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Glycaemic load versus carbohydrate counting for insulin bolus calculation in patients with type 1 diabetes on insulin pump

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Abstract

Aims

To evaluate feasibility and effectiveness on short-term blood glucose control of using glycaemic load counting (GLC) versus carbohydrate counting (CC) for prandial insulin dosing in patients with type 1 diabetes (T1D).

Methods

Nine T1D patients on insulin pump, aged 26–58 years, HbA1c 7.7 ± 0.8 % (61 ± 8.7 mmol/mol), participated in this real-life setting study. By a crossover design, patients were randomised to calculate their pre-meal insulin dose based on the insulin/glycaemic load ratio (GLC period) or the insulin/carbohydrate ratio (CC period) for 1 week, shifting to the alternate method for the next week, when participants duplicated their first week food plan. Over either week, a blind subcutaneous continuous glucose monitoring was performed, and a 7-day food record was filled in.

Results

Total daily insulin doses (45 ± 10 vs. 44 ± 9 I.U.; M ± SD, p = 0.386) and basal infusion (26 ± 7 vs. 26 ± 8 I.U., p = 0.516) were not different during GLC and CC periods, respectively. However, the range of insulin doses (difference between highest and lowest insulin dose) was wider during GLC, with statistical significance at dinner (8.4 ± 6.2 vs. 6.0 ± 3.9 I.U., p = 0.041). Blood glucose iAUC after lunch was lower, albeit not significantly, during GLC than CC period (0.6 ± 8.6 vs. 3.4 ± 8.2 mmol/l∙3 h, p = 0.059). Postprandial glucose variability, evaluated as the maximal amplitude after meal (highest minus lowest glucose value), was significantly lower during GLC than CC period at lunch (4.22 ± 0.28 vs. 5.47 ± 0.39 mmol/l, p = 0.002) and dinner (3.89 ± 0.33 vs. 4.89 ± 0.33, p = 0.026).

Conclusions

Calculating prandial insulin bolus based on glycaemic load counting is feasible in a real-life setting and may improve postprandial glucose control in people with T1D.

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Acknowledgments

LB received a research grant from the Italian Diabetes Society: ‘Borsa di studio annuale SID-AMD Pasquale di Coste’.

Conflict of interest

The authors have no conflict of interest to disclose.

Ethical standard

This study was approved by the Ethics Committee for the Biomedical Activity of the Federico II University of Naples.

Human and Animal Rights disclosure

All human rights were observed in keeping with the Declaration of Helsinki 2008 (ICH GCP), and with the ethical standards of the responsible committee on human experimentation (Ethics Committee for the Biomedical Activity of the Federico II University of Naples). There are no animal rights issues as this is a clinical study.

Informed consent

Written informed consent was obtained from all participants being included in the study.

Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy

    L. Bozzetto, M. Giorgini, A. Alderisio, L. Costagliola, A. Giacco, G. Riccardi, A. A. Rivellese & G. Annuzzi

Authors
  1. L. Bozzetto
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  2. M. Giorgini
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  3. A. Alderisio
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  4. L. Costagliola
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  5. A. Giacco
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  6. G. Riccardi
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  7. A. A. Rivellese
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  8. G. Annuzzi
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Corresponding author

Correspondence to A. A. Rivellese.

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Managed by Massimo Porta.

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Bozzetto, L., Giorgini, M., Alderisio, A. et al. Glycaemic load versus carbohydrate counting for insulin bolus calculation in patients with type 1 diabetes on insulin pump. Acta Diabetol 52, 865–871 (2015). https://doi.org/10.1007/s00592-015-0716-1

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  • DOI: https://doi.org/10.1007/s00592-015-0716-1

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