Evaluation of a novel continuous glucose monitoring-based method for mealtime insulin dosing - the iBolus - in subjects with type 1 diabetes using continuous subcutaneous insulin infusion therapy: a randomized controlled trial

This is a copy of an article published in the Diabetes Technology and Therapeutics © 2012 [copyright Mary Ann Liebert, Inc.]; Diabetes Technology and Therapeutics is available online at: http://online.liebertpub.com.[EN] Objective: Prandial insulin dosing is an empirical practice associated frequently with poor reproducibility in postprandial glucose response. Based on continuous glucose monitoring (CGM), a method for prandial insulin administration (iBolus) is presented and evaluated for people with type 1 diabetes using CSII therapy. Subjects and Methods: An individual patient¿s model for a 5-h postprandial period was obtained from 6-day ambulatory CGM and used for iBolus calculation in 12 patients with type 1 diabetes. In a double-blind, crossover study each patient underwent four meal tests with 40 g or 100 g of carbohydrates (CHOs), both on two occasions. For each meal, the iBolus or the traditional bolus (tBolus) was given before mealtime (t 0) in a randomized order. We measured the postprandial glycemic response as the area under the curve of plasma glucose (AUC-PG0¿5h) and variability as the individual coef¿cient of variation (CV) of AUC-PG0¿5h. The contribution of the insulin-to-CHO ratio, CHO, plasma glucose at t 0 (PGt0), and insulin dose to AUC-PG0¿5h and its CV was also investigated. Results: AUC-PG0¿5h was similar with either bolus for 40-g (iBolus vs. tBolus, 585.5¿127.5 vs. 689.2¿180.7 mg/dL$h) or 100-g (752.1¿237.7 vs. 760.0¿263.2 mg/dL$h) CHO meals. A multiple regression analysis revealed a signi¿cant model only for the tBolus, with PGt0 being the best predictor of AUC-PG0¿5h explaining approximately 50% of the glycemic response. Observed variability was greater with the iBolus (CV, 16.7¿15.3% vs. 10.1¿12.5%) but independent of the factors studied. Conclusions: A CGM-based algorithm for calculation of prandial insulin is feasible, although it does not reduce unpredictability of individual glycemic responses. Causes of variability need to be identi¿ed and analyzed for further optimization of postprandial glycemic control.We are grateful to Mrs. Sara Correa, Fundacion INCLIVA-Hospital Clinico Universitario de Valencia, and Mrs. Geles Viguer, Hospital Clinico Universitario de Valencia, for their invaluable help in conducting the study. We also thanks Dr. Carmine Fanelli, University of Perugia, Dr. Howard Zisser, Sansum Diabetes Research Institute, and Prof. Alberto Ferrer, Universitat Politecnica de Valencia, for their suggestions on study design and data analysis. The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007/2013) under grant agreement 252085 and from the Spanish Ministry of Science under grants DPI2010-20764-C02-01 and DPI2011-28112-C04-01.Rossetti, P.; Ampudia Blasco, FJ.; Laguna Sanz, AJ.; Revert Tomás, A.; Vehí Casellas, J.; Ascaso, JF.; Bondía Company, J. (2012). Evaluation of a novel continuous glucose monitoring-based method for mealtime insulin dosing - the iBolus - in subjects with type 1 diabetes using continuous subcutaneous insulin infusion therapy: a randomized controlled trial. Diabetes Technology & Therapeutics. 14(11):1043-1052. https://doi.org/10.1089/dia.2012.0145S10431052141