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Published online May 28, 2008
Diabetes Care 31:1491-1495, 2008
DOI: 10.2337/dc08-0306
© 2008 by the American Diabetes Association
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Clinical Care/Education/Nutrition/Psychosocial Research
Original Research

Optimizing Postprandial Glycemia in Pediatric Patients With Type 1 Diabetes Using Insulin Pump Therapy

Impact of glycemic index and prandial bolus type

Michele A. O'Connell, MRCPI1, Heather R. Gilbertson, PHD2, Susan M. Donath, MA3 and Fergus J. Cameron, MD1

1 Department of Endocrinology and Diabetes and Centre for Hormone Research, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia
2 Department of Nutrition and Food Services, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia
3 Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia

Corresponding author: Fergus Cameron, fergus.cameron{at}rch.org.au

OBJECTIVE—Postprandial glycemic excursions may contribute to the development of diabetes-related complications. Meals of high and low glycemic index (GI) have distinct effects on postprandial glycemia (PPG). Insulin pump therapy offers the potential to tailor insulin delivery to meal composition; however, optimal bolus types for meals of different glycemic loads have not been defined. We sought to compare the impact of GI combined with varying prandial bolus types on PPG.

RESEARCH DESIGN AND METHODS—An open crossover study examining the effects of four different meal and bolus-type combinations on 3-h PPG (measured by continuous glucose-monitoring system [CGMS]) was conducted. A total of 20 young people aged 8–18 years with type 1 diabetes using insulin-pump therapy participated. Meals had equal macronutrient, energy, and fiber content and differed only in GI (low vs. high). Participants consumed meals of the same GI on consecutive days and were randomized to receive either a standard (100%) or a dual-wave (DW) (50:50% over 2 h) bolus each day. CGMS data from 10 healthy control participants established the target response to each meal.

RESULTS—A DW bolus before low-GI meals decreased PPG area under the curve (AUC) by up to 47% (P = 0.004) and lowered the risk of hypoglycemia for the same premeal glucose (P = 0.005) compared with standard bolus. High-GI meals resulted in significant upward PPG excursions with greater AUC (P = 0.45), regardless of bolus type.

CONCLUSIONS—These data support the use of a DW bolus with low GI meals to optimize PPG in patients with type 1 diabetes using insulin pump therapy.


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