title: The dual-wave bolus feature in type 1 diabetes adult users of insulin pumps.
abstract: One of the attributes of CSII (continuous subcutaneous insulin infusion) is its ability to tailor prandial insulin delivery to the composition of a meal and anticipated glycemic effects. The dual-wave bolus (DWB) is a tool implemented in contemporary insulin pumps that delivers a combination of an instant insulin bolus followed by a square bolus (SB) infused over several hours. We assessed the effectiveness of DWB in 56 adult patients with type 1 diabetes (T1DM) who were on continuous subcutaneous insulin infusion via insulin pump for at least 2 years. We divided patients into frequent (DWB+, n = 32) and infrequent (DWB-, n = 24) DWB users (>20% vs. <20% of daily bolus dose delivered as SB). CSII implementation resulted in a decrease of adjusted HbA1c level by 0.80% (95% CI 0.67-0.93, P < 0.0001) and adjusted mean glycemia by 18.4 mg/dl (95% CI 15.3-21.4, P < 0.0001) in the whole cohort within the first year of observation. It was sustained in the second year, but without further improvement. Frequent DWB use was associated with male sex (59% vs. 17%, p = 0.001) and shorter duration of T1DM (3.4 vs. 11.3 yrs, p < 0.0001), but not with patients' age (25.7 vs. 27.0 years, P = 0.6). DWB+ patients improved their HbA1c by 0.45% more (95% CI 0.20-0.71, P = 0.0009) than DWB- individuals. In conclusion, DWB might be a tool potentially helping to improve glycemic control in T1DM adult users of insulin pumps. Male patients and those with a shorter duration of diabetes seem to use it more willingly.
authors.affiliation: Department of Metabolic Diseases, Jagiellonian University, Medical College, 15 Kopernika Street, Krakow, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Klupa
authors.forename: Jan
authors.initials: J
authors.lastname: Skupien
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Cyganek
authors.forename: Barbara
authors.initials: B
authors.lastname: Katra
authors.forename: Jacek
authors.initials: J
authors.lastname: Sieradzki
authors.forename: Maciej T
authors.initials: MT
authors.lastname: Malecki
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin