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Bolus calculators improve glycemic control in type 1 diabetes

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December 7, 2016

Patients with type 1 diabetes who used bolus calculators to count carbohydrates achieved “optimal and persistent” glycemic control compared with patients who did not, according to study data from Japan.

“The Diabetes Control and Complication Trial showed that both intensive insulin therapy, which is performed by multiple daily injections or continuous subcutaneous insulin infusion, and carbohydrate counting were necessary to achieve optimal glycemic control to prevent diabetic complications in type 1 diabetes,” Eijiro Yamada, MD, PhD, of the department of medicine and molecular science at Gunma University Graduate School of Medicine, Maebashi, Japan, and colleagues wrote. “Bolus insulin in carbohydrate counting is determined using the carbohydrate-insulin ratio, insulin sensitivity factor and target blood glucose levels. Patients using continuous subcutaneous insulin infusion could calculate bolus insulin using software (bolus calculator). The calculator considers active insulin; therefore, patients can avoid hypoglycemia. Carbohydrate counting’s efficacy, especially its long-term efficacy, using a bolus calculator during continuous subcutaneous insulin infusion remains unclear.”

Researchers identified 22 patients with type 1 diabetes who had recently begun subcutaneous insulin infusion at Gunma University Hospital between 2011 and 2015. Patients fell into two groups: 14 patients who used bolus calculators and eight who did not. Yamada and colleagues tracked patients’ HbA1c levels as a measure of glycemic control, and patients received at least 30 minutes of dietary counseling, as well as either a Minimed Paradigm 722 or Minimed 620G (Medtronic) insulin pump.

Patients using bolus calculators saw a slow, but significant and persistent HbA1c decrease that continued over the course of 1 year, the researchers wrote (P = .0297). Patients who did not receive bolus calculators did not experience any decrease in HbA1c, despite receiving regular dietary counseling, Yamada and colleagues reported. Their HbA1c levels had returned to baseline by the end of 1 year. Neither group experienced a change in body weight.

“In summary, we investigated the efficacy of carbohydrate counting using a bolus calculator during continuous subcutaneous insulin infusion therapy. Patients [who used bolus calculators] achieved optimal glycemic control without any change in bodyweight or total daily insulin dose while patients [who did not use bolus calculators] did not have this outcome. Importantly, this effect was maintained over 1 year. Future studies including more patients are necessary to reconfirm these results.” ­– by Andy Polhamus

 

Disclosure: The authors report no relevant financial disclosures.

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