Center for Diabetes Technology, University of Virginia, Charlottesville, VA
Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA.
Diabetes Care. 2020 Apr;43(4):799-805. doi: 10.2337/dc19-1675. Epub 2020 Mar 6.
Insulin dosing in type 1 diabetes (T1D) is oftentimes complicated by fluctuating insulin requirements driven by metabolic and psychobehavioral factors impacting individuals' insulin sensitivity (IS). In this context, smart bolus calculators that automatically tailor prandial insulin dosing to the metabolic state of a person can improve glucose management in T1D.
Fifteen adults with T1D using continuous glucose monitors (CGMs) and insulin pumps completed two 24-h admissions in a hotel setting. During the admissions, participants engaged in an early afternoon 45-min aerobic exercise session, after which they received a standardized dinner meal. The dinner bolus was computed using a standard bolus calculator or smart bolus calculator informed by real-time IS estimates. Glucose control was assessed in the 4 h following dinner using CGMs and was compared between the two admissions.
The IS-informed bolus calculator allowed for a reduction in postprandial hypoglycemia as quantified by the low blood glucose index (2.02 vs. 3.31, = 0.006) and percent time <70 mg/dL (8.48% vs. 15.18%, = 0.049), without increasing hyperglycemia (high blood glucose index: 3.13 vs. 2.09, = 0.075; percent time >180 mg/dL: 13.24% vs. 10.42%, = 0.5; percent time >250 mg/dL: 2.08% vs. 1.19%, = 0.317). In addition, the number of hypoglycemia rescue treatments was reduced from 12 to 7 with the use of the system.
The study shows that the proposed IS-informed bolus calculator is safe and feasible in adults with T1D, appropriately reducing postprandial hypoglycemia following an exercise-induced IS increase.
1 型糖尿病（T1D）患者的胰岛素剂量常常因代谢和心理行为因素导致的胰岛素敏感性（IS）波动而变得复杂，这些因素会影响个体的胰岛素需求。在这种情况下，能够根据个体的代谢状态自动调整餐时胰岛素剂量的智能推注计算器可以改善 T1D 的血糖管理。
15 名使用连续血糖监测仪（CGM）和胰岛素泵的 T1D 成年人在酒店环境中完成了两次 24 小时入住。在入住期间，参与者在下午早些时候进行了 45 分钟的有氧运动，之后他们接受了一顿标准化的晚餐。晚餐推注量使用标准推注计算器或实时 IS 估算值提供信息的智能推注计算器进行计算。使用 CGM 比较了两次入住后晚餐后 4 小时的血糖控制情况。
实时 IS 信息智能推注计算器可减少餐后低血糖，其低血糖指数（2.02 比 3.31， = 0.006）和血糖 <70mg/dL 的时间百分比（8.48%比 15.18%， = 0.049）降低，而不会增加高血糖（高血糖指数：3.13 比 2.09， = 0.075；血糖 >180mg/dL 的时间百分比：13.24%比 10.42%， = 0.5；血糖 >250mg/dL 的时间百分比：2.08%比 1.19%， = 0.317）。此外，使用该系统后，低血糖抢救治疗的次数从 12 次减少到 7 次。
该研究表明，对于 T1D 成年人，所提出的基于 IS 的智能推注计算器是安全可行的，可适当减少运动引起的 IS 增加后的餐后低血糖。
