Introduction and Objective: Achieving optimal postprandial glucose control is a primary goal in managing type 1 diabetes. While insulin delivery prior to meals is recommended for tighter glucose control, many individuals do not adhere to this practice for various reasons. Meal announcements in conjunction with Advanced Hybrid Closed Loop (AHCL) systems play a pivotal role in determining post-meal glucose excursions. This study evaluated the impact of meal bolus timing with an AHCL system by assessing the effect of different bolus schedules on postprandial glucose levels following a medium-sized meal.Methods: A group of thirteen people with type 1 diabetes, aged 42.8±13.6 years, with a baseline hemoglobin A1c of 6.9±0.67%, participated in this study. Participants completed meal tests representing four bolus timing strategies: administration ten minutes before the meal, delivery at meal onset, reduced bolus by 50% delivered thirty minutes after the meal, and reduced bolus by 50% delivered sixty minutes after the meal.Results: The study revealed that bolusing at meal onset yielded comparable Time in Range (TIR) compared to the ten-minute pre-meal bolus approach (82.2% vs. 77.4%, p=0.5), while significantly reducing time spent in hypoglycemia (p=0.016).Conclusion: These findings underscore the potential of AHCL systems utilizing real-time sensor glucose measurements to eliminate pre-meal bolusing requirements, thereby enhancing postprandial glycemic control and reducing the management burden for people with type 1 diabetes. This research illuminates innovative approaches to optimize glucose management.
M. Laron Hirsh: Consultant; Medtronic. A. Benedetti: None. A. Roy: Employee; Metronics. B. Grosman: Employee; Medtronic. O. Cohen: Employee; Medtronic. A. Tirosh: Advisory Panel; Abbott. Speaker’s Bureau; AstraZeneca, Eli Lilly and Company. Advisory Panel; Sanofi. Research Support; Medtronic. Advisory Panel; Novo Nordisk A/S. Consultant; Radella Pharma, Dreamed Diabetes.
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