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Behavioral Patterns and Associations with Glucose Control During 12-Week Randomized Free-Living Clinical Trial of Day and Night Hybrid Closed-Loop Insulin Delivery in Adults with Type 1 Diabetes

Year: 2017
Type: article
Abstract: OBJECTIVES: We evaluated patterns of meal intake, insulin bolus delivery, and fingerstick glucose measurements during hybrid closed-loop and sensor-augmented pump (SAP) therapy, including associations with glucose control. METHODS: Data were retrospectively analyzed from pump-treated adults with type 1 diabetes who underwent, in random order, 12 weeks free-living closed-loop (n = 32) and 12 weeks SAP (n = 33) periods. We quantified daily patterns of main meals, snacks, prandial insulin boluses, correction boluses, and fingerstick glucose measurements by analyzing data recorded on the study glucometer and on study insulin pump. RESULTS: We analyzed 1942 closed-loop days and 2530 SAP days. The total number of insulin boluses was reduced during closed-loop versus SAP periods by mean 1.0 per day (95% confidence interval 0.6-1.4, P < 0.001) mainly because of a reduced number of correction boluses by mean 0.7 per day (0.4-1.0, P < 0.001). Other behavioral patterns were unchanged. The carbohydrate content of snacks but not the number of snacks was positively correlated with (1) glycemic variability as measured by standard deviation of sensor glucose (closed-loop P < 0.05; SAP P < 0.01), (2) mean sensor glucose (P < 0.05), and (3) postintervention HbA1c (P < 0.05). Behavioral patterns explained 47% of between-subject variance in glucose variability during SAP period and 30%-33% of variance of means sensor glucose and postintervention HbA1c. CONCLUSION: Fewer correction boluses are delivered during closed-loop period. The size of snacks appears to worsen glucose control possibly because of carbohydrate-rich content of snacks. Modifiable behavioral patterns may be important determinants of glucose control.
DOI: 10.1089/dia.2016.0307
Authors: Ali Emami, Malgorzata E. Willinska, Hood Thabit, Lalantha Leelarathna, Sara Hartnell, Sibylle Dellweg, Carsten Benesch, Julia K. Mader, Manuel Holzer, Harald Kojzar, Thomas R. Pieber, Sabine Arnolds, Mark L. Evans, Roman Hovorka
Institutions: University of Cambridge, Wellcome/MRC Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, University of Manchester, Manchester University NHS Foundation Trust, Profil Institute for Metabolic Research, Medical University of Graz
Language: English
Field: Medicine
Open Access status: bronze
Estimated APC paid: $3,816
Funders: Leona M. and Harry B. Helmsley Charitable Trust, Wellcome Trust, National Institute for Health and Care Research, European Commission, Karl-Franzens-Universität Graz, Medizinische Universität Graz, Horizon 2020 Framework Programme, Abbott Diabetes Care, Efficacy and Mechanism Evaluation Programme, NIHR Cambridge Biomedical Research Centre, National Institute of Diabetes and Digestive and Kidney Diseases, NIHR Evaluation Trials and Studies Coordinating Centre
Awards: G10500178, G1178615512, G2018687014, G434337789, G4577803176, G461391184, Institute of Metabolic Science., 24/7 closed-loop in older subjects with type 1 diabetes, One year day-and-night home closed loop in young people with type 1 diabetes, G4937468798, G5246447471, G6049260834, Bringing the artificial pancreas home, G6351477851, G6525891988, Effect of closed loop insulin delivery from onset of diabetes in youth on progression of type 1 diabetes, G8589133502, The artificial pancreas in children aged 1 to 7 years with type 1 diabetes
OpenAlex ID: W2610186859
FWCI: 1.512
Cites: 14
Cited by: 16
Related to: 10