Abstract
Fully automated closed-loop insulin delivery may offer a novel way to manage diabetes in hospital. However, postprandial glycaemic control remains challenging. We aimed to assess the effect of nutritional intake on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully closed-loop insulin therapy. The effects of different meal types and macronutrient composition on sensor glucose time-in-target (TIT, 3.9-10.0 mmol/L) and mean sensor glucose were assessed with hierarchical linear models using a Bayesian estimation approach. TIT was lower and the mean sensor glucose slightly higher, after breakfast compared with lunch and dinner, whereas the insulin dose was higher. Across meals, when carbohydrates were replaced by fat, or to a lesser extent by protein, postprandial glucose control improved. For breakfast, a 3.9% improvement in TIT was observed when 10% of the energy from carbohydrates was replaced by fat. Improvements were slightly lower during lunch and dinner (3.2% and 3.4%) or when carbohydrates were replaced by protein (2.2 and 2.7%, respectively). We suggest that reducing carbohydrate at the expense of fat or protein, could further improve glucose control during fully closed-loop insulin therapy in hospital.
Highlights
The present study assessed the effects of meal type and macronutrient composition on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully closed-loop insulin therapy
Macronutrient composition had a relevant effect on postprandial glucose control
This is the first study evaluating the effects of meal type and macronutrient composition on glucose control during fully closed-loop insulin delivery
Summary
The prevalence of diabetes among hospitalized patients is growing worldwide, calling for effective, resource-efficient and safe glucose management strategies.[1]. While nutritional intake is known to have an important effect on postprandial glucose control,[4] the impact of specific meal characteristics during fully automated closed-loop insulin delivery is largely unexplored. The objective of this work was to assess the effect of nutritional intake on postprandial glucose control in patients with type 2 diabetes receiving fully closed-loop insulin therapy while in hospital. Nutritional intake (meal type, energy and macronutrient content) was assessed by a member of the research team using food records and nutritional information from the hospital menu planning system and food database. Records containing at least two postprandial data sets for each meal type and participant were eligible. Missing sensor glucose values in the postprandial period were imputed using linear interpolation
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