title: Lowering postprandial glycemia in children with type 1 diabetes after Italian pizza "margherita" (TyBoDi2 Study).
abstract: 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 type and timing. We evaluated the most effective type and timing of a pump-delivered, preprandial bolus in children with type 1 diabetes for a pizza "margherita" meal.
  
  
  METHODS
  We assessed the response of 38 children with type 1 diabetes to a meal based on pizza "margherita" (with mozzarella cheese and tomato sauce) after different types and timings of a bolus dose.
  
  
  RESULTS
  The glucose levels for 6 h after the meal were lower (i.e., closer to the therapeutic target of <140 mg/dL) when the bolus doses were administered as a simple bolus 15 min before the meal (area under the curve [AUC] 0-6 h, 6.9 ± 14.9 mg/dL/min) versus a simple bolus administered immediately before the meal (AUC 0-6 h, 4.2 ± 25.9 mg/dL/min) (P = not significant) versus a double-wave bolus 30/70 extended over a 6-h period administered 15 min before the meal (AUC 0-6 h, 1.9 ± 21.3 mg/dL/min) (P = not significant) versus a double-wave bolus 30/70 extended over a 6-h period administered immediately before the meal (AUC 0-6 h, 13.3 ± 15.6 mg/dL/min) (P = 0.01).
  
  
  CONCLUSIONS
  In the case of a pizza "margherita," our data support the injection of the simple bolus 15 min before a meal, rather than immediately before or delivered as a double-wave bolus, to control the glycemic rise usually observed.
authors.affiliation: Department of Pediatrics, University of Milano, Luigi Sacco Hospital, Milano, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: De Palma
authors.forename: Elisa
authors.initials: E
authors.lastname: Giani
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bosetti
authors.forename: Maddalena
authors.initials: M
authors.lastname: Macedoni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gazzarri
authors.forename: Daniele
authors.initials: D
authors.lastname: Spiri
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Scaramuzza
authors.forename: Gian Vincenzo
authors.initials: GV
authors.lastname: Zuccotti
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015918:Infusion Pumps, Implantable; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin