TY - JOUR
T1 - Effect of nutrition on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully automated closed-loop insulin therapy
AU - Banholzer, Nicolas
AU - Herzig, David
AU - Piazza, Camillo
AU - Alvarez Martinez, Mario
AU - Nakas, Christos T.
AU - Kosinski, Christophe
AU - Feuerriegel, Stefan
AU - Hovorka, Roman
AU - Bally, Lia
N1 - Funding Information:
We are grateful to study participants for their involvement. Mich?le Monnard (Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern) supported data management and Regula Schneider (Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, University Hospital Bern) provided administrative support.
Publisher Copyright:
© 2020 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Fully automated closed-loop insulin delivery may offer a novel way to manage diabetes in hospital. However, postprandial glycaemic control remains challenging. We aimed to assess the effect of nutritional intake on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully closed-loop insulin therapy. The effects of different meal types and macronutrient composition on sensor glucose time-in-target (TIT, 3.9-10.0 mmol/L) and mean sensor glucose were assessed with hierarchical linear models using a Bayesian estimation approach. TIT was lower and the mean sensor glucose slightly higher, after breakfast compared with lunch and dinner, whereas the insulin dose was higher. Across meals, when carbohydrates were replaced by fat, or to a lesser extent by protein, postprandial glucose control improved. For breakfast, a 3.9% improvement in TIT was observed when 10% of the energy from carbohydrates was replaced by fat. Improvements were slightly lower during lunch and dinner (3.2% and 3.4%) or when carbohydrates were replaced by protein (2.2 and 2.7%, respectively). We suggest that reducing carbohydrate at the expense of fat or protein, could further improve glucose control during fully closed-loop insulin therapy in hospital.
AB - Fully automated closed-loop insulin delivery may offer a novel way to manage diabetes in hospital. However, postprandial glycaemic control remains challenging. We aimed to assess the effect of nutritional intake on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully closed-loop insulin therapy. The effects of different meal types and macronutrient composition on sensor glucose time-in-target (TIT, 3.9-10.0 mmol/L) and mean sensor glucose were assessed with hierarchical linear models using a Bayesian estimation approach. TIT was lower and the mean sensor glucose slightly higher, after breakfast compared with lunch and dinner, whereas the insulin dose was higher. Across meals, when carbohydrates were replaced by fat, or to a lesser extent by protein, postprandial glucose control improved. For breakfast, a 3.9% improvement in TIT was observed when 10% of the energy from carbohydrates was replaced by fat. Improvements were slightly lower during lunch and dinner (3.2% and 3.4%) or when carbohydrates were replaced by protein (2.2 and 2.7%, respectively). We suggest that reducing carbohydrate at the expense of fat or protein, could further improve glucose control during fully closed-loop insulin therapy in hospital.
KW - glycaemic control
KW - insulin therapy
KW - type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85091420811&partnerID=8YFLogxK
U2 - 10.1111/dom.14187
DO - 10.1111/dom.14187
M3 - Article
C2 - 32885596
VL - 23
SP - 234
EP - 239
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
SN - 1462-8902
IS - 1
ER -