Article, 2024

Impact of Missed and Late Meal Boluses on Glycemic Outcomes in Automated Insulin Delivery-Treated Children and Adolescents with Type 1 Diabetes: A Two-Center, Population-Based Cohort Study

Diabetes Technology & Therapeutics, ISSN 1557-8593, 1520-9156, 10.1089/dia.2024.0022

Contributors

Laugesen, Christian 0000-0001-9253-9457 (Corresponding author) [1] [2] Ritschel, Tobias Kasper Skovborg 0000-0002-5843-240X [3] Ranjan, Ajenthen Gayathri 0000-0002-2253-6071 [1] Hsu, Liana [2] Jørgensen, John Bagterp 0000-0001-9799-2808 [3] Svensson, Jannet 0000-0002-9365-0728 [1] [4] Ekhlaspour, Laya [5] Buckingham, Bruce A 0000-0003-4581-4887 [2] Nørgaard, Kirsten 0000-0003-1620-8271 [1] [4]

Affiliations

  1. [1] Steno Diabetes Center
    2. [NORA names: Steno Diabetes Centers; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] Stanford University
    3. [NORA names: United States; America, North; OECD];
  3. [3] Technical University of Denmark
    4. [NORA names: DTU Technical University of Denmark; University; Denmark; Europe, EU; Nordic; OECD];
  4. [4] University of Copenhagen
    5. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
  5. [5] University of San Francisco
    6. [NORA names: United States; America, North; OECD]

Abstract

Objective: To evaluate the impact of missed or late meal boluses (MLBs) on glycemic outcomes in children and adolescents with type 1 diabetes using automated insulin delivery (AID) systems. Research Design and Methods: AID-treated (Tandem Control-IQ or Medtronic MiniMed 780G) children and adolescents (aged 6-21 years) from Stanford Medical Center and Steno Diabetes Center Copenhagen with ≥10 days of data were included in this two-center, binational, population-based, retrospective, 1-month cohort study. The primary outcome was the association between the number of algorithm-detected MLBs and time in target glucose range (TIR; 70-180 mg/dL). Results: The study included 189 children and adolescents (48% females with a mean ± standard deviation age of 13 ± 4 years). Overall, the mean number of MLBs per day in the cohort was 2.2 ± 0.9. For each additional MLB per day, TIR decreased by 9.7% points (95% confidence interval [CI] 11.3; 8.1), and compared with the quartile with fewest MLBs (Q1), the quartile with most (Q4) had 22.9% less TIR (95% CI: 27.2; 18.6). The age-, sex-, and treatment modality-adjusted probability of achieving a TIR of >70% in Q4 was 1.4% compared with 74.8% in Q1 (P < 0.001). Conclusions: MLBs significantly impacted glycemic outcomes in AID-treated children and adolescents. The results emphasize the importance of maintaining a focus on bolus behavior to achieve a higher TIR and support the need for further research in technological or behavioral support tools to handle MLBs.

Keywords

Children, Conclusions:</i></b, Copenhagen, Late, Objective:</i></b, Results:</i></b, Stanford, Steno Diabetes Center Copenhagen, TIR, adolescents, association, automated insulin delivery, behavior, bolus, bolus behavior, children, cohort, cohort study, data, days, days of data, delivery, glucose range, glycemic, glycemic outcomes, higher TIR, impact, insulin delivery, meal bolus, outcomes, population-based, population-based cohort study, primary outcome, probability, quartile, range, research, results, sex, study, support tool, target, target glucose range, time, tools, treatment, two-center, type, type 1 diabetes

Data Provider: Digital Science

LINKS
-

Matching Records in NORA

SUBJECTS
+

METRICS
+