708-P: Complexity of Mealtime Insulin Dosing in Free-Living People with T1D: Novel Study with Varied Meal Macronutrient Content

Abstract

Controlled in-patient studies indicate that high fat/protein meals require more insulin coverage than low fat meals with similar carbohydrate (CHO). However, it is unclear how dietary macronutrient content impacts on glycemic responses and insulin requirements in free-living T1D individuals. Adults with T1D (n=25) (mean±SD age 52±15 yrs, A1C 7.1±0.7%, 39% female) on insulin pump and continuous glucose monitoring (CGM) were enrolled in this 18-week duration study. Participants ate meals with specific macronutrient content (high glycemic index [GI], high fat [HGI-HF]; high GI, low fat [HGI-LF]; low GI, high fat [LGI-HF]; low GI, low fat [LGI-LF]). Meal, CGM, and insulin dosing data were reviewed by the study investigator, who provided dose optimization recommendations. Participants provided dosing and CGM data from 463 meals. Time-in-range (TIR) was similar for all meal types (table, p=0.72). LGI meals required significantly more insulin than HGI meals (p=0.01). Significantly more insulin per gram of CHO was used for LGI-HF vs. all other meal types (mean CHO-to-insulin ratio = 4.5 vs. 8.7 for HGI-HF, 7.6 for HGI-LF, and 5.5 for LGI-LF; p= 0.02). This exploratory study in free-living individuals with T1D highlights the complexity of mealtime insulin dosing, pointing to the need for bolus advisors that incorporate other dietary inputs in addition to CHO.View largeDownload slideView largeDownload slide DisclosureS. S. Edwards: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. W. Wang: Employee; Self; Eli Lilly and Company. E. Toschi: Consultant; Self; Medtronic. A. Atakov-castillo: None. R. Dewar: None. G. M. Steil: Consultant; Self; Abbott Diabetes, Eli Lilly and Company. H. Wolpert: Employee; Self; Eli Lilly and Company.FundingEli Lilly and Company