Timing of bolus in children with type 1 diabetes using continuous subcutaneous insulin infusion (TiBoDi Study).
BACKGROUND
Continuous subcutaneous insulin infusion is considered a safe and effective way to administer insulin in pediatric patients with type 1 diabetes, but achieving satisfactory and stable glycemic control is difficult. Several factors contribute to control, including fine-tuning the basal infusion rate and bolus timing. We evaluated the most effective timing of a pump-delivered, preprandial bolus in children with type 1 diabetes.


METHODS
We assessed the response of 30 children with type 1 diabetes to a standard meal after different timing of a bolus dose.


RESULTS
The glucose levels for 3 h after the meal were lower (i.e., closer to the therapeutic target of <140 mg/dL) when the bolus doses were administered 15 min or immediately before the meal, rather than after the meal. However, these differences were not statistically significant, except at the 1-h postprandial time point: bolus just after meal, 177 +/- 71 mg/dL (9.83 +/- 3.94 mmol/L); 15 min before meal, 136 +/- 52 mg/dL (7.55 +/- 2.89 mmol/L) (P = 0.044); and just before meal, 130 +/- 54 mg/dL (7.22 +/- 3.00 mmol/L) (P = 0.024). The area under the curve (AUC) (in mg/min) did not differ significantly with different bolus times, but the SD of the AUC was the lowest with the bolus given 15 min before the meal.


CONCLUSIONS
These data support injection of the bolus before, rather than after, eating, even if the patient is hypoglycemic before meals.
Scaramuzza
Andrea E
AE
Department of Paediatrics, University of Milano, Ospedale Luigi Sacco, 20154 Milan, Italy. scaramuzza.andrea@hsacco.it
Iafusco
Dario
D
Santoro
Laura
L
Bosetti
Alessandra
A
De Palma
Alessandra
A
Spiri
Daniele
D
Mameli
Chiara
C
Zuccotti
Gian Vincenzo
GV
D000293:Adolescent; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D013997:Time Factors; D055815:Young Adult
D001786:Blood Glucose; D007328:Insulin