P-321: Food intake and meal BOLUS strategies and its association to glycemic outcomes in preschool children with type 1 diabetes
E Jelleryd, C E Smart, U Käck, A -L Brorsson, A Lindholm-OlinderAbstract
Introduction
Preschool children with type 1 diabetes entail specific challenges in meal situations due to their unpredictable eating behaviour and low insulin requirements. Access to modern diabetes technology such as continuous glucose monitoring (CGM) and insulin pumps with automated insulin delivery (AID) have improved glycemic outcomes and simplified meal bolus dosing. However, dietary quality has not improved risking cardiovascular health.
Objectives
The aim of this study was to examine food intake and bolus strategies and its association to glycemic outcomes and postprandial glucose levels.
Methods
A cross-sectional study of 27 children age <6 years with T1D on insulin pump therapy, using 3-day food records and data from insulin pumps and CGM to retrieve information on glucose outcomes, meal bolus dosing and postprandial glucose levels. Analysed using general linear mixed model, independent sample T-test and Pearson Correlation test.
Results
Using a pre-bolus dose overall improved postprandial glucose outcomes compared to using split doses for meals (p=<.001). The effect of bolus type varied by type of meal, with the largest differences observed for breakfast and lunch. No correlations between macronutrient intake and TIR or meal composition to postprandial glucose levels were found, however larger meals correlated to more bolus doses as well as a higher blood glucose at 60 min. The total number of manual bolus doses administered varied greatly (mean: 39, range: 21-102) and did not differ by type of pump used.
Conclusions
Using pre-bolus is advantageous in optimizing postprandial glucose levels compared to splitting bolus doses for meals, with the largest differences observed for breakfast and lunch. Caregivers to young children with T1D dose in a reactive manner as glucose spike after meals, increasing risk for late hypoglycemia despite use of automated insulin delivery systems.