P-368: Does the type of insulin affect postprandial hyperglycemia following a missed BOLUS in children using AID?
A Šantová, L Plachý, V Neuman, S A Amaratunga, M G Slavenko, B Obermannová, L Drnková, Š Průhová, Z ŠumníkAbstract
Introduction
In children with type 1 diabetes (CwD) treated with automated insulin delivery (AID) systems, missed premeal boluses remain a common issue that adversely impacts long-term glycemic outcomes. Rapid-acting insulin analogs differ in their pharmacokinetic and pharmacodynamic profile, which may affect the efficacy of hyperglycemia correction following a missed bolus.
Objectives
The aim of this study was to compare glycemic outcomes following a missed premeal bolus between two rapid-acting insulin analogs—insulin aspart (IAsp) and ultra-rapid lispro (URLi).
Methods
CwD treated with AID systems (MiniMed 780G [780G], Tandem Control-IQ [CIQ], and Ypsomed CamAPS [CamAPS]) consumed 30 and 50 grams of carbohydrates (CH) in the form of a standardized enteral nutrition without administration of a premeal bolus (twice with IAsp and twice with URLi). The differences between the insulin analogs in the area under the curve (AUC) of glucose concentration change and in time spent in hyperglycemia >13.9 mmol/L during the 4-hour postprandial period were analyzed.
Results
Forty-three CwD completed the study (mean age 13.4 years, mean HbA1c 46.9 mmol/mol [6.4%]). No significant differences between the insulin analogs were observed in any of the assessed parameters. The AUC was comparable across all AID systems: 780G 160 vs 164, CIQ 169 vs 168, CamAPS 180 vs 182 mmol/L·s ×103 for IAsp vs URLi after 50 g of CH (P=0.84, 95% CI for differences −9 to 13). Time spent in hyperglycemia >13.9 mmol/L was also similar: 22% vs 21% (780G), 27% vs 25% (CIQ), and 43% vs 42% (CamAPS) for IAsp vs URLi after 50 g of CH (P=0.88, 95% CI for differences −8%pt. to 5%pt.).
Conclusions
The glycemic response to a missed premeal bolus was comparable between the tested insulin analogs. Switching the insulin type is not likely to improve outcomes in CwD who frequently miss boluses.