Marigliano Marco, Piona Claudia, Tommaselli Francesca, Maguolo Alice, Morandi Anita, Maffeis Claudio
Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Gynecology and Pediatrics, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Acta Diabetol. 2023 May;60(5):609-618. doi: 10.1007/s00592-022-02019-2. Epub 2023 Jan 27.
To evaluate whether a second insulin bolus, calculated with a new approach, could improve postprandial glucose (PPG) after the intake of real-life high-fat (HF) and high-protein (HP) mixed meals.
Fifteen adolescents with T1D treated with non-automated insulin pumps and CGM were enrolled. Patients received standard, HF and HP mixed meals treated with one pre-meal insulin bolus; based on differences in PPG between standard, HF and HP meals, correction boluses were calculated (30% and 60% of pre-meal bolus for HF and HP meals, respectively). Then patients received the same HF or HP meal treated with pre-meal bolus plus second insulin bolus after 3 h. Differences between postprandial variables after HF and HP meals treated with one or two insulin boluses were assessed by paired Student's t-test.
Treating HF and HP meals with two insulin boluses significantly reduced the postprandial BG-AUC (21% and 26% respectively, p < 0.05), increased %TIR (from 52.5 to 78.3% for HF meal; from 32.7 to 57.1% for HP meal; p < 0.01), and reduced mean BG and %TAR (p < 0.01), with no differences in %TBR.
The new way to calculate and administer correction boluses 3 h after HF and HP meals is effective and safe in reducing PPG and the hypoglycemia risk.
评估采用新方法计算的第二次胰岛素推注是否能改善摄入实际生活中的高脂肪（HF）和高蛋白（HP）混合餐后的餐后血糖（PPG）。
招募了15名使用非自动化胰岛素泵和连续血糖监测（CGM）治疗的1型糖尿病青少年患者。患者接受标准餐、HF餐和HP餐，并给予一次餐前胰岛素推注；根据标准餐、HF餐和HP餐之间PPG的差异计算校正推注量（HF餐和HP餐分别为餐前推注量的30%和60%）。然后患者在3小时后接受相同的HF或HP餐，同时给予餐前推注加第二次胰岛素推注。通过配对t检验评估一次或两次胰岛素推注治疗HF餐和HP餐后餐后变量之间的差异。
两次胰岛素推注治疗HF餐和HP餐可显著降低餐后血糖曲线下面积（分别降低21%和26%，p<0.05），增加血糖达标时间百分比（HF餐从52.5%增至78.3%；HP餐从32.7%增至57.1%；p<0.01），并降低平均血糖和血糖高于目标值时间百分比（p<0.01），血糖低于目标值时间百分比无差异。
在HF餐和HP餐后3小时计算并给予校正推注的新方法在降低PPG和低血糖风险方面是有效且安全的。
