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Lu, Jean C.; Vogrin, Sara; McAuley, Sybil A.; Lee, Melissa H.; Paldus, Barbora; Bach, Leon A.; Burt, Morton G.; Clarke, Philip M.; Cohen, Neale D.; Colman, Peter G.; de Bock, Martin I.; Jane Holmes-Walker, D.; Jenkins, Alicia J.; Kaye, Joey; Keech, Anthony C.; Kumareswaran, Kavita; MacIsaac, Richard J.; McCallum, Roland W.; Roem, Kerryn; Sims, Catriona; Stranks, Stephen N.; Trawley, Steven; Ward, Glenn M.; Sundararajan, Vijaya; Jones, Timothy W.; O'Neal, David N.
Diabetes research and clinical practice, September 2021, 2021-09-00, 20210901, Volume: 179Journal Article
To compare meal-time glycaemia in adults with type 1 diabetes mellitus (T1D) managed with multiple daily injections (MDI) vs. insulin pump therapy (IPT), using self-monitoring blood glucose (SMBG), following diabetes education. Adults with T1D received carbohydrate-counting education and a bolus calculator: MDI (Roche Aviva Expert) and IPT (pump bolus calculator). All then wore 3-weeks of masked-CGM (Enlite, Medtronic). Meal-times were assessed by two approaches: 1) Set time-blocks (breakfast 06:00–10:00hrs; lunch 11:00–15:00hrs; dinner 17:00–21:00hrs) and 2) Bolus-calculator carbohydrate entries signalling meal commencement. Post-meal masked-CGM time-in-range (TIR) 3.9–10.0 mmol/L was the primary outcome. MDI(n = 61) and IPT (n = 59) participants were equivalent in age, sex, diabetes duration and HbA1c. Median (IQR) education time provided did not differ (MDI: 1.1 h (0.75, 1.5) vs. IPT: 1.1 h (1.0, 2.0); p = 0.86). Overall, daytime (06:00–24:00hrs), lunch and dinner TIR did not differ for MDI vs. IPT participants but was greater for breakfast with IPT in both analyses with a mean difference of 12.8%, (95 CI 4.8, 20.9); p = 0.002 (time-block analysis). After diabetes education, MDI and IPT use were associated with similar day-time glycemia, though IPT users had significantly greater TIR during the breakfast period. With education, meal-time glucose levels are comparable with use of MDI vs. pumps.
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