Abstract
Post-prandial hyperglycemia is still a challenging issue in intensified insulin therapy. Data of 35 T1D patients during a four-week period were analyzed: RT-CGM (real time continuous glucose monitoring) record, insulin doses, diet (including meal photos), energy expenditure, and other relevant conditions. Patients made significant errors in carbohydrate counting (in 56% of cooked and 44% of noncooked meals), which resulted in inadequate insulin doses. Subsequently, a mobile application was programmed to provide individualized advice on prandial insulin dose. When using the application, a patient chooses only the type of categorized situation (e.g., meals with other relevant data) without carbohydrates counting. The application significantly improved postprandial glycemia as normoglycemia was reached in 95/105 testing sessions. Other important findings of the study include: A high intake of saturated fat (median: 162% of recommended intake); a low intake of fiber and vitamin C (median: 42% and 37%, respectively, of recommended intake); an increase in overweight/obesity status (according to body fat measurement), especially in women (median of body fat: 30%); and low physical activity (in 16/35 patients). The proposed individualized approach without carbohydrate counting may help reach postprandial normoglycemia but it is necessary to pay attention to the lifestyle habits of T1D patients too.
Highlights
The therapeutic targets for patients with type 1 diabetes are clearly defined: Achieve normoglycemia without severe hypoglycemic events, maintain other biochemical parameters within the normal range, and maintain or lower blood pressure and anthropometric parameters
In hybrid closed-loop systems, basal doses are driven automatically according to continuous glucose monitoring (CGM) data to maintain glycemia within the target range
Ininmen, men,there therewere wereonly onlytwo twopatients patientsoverweight/obese overweight/obeseas asconfirmed confirmedby bybody bodyfat fatcontent content measurement using BIA; in other men having a BMI higher than normal, this finding was due to measurement using BIA; in other men having a BMI higher than normal, this finding was due to higher muscle mass
Summary
The therapeutic targets for patients with type 1 diabetes are clearly defined: Achieve (near) normoglycemia without severe hypoglycemic events, maintain other biochemical parameters within the normal range (lipids, etc.), and maintain or lower blood pressure and anthropometric parameters (body weight, waist/hip ratio). For other important therapeutic goals, optimal physical fitness and an overall good quality of life should be considered [1]. Despite all the modern treatment modalities, reality is often far from the optimal situation described. The first hybrid closed-loop system with official FDA approval is available in some countries. In hybrid closed-loop systems (approved or not yet), basal doses are driven automatically according to continuous glucose monitoring (CGM) data to maintain glycemia within the target range.
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