or insulin-using T2D with A1C ≥8% and ≥3 reported insulin boluses/day at baseline. Connected pen and CGM data were used to identify meal-related glucose excursions defined as glucose increase ≥50 mg/dL within 2 hours with no glucose <70 mg/dL in the preceding 30 min. A pre-meal bolus (PB) was taken within one h prior to the nadir of excursion or during excursion with maximum of rate-of-change of BG within preceding 20 minutes less than 1.0 mg/dL/min. Doses taken during the excursions that were not labeled as PB were defined to be delayed bolus (DB), while doses taken within 6 h of nadir and after the peak but before the next nadir of excursions were defined as correction bolus (CB). We defined an excursion to have a missed bolus (MB) if neither PB nor DB was taken.
Results
Participants were (mean±SD) 48 years (± 12), 44% female, 59% T1D, 51% BMI ≥30, and 65% with A1C ≥9.0%. DB and MB significantly impaired postprandial glucose control compared to PB (table). Use of a CB reduced the impact of DB and MB, but slightly increased time below range.
Conclusions
These findings highlight the clinical utility of connected pens to identify insulin dosing practices that contribute to suboptimal postprandial control. Individuals who do not inject consistently premeal could potentially benefit from faster-acting bolus insulins.