title: Evaluation of a novel continuous glucose monitoring-based method for mealtime insulin dosing--the iBolus--in subjects with type 1 diabetes using continuous subcutaneous insulin infusion therapy: a randomized controlled trial.
abstract: OBJECTIVE
  Prandial insulin dosing is an empirical practice associated frequently with poor reproducibility in postprandial glucose response. Based on continuous glucose monitoring (CGM), a method for prandial insulin administration (iBolus) is presented and evaluated for people with type 1 diabetes using CSII therapy.
  
  
  METHODS
  An individual patient's model for a 5-h postprandial period was obtained from 6-day ambulatory CGM and used for iBolus calculation in 12 patients with type 1 diabetes. In a double-blind, crossover study each patient underwent four meal tests with 40 g or 100 g of carbohydrates (CHOs), both on two occasions. For each meal, the iBolus or the traditional bolus (tBolus) was given before mealtime (t(0)) in a randomized order. We measured the postprandial glycemic response as the area under the curve of plasma glucose (AUC-PG(0-5h)) and variability as the individual coefficient of variation (CV) of AUC-PG(0-5h). The contribution of the insulin-to-CHO ratio, CHO, plasma glucose at t(0) (PG(t0)), and insulin dose to AUC-PG(0-5h) and its CV was also investigated.
  
  
  RESULTS
  AUC-PG(0-5h) was similar with either bolus for 40-g (iBolus vs. tBolus, 585.5±127.5 vs. 689.2±180.7 mg/dL·h) or 100-g (752.1±237.7 vs. 760.0±263.2 mg/dL·h) CHO meals. A multiple regression analysis revealed a significant model only for the tBolus, with PG(t0) being the best predictor of AUC-PG(0-5h) explaining approximately 50% of the glycemic response. Observed variability was greater with the iBolus (CV, 16.7±15.3% vs. 10.1±12.5%) but independent of the factors studied.
  
  
  CONCLUSIONS
  A CGM-based algorithm for calculation of prandial insulin is feasible, although it does not reduce unpredictability of individual glycemic responses. Causes of variability need to be identified and analyzed for further optimization of postprandial glycemic control.
authors.affiliation: University Institute of Control Systems and Industrial Computing, Polytechnic University of Valencia, Valencia, Spain. prossetti73@gmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossetti
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Ampudia-Blasco
authors.forename: Alejandro
authors.initials: A
authors.lastname: Laguna
authors.forename: Ana
authors.initials: A
authors.lastname: Revert
authors.forename: Josep
authors.initials: J
authors.lastname: Vehì
authors.forename: Juan F
authors.initials: JF
authors.lastname: Ascaso
authors.forename: Jorge
authors.initials: J
authors.lastname: Bondia
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D038321:Glycemic Index; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D018670:Monitoring, Ambulatory; D019518:Postprandial Period; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human