title: Application of novel dual wave meal bolus and its impact on glycated hemoglobin A1c level in children with type 1 diabetes.
abstract: BACKGROUND
  An insulin pump is an advanced technology offering new options of bolus - normal (N), dual wave (D-W) or square wave (S-W) bolus to deliver mealtime insulin.
  
  
  OBJECTIVE
  To assess the impact of D-W/S-W boluses on metabolic control (glycated haemoglobin A1c, HbA1c) and to estimate the paediatric patients compliance with implementation of this system in daily practice.
  
  
  METHODS
  The cross-sectional study included 499 records of patients aged 0-18 yr. Data from the insulin pump memory provided information on the number of D-W/S-W boluses during a 2-wk period, the insulin requirement (U/kg/d) and the percentage of basal insulin. The HbA1c value (%) and the patient's weight were determined during medical examinations. Mealtime dose of insulin in D-W/S-W bolus was calculated based on the amount of carbohydrate and fat/protein products.
  
  
  RESULTS
  The number of applied D-W/S-W boluses was 16.6 +/- 0.77/14 d (ranged 0-95), while 18.8% of patients did not program D-W/S-W boluses. The lowest HbA1c value was found in the group using two and/or more D-W/S-W boluses per day (p = 0.001) compared with the group administrating less than one D-W/S-W bolus/d. Patients with HbA1c level <7.5% had a statistically higher relevant number of D-W/S-W boluses, 19.55 (95% CI: 17.44-21.65) vs. 12.42 (95% CI: 10.22-14.61) (p < 0.001), while there was no correlation between the number of boluses and HbA1c in patients in the remission phase (<0.5 IU/kg/d) (r = 0.012, p = 0.930).
  
  
  CONCLUSIONS
  Patients using at least one D-W/S-W bolus per day achieved a recommended level of HbA1c. Paediatric patients with type 1 diabetes mellitus were found to be able to apply D-W/S-W boluses in daily self-treatment process based on food counting.
authors.affiliation: Second Department of Paediatrics, Medical University of Warsaw, 01-184 Warsaw, Poland. epankowska@interia.pl
authors.forename: Ewa
authors.initials: E
authors.lastname: Pańkowska
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Szypowska
authors.forename: Maria
authors.initials: M
authors.lastname: Lipka
authors.forename: Monika
authors.initials: M
authors.lastname: Szpotańska
authors.forename: Marlena
authors.initials: M
authors.lastname: Błazik
authors.forename: Lidia
authors.initials: L
authors.lastname: Groele
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000032:analysis; D004041:Dietary Fats / Q000008:administration & dosage / Q000032:analysis; D004044:Dietary Proteins / Q000008:administration & dosage / Q000032:analysis; D054796:Drug Dosage Calculations; D004435:Eating / Q000502:physiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D015918:Infusion Pumps, Implantable; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D049528:Insulin, Long-Acting; D008297:Male; D010349:Patient Compliance; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting