Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth 6009, Australia.
Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth 6009, Australia.
Nutrients. 2021 Nov 19;13(11):4154. doi: 10.3390/nu13114154.
The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8-15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs. within-person SD; controlled breakfast 18.5 vs. 38.9 min; FLB 14.1 vs. 49.6 min; FLD 5.7 vs. 64.5 min). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability.
对于 1 型糖尿病（T1D）患儿和青少年来说，为餐时注射胰岛素的最佳时间颇具挑战性。目前的血糖控制指南并未考虑到个体对餐时血糖反应的差异。本研究旨在检测在受控和自由生活条件下进食后血糖反应达峰时间（TTP）的个体内和个体间变异性。招募了年龄在 8-15 岁、T1D 患病时间≥1 年且使用连续血糖监测仪（CGM）的参与者。参与者在六个受控日中每天进食标准早餐，并在 14 天的自由生活日中维持日常惯例。在进食后采集 CGM 轨迹。线性混合模型用于确定在每个受控早餐、自由生活早餐（FLB）和自由生活晚餐（FLD）条件下，TTP 的个体内和个体间变异性。30 名参与者完成了该研究（16 名女性；平均年龄和标准差（SD）为 10.5（1.9）岁）。对于所有三种进餐类型，TTP 的个体内变异性均大于个体间变异性（个体间与个体内 SD；受控早餐 18.5 分钟 vs. 38.9 分钟；FLB 14.1 分钟 vs. 49.6 分钟；FLD 5.7 分钟 vs. 64.5 分钟）。本研究首次表明，TTP 血糖反应的个体内变异性甚至大于个体间变异性。
