Optimizing Insulin Pump Therapy: Advanced Bolus Options

Abstract

Introduction The advanced bolus options improve glycemic control of patients with type 1 diabetes (T1D) on insulin pump (IP) therapy. This is extremely important for the patients who do not use CGM (continuous glucose monitoring) regularly. Objective To compare the difference in the parameters of glycemic control (HbA1c, postprandial increase of blood glucose and number of hypoglycemic episodes per week) between the group of patients who use bolus calculator for <50% of the total daily boluses and the group the patients who use bolus calculator for ≥50% of total daily boluses. Patients and methods The study included 41 patients aged over 18 years with T1D on IP therapy in Republika of Srpska. All patients used IP for at least one year prior to participation in the study. Before the IP therapy was initiated, all the patients were trained for carbohydrate counting in course of flexible insulin therapy training (FIT). Professional software, CareLink Pro® Software (Medtronic Inc., Northridge, CA, USA) was used to download data from insulin pumps to a personal computer. The default frequency of bolus calculator use was ≥50% of total daily boluses. Results No statistically significant difference was found in HbA1c (6.61 ± 1.10 vs. 6.77 ± 0.97, p = 0.624) or the number of hypoglycemic episodes (2.00 (1.00, 4.00) (1.0–6.0) versus 3.00 (2.00, 3.50) (1.0–5.0), p = 0.322) between the group of patients who have used bolus calculator for <50% of the total daily boluses and the group of patients who used bolus calculator for ≥50% of total daily boluses. Patients who have used bolus calculator had significantly lower postprandial increase in blood glucose after breakfast. Conclusion Among the patients with T1D on IP therapy, who do not regularly use CGM the use of the bolus calculator and use of different types of boluses, can improve glycemic control on IP therapy.