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, Heather R Gilbertson, Susan M Donath, Fergus J Cameron, Michele A O'Connell, Heather R Gilbertson, Susan M Donath, Fergus J Cameron

Abstract

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.

Figures

Figure 1
Figure 1
Schematic timeline of each study day.
Figure 2
Figure 2
A: Low GI meal. B: High GI meal. PPG profiles: mean ± SE from premeal glucose.

References

    1. Lowe LP, Liu K, Greenland P, Metzger BE, Dyer AR, Stamler J: Diabetes, asymptomatic hyperglycemia, and 22-year mortality in black and white men: the Chicago Heart Association Detection Project in Industry Study. Diabetes Care 20:163–169, 1997
    1. The DECODE study group, the European Diabetes Epidemiology Group: Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The Lancet 354:617–621, 1999
    1. Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch HJ, Lindner J: Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 39:1577–1583, 1996
    1. Temelkova-Kurktschiev TS, Koehler C, Henkel E, Leonhardt W, Fuecker K, Hanefeld M: Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c level. Diabetes Care 23:1830–1834, 2000
    1. The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986, 1993
    1. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes 44:968–983, 1995
    1. Heptulla RA, Allen HF, Gross TM, Reiter EO: Continuous glucose monitoring in children with type 1 diabetes: before and after insulin pump therapy. Pediatric Diabetes 5:10–15, 2004
    1. Chase HP, Saib SZ, MacKenzie T, Hansen MM, Garg SK: Post-prandial glucose excursions following four methods of bolus insulin administration in subjects with Type 1 diabetes. Diabet Med 19:317–321, 2002
    1. Jones SM, Quarry JL, Caldwell-McMillan M, Mauger DT, Gabbay RA: Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. Diabetes Technol Ther 7:233–240, 2005
    1. Lee SW, Cao M, Sajid S, Hayes M, Choi L, Rother C, de Leon R: The dual-wave bolus feature in continuous subcutaneous insulin infusion pumps controls prolonged post-prandial hyperglycaemia better than standard bolus in Type 1 diabetes. Diabetes Nutr Metab 17:211–216, 2004
    1. American Diabetes Association: Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care 30:S48–S65, 2007
    1. Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins AL, Goff DV: Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 34:362–366, 1981
    1. Wolever TM, Jenkins DJ, Collier GR, Ehrlich RM, Josse RG, Wong GS, Lee R: The glycaemic index: effect of age in insulin dependent diabetes mellitus. Diabetes Res 7:71–74, 1988
    1. Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC: Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. Jama 277:472–477, 1997
    1. Brand-Miller JC, Thomas M, Swan V, Ahmad ZI, Petocz P, Colagiuri S: Physiological validation of the concept of glycemic load in lean young adults. J Nutr 133:2728–2732, 2003
    1. American Diabetes Association: Postprandial blood glucose. Diabetes Care 24:775–778, 2001
    1. Boland E, Monsod T, Delucia M, Brandt CA, Fernando S, Tamborlane WV: Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes. Diabetes Care 24:1858–1862, 2001
    1. Gilbertson HR, Brand-Miller JC, Thorburn AW, Evans S, Chondros P, Werther GA: The effect of flexible low glycemic index dietary advice versus measured carbohydrate exchange diets on glycemic control in children with type 1 diabetes. Diabetes Care 24:1137–1143, 2001
    1. Buyken AE, Toeller M, Heitkamp G, Karamanos B, Rottiers R, Muggeo M, Fuller JH: Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids. Am J Clin Nutr 73:574–581, 2001
    1. Brand-Miller J, Hayne S, Petocz P, Colagiuri S: Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials. Diabetes Care 26:2261–2267, 2003
    1. Sheard NF, Clark NG, Brand-Miller JC, Franz MJ, Pi-Sunyer FX, Mayer-Davis E, Kulkarni K, Geil P: Dietary carbohydrate (amount and type) in the prevention and management of diabetes: A statement by the American Diabetes Association. Diabetes Care 27:2266–2271, 2004
    1. Wolever TMS, Bolognesi C: Prediction of glucose and insulin responses of normal subjects after consuming mixed meals varying in energy, potein, fat, carbohydrate and glycemic index. J Nutr 126:2807–2812, 1996

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