Splitting Mealtime Insulin Doses for Mixed Fat and Protein Meals in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injection Regimen: A Randomized Cross-Over Trial
Authors' conclusion
Using regular insulin as a postmeal portion of increased and split insulin doses provided better late postprandial glycemic outcomes following mixed fat and protein meals. However, the amount of additional insulin used needs optimization to reduce the frequency of postprandial hypoglycemia. This trial is
Study context
- Population
- Children and adolescents with T1D on MDI; test meal two slices of pizza (40 g carbohydrate, 15 g fat, 20 g protein, 380 kcal)crossover, 3 consecutive days
- Participants
- 43 children
- Comparison
- Three mealtime insulin dosing strategies for a mixed fat and protein meal (pizza lunch): 100% insulin-to-carbohydrate ratio (ICR) premeal lispro + correction vs 130% ICR split lispro/lispro vs 130% ICR split lispro/regular insulin
- Intervention An = 43reference
- Intervention Bn = 43
- Intervention Cn = 43
- Primary endpoint
- Postprandial glycemic outcomes (blood glucose monitored for 6 hr)
- Follow-up
- 6 hr
Methodological detailssingle-centre, randomized, cross-over
- Single-centre
- Randomized
- Cross-over
Primary result
As reported in the abstract
Postprandial blood glucose excursions
- No significant differences in postprandial blood glucose excursions following the three interventions
Further findings
| Outcome | P value |
|---|---|
| Late (3–6 hr) blood glucose AUCIntervention C vs Intervention A, Intervention B · significantly lower with Intervention C | P = 0.01 |
Safety
| Outcome | Intervention B | Intervention C | P value |
|---|---|---|---|
| Postprandial hypoglycemiaIntervention C vs Intervention A, Intervention B | 27.9% | 39.5% | P = 0.32 |
Original publication
Splitting Mealtime Insulin Doses for Mixed Fat and Protein Meals in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injection Regimen: A Randomized Cross-Over Trial. Pediatr Diabetes. Published 27 October 2023. doi:10.
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