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Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy
Poor self-management contributes to insufficient glycemic control in adolescents with type 1 diabetes (T1DM). We assessed the effects on glycemic control of adherence to self-measurement of blood glucose (SMBG) and insulin boluses in 90 adolescents with T1DM on insulin pump therapy over a 2-month pe...
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| Published in: | European journal of pediatrics 2018-12, Vol.177 (12), p.1831-1836 |
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| container_end_page | 1836 |
| container_issue | 12 |
| container_start_page | 1831 |
| container_title | European journal of pediatrics |
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| creator | Spaans, Engelina van Hateren, Kornelis J. J. Groenier, Klaas H. Bilo, Henk J. G. Kleefstra, Nanne Brand, Paul L. P. |
| description | Poor self-management contributes to insufficient glycemic control in adolescents with type 1 diabetes (T1DM). We assessed the effects on glycemic control of
adherence
to self-measurement of blood glucose (SMBG) and insulin boluses in 90 adolescents with T1DM on insulin pump therapy over a 2-month period. We compared the number of insulin boluses and SMBGs around main meals to the “gold standard” of optimal diabetes management (SMBGs and a bolus before each main meal and SMBG before bedtime). The mean (95% CI) HbA1c levels were 2.9(1.7 to 4.0) mmol/mol lower for every additional insulin bolus and 3.1(1.6 to 4.5) mmol/mol lower for every additional SMBG. Patients performing SMBG and bolusing around each main meal had considerably lower HbA1c levels than those unable to do (95% CI for difference 4.3 to 10.4 mmol/mol and 11.5 to 20.1 mmol/mol respectively). For each additional
mealtime
bolus/day, the odds ratio of achieving target HbA1c levels of
<
58 mmol/mol was 6.73 (95% CI 2.94–15.38), after adjustment for gender, age, diabetes duration, and affective responses to SMBG in a multiple logistic regression model.
Conclusion
: Glycemic control in adolescents with T1DM on insulin pump therapy is strongly dependent on
adherence
to insulin boluses around
mealtimes.
What is Known:
• In mixed groups of children and adolescents, insulin bolus frequency and self-monitoring of blood glucose (SMBG) frequency were determinants of HbA1c levels.
• Adherence to insulin boluses and SMBG is particularly challenging in adolescents.
What is New:
• In adolescents on insulin pump therapy, each additional insulin bolus, particularly around mealtime, was significantly associated with approximately 3 mmol/mol lower HbA1c levels.
• This beneficial effect of mealtime bolusing was strongest for the evening meal. |
| doi_str_mv | 10.1007/s00431-018-3256-1 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2111143341</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2110113610</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-471ba616d556307eb7d98383fbdbd12d4d6afef5dea66bf3733ea66153d77253</originalsourceid><addsrcrecordid>eNp1kE9r3DAQxUVIyG6TfIBcgiGXXtxoPLbkPYaQ_oGUXHIMCNkab73IkiPZh_32ldl0C4HMRQP6vTePx9g18G_AubyLnJcIOYc6x6ISOZywNZRY5MClOGVrjiXPBWw2K_Ylxh1Pmg3U52yFvMAaKlyz19-k7dQPlPUuzrZ3WePtHDNt_lAg11Kmncm2dt_S0LdZ690UvE1wIryl2JKbYubdUT7Ow5hNSazH_SU767SNdPX-XrCX748vDz_zp-cfvx7un_IWZTHlpYRGCxCmqgRySY00mxpr7BrTGChMaYTuqKsMaSGaDiXisqX8Rsqiwgv29WA7Bv82U5zU0Kdg1mpHfo6qgDQlYgkJvf2A7vwcXAq3UBwABfBEwYFqg48xUKfG0A867BVwtTSvDs2r1LxamleL882789wMZI6Kf1UnoDgAMX25LYX_pz93_QuxPo5J</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2110113610</pqid></control><display><type>article</type><title>Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy</title><source>Springer Link</source><creator>Spaans, Engelina ; van Hateren, Kornelis J. J. ; Groenier, Klaas H. ; Bilo, Henk J. G. ; Kleefstra, Nanne ; Brand, Paul L. P.</creator><creatorcontrib>Spaans, Engelina ; van Hateren, Kornelis J. J. ; Groenier, Klaas H. ; Bilo, Henk J. G. ; Kleefstra, Nanne ; Brand, Paul L. P.</creatorcontrib><description>Poor self-management contributes to insufficient glycemic control in adolescents with type 1 diabetes (T1DM). We assessed the effects on glycemic control of
adherence
to self-measurement of blood glucose (SMBG) and insulin boluses in 90 adolescents with T1DM on insulin pump therapy over a 2-month period. We compared the number of insulin boluses and SMBGs around main meals to the “gold standard” of optimal diabetes management (SMBGs and a bolus before each main meal and SMBG before bedtime). The mean (95% CI) HbA1c levels were 2.9(1.7 to 4.0) mmol/mol lower for every additional insulin bolus and 3.1(1.6 to 4.5) mmol/mol lower for every additional SMBG. Patients performing SMBG and bolusing around each main meal had considerably lower HbA1c levels than those unable to do (95% CI for difference 4.3 to 10.4 mmol/mol and 11.5 to 20.1 mmol/mol respectively). For each additional
mealtime
bolus/day, the odds ratio of achieving target HbA1c levels of
<
58 mmol/mol was 6.73 (95% CI 2.94–15.38), after adjustment for gender, age, diabetes duration, and affective responses to SMBG in a multiple logistic regression model.
Conclusion
: Glycemic control in adolescents with T1DM on insulin pump therapy is strongly dependent on
adherence
to insulin boluses around
mealtimes.
What is Known:
• In mixed groups of children and adolescents, insulin bolus frequency and self-monitoring of blood glucose (SMBG) frequency were determinants of HbA1c levels.
• Adherence to insulin boluses and SMBG is particularly challenging in adolescents.
What is New:
• In adolescents on insulin pump therapy, each additional insulin bolus, particularly around mealtime, was significantly associated with approximately 3 mmol/mol lower HbA1c levels.
• This beneficial effect of mealtime bolusing was strongest for the evening meal.</description><identifier>ISSN: 0340-6199</identifier><identifier>EISSN: 1432-1076</identifier><identifier>DOI: 10.1007/s00431-018-3256-1</identifier><identifier>PMID: 30238153</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adolescents ; Blood glucose ; Blood Glucose - analysis ; Blood Glucose - drug effects ; Child ; Children ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (insulin dependent) ; Diabetes Mellitus, Type 1 - blood ; Diabetes Mellitus, Type 1 - drug therapy ; Female ; Glucose ; Glycated Hemoglobin A - analysis ; Humans ; Insulin ; Insulin - administration & dosage ; Insulin Infusion Systems - statistics & numerical data ; Male ; Meals ; Medicine ; Medicine & Public Health ; Original Article ; Patient Compliance - statistics & numerical data ; Pediatrics ; Self-Management - methods ; Teenagers</subject><ispartof>European journal of pediatrics, 2018-12, Vol.177 (12), p.1831-1836</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>European Journal of Pediatrics is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-471ba616d556307eb7d98383fbdbd12d4d6afef5dea66bf3733ea66153d77253</citedby><cites>FETCH-LOGICAL-c372t-471ba616d556307eb7d98383fbdbd12d4d6afef5dea66bf3733ea66153d77253</cites><orcidid>0000-0003-1881-3475</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30238153$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Spaans, Engelina</creatorcontrib><creatorcontrib>van Hateren, Kornelis J. J.</creatorcontrib><creatorcontrib>Groenier, Klaas H.</creatorcontrib><creatorcontrib>Bilo, Henk J. G.</creatorcontrib><creatorcontrib>Kleefstra, Nanne</creatorcontrib><creatorcontrib>Brand, Paul L. P.</creatorcontrib><title>Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy</title><title>European journal of pediatrics</title><addtitle>Eur J Pediatr</addtitle><addtitle>Eur J Pediatr</addtitle><description>Poor self-management contributes to insufficient glycemic control in adolescents with type 1 diabetes (T1DM). We assessed the effects on glycemic control of
adherence
to self-measurement of blood glucose (SMBG) and insulin boluses in 90 adolescents with T1DM on insulin pump therapy over a 2-month period. We compared the number of insulin boluses and SMBGs around main meals to the “gold standard” of optimal diabetes management (SMBGs and a bolus before each main meal and SMBG before bedtime). The mean (95% CI) HbA1c levels were 2.9(1.7 to 4.0) mmol/mol lower for every additional insulin bolus and 3.1(1.6 to 4.5) mmol/mol lower for every additional SMBG. Patients performing SMBG and bolusing around each main meal had considerably lower HbA1c levels than those unable to do (95% CI for difference 4.3 to 10.4 mmol/mol and 11.5 to 20.1 mmol/mol respectively). For each additional
mealtime
bolus/day, the odds ratio of achieving target HbA1c levels of
<
58 mmol/mol was 6.73 (95% CI 2.94–15.38), after adjustment for gender, age, diabetes duration, and affective responses to SMBG in a multiple logistic regression model.
Conclusion
: Glycemic control in adolescents with T1DM on insulin pump therapy is strongly dependent on
adherence
to insulin boluses around
mealtimes.
What is Known:
• In mixed groups of children and adolescents, insulin bolus frequency and self-monitoring of blood glucose (SMBG) frequency were determinants of HbA1c levels.
• Adherence to insulin boluses and SMBG is particularly challenging in adolescents.
What is New:
• In adolescents on insulin pump therapy, each additional insulin bolus, particularly around mealtime, was significantly associated with approximately 3 mmol/mol lower HbA1c levels.
• This beneficial effect of mealtime bolusing was strongest for the evening meal.</description><subject>Adolescent</subject><subject>Adolescents</subject><subject>Blood glucose</subject><subject>Blood Glucose - analysis</subject><subject>Blood Glucose - drug effects</subject><subject>Child</subject><subject>Children</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (insulin dependent)</subject><subject>Diabetes Mellitus, Type 1 - blood</subject><subject>Diabetes Mellitus, Type 1 - drug therapy</subject><subject>Female</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Humans</subject><subject>Insulin</subject><subject>Insulin - administration & dosage</subject><subject>Insulin Infusion Systems - statistics & numerical data</subject><subject>Male</subject><subject>Meals</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Patient Compliance - statistics & numerical data</subject><subject>Pediatrics</subject><subject>Self-Management - methods</subject><subject>Teenagers</subject><issn>0340-6199</issn><issn>1432-1076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kE9r3DAQxUVIyG6TfIBcgiGXXtxoPLbkPYaQ_oGUXHIMCNkab73IkiPZh_32ldl0C4HMRQP6vTePx9g18G_AubyLnJcIOYc6x6ISOZywNZRY5MClOGVrjiXPBWw2K_Ylxh1Pmg3U52yFvMAaKlyz19-k7dQPlPUuzrZ3WePtHDNt_lAg11Kmncm2dt_S0LdZ690UvE1wIryl2JKbYubdUT7Ow5hNSazH_SU767SNdPX-XrCX748vDz_zp-cfvx7un_IWZTHlpYRGCxCmqgRySY00mxpr7BrTGChMaYTuqKsMaSGaDiXisqX8Rsqiwgv29WA7Bv82U5zU0Kdg1mpHfo6qgDQlYgkJvf2A7vwcXAq3UBwABfBEwYFqg48xUKfG0A867BVwtTSvDs2r1LxamleL882789wMZI6Kf1UnoDgAMX25LYX_pz93_QuxPo5J</recordid><startdate>20181201</startdate><enddate>20181201</enddate><creator>Spaans, Engelina</creator><creator>van Hateren, Kornelis J. J.</creator><creator>Groenier, Klaas H.</creator><creator>Bilo, Henk J. G.</creator><creator>Kleefstra, Nanne</creator><creator>Brand, Paul L. P.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1881-3475</orcidid></search><sort><creationdate>20181201</creationdate><title>Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy</title><author>Spaans, Engelina ; van Hateren, Kornelis J. 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J.</au><au>Groenier, Klaas H.</au><au>Bilo, Henk J. G.</au><au>Kleefstra, Nanne</au><au>Brand, Paul L. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy</atitle><jtitle>European journal of pediatrics</jtitle><stitle>Eur J Pediatr</stitle><addtitle>Eur J Pediatr</addtitle><date>2018-12-01</date><risdate>2018</risdate><volume>177</volume><issue>12</issue><spage>1831</spage><epage>1836</epage><pages>1831-1836</pages><issn>0340-6199</issn><eissn>1432-1076</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Poor self-management contributes to insufficient glycemic control in adolescents with type 1 diabetes (T1DM). We assessed the effects on glycemic control of
adherence
to self-measurement of blood glucose (SMBG) and insulin boluses in 90 adolescents with T1DM on insulin pump therapy over a 2-month period. We compared the number of insulin boluses and SMBGs around main meals to the “gold standard” of optimal diabetes management (SMBGs and a bolus before each main meal and SMBG before bedtime). The mean (95% CI) HbA1c levels were 2.9(1.7 to 4.0) mmol/mol lower for every additional insulin bolus and 3.1(1.6 to 4.5) mmol/mol lower for every additional SMBG. Patients performing SMBG and bolusing around each main meal had considerably lower HbA1c levels than those unable to do (95% CI for difference 4.3 to 10.4 mmol/mol and 11.5 to 20.1 mmol/mol respectively). For each additional
mealtime
bolus/day, the odds ratio of achieving target HbA1c levels of
<
58 mmol/mol was 6.73 (95% CI 2.94–15.38), after adjustment for gender, age, diabetes duration, and affective responses to SMBG in a multiple logistic regression model.
Conclusion
: Glycemic control in adolescents with T1DM on insulin pump therapy is strongly dependent on
adherence
to insulin boluses around
mealtimes.
What is Known:
• In mixed groups of children and adolescents, insulin bolus frequency and self-monitoring of blood glucose (SMBG) frequency were determinants of HbA1c levels.
• Adherence to insulin boluses and SMBG is particularly challenging in adolescents.
What is New:
• In adolescents on insulin pump therapy, each additional insulin bolus, particularly around mealtime, was significantly associated with approximately 3 mmol/mol lower HbA1c levels.
• This beneficial effect of mealtime bolusing was strongest for the evening meal.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30238153</pmid><doi>10.1007/s00431-018-3256-1</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1881-3475</orcidid></addata></record> |
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| language | eng |
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| subjects | Adolescent Adolescents Blood glucose Blood Glucose - analysis Blood Glucose - drug effects Child Children Diabetes Diabetes mellitus Diabetes mellitus (insulin dependent) Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - drug therapy Female Glucose Glycated Hemoglobin A - analysis Humans Insulin Insulin - administration & dosage Insulin Infusion Systems - statistics & numerical data Male Meals Medicine Medicine & Public Health Original Article Patient Compliance - statistics & numerical data Pediatrics Self-Management - methods Teenagers |
| title | Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy |
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