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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.
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 Laugesen, C., Ritschel, T., Ranjan, A., Hsu, L. J., Jørgensen, J. B., Svensson, J., Ekhlaspour, L., Buckingham, B. A., Norgaard, K. 2024Abstract
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.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 number of algorithm-detected MLBs and time in target glucose range (TIR; 70-180 mg/dL).The study included 189 children and adolescents (48% females with a mean ± SD 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% CI 11.3; 8.1), and compared to 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 to 74.8% in Q1 (p<0.001).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 higher TIR, and supports the need for further research in technological or behavioral support tools to handle missed and late meal boluses.
View details for DOI 10.1089/dia.2024.0022
View details for PubMedID 38805311