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Effect of nutrition on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully automated closed‐loop insulin therapy
Author(s) -
Banholzer Nicolas,
Herzig David,
Piazza Camillo,
ÁlvarezMartínez Mario,
Nakas Christos T,
Kosinski Christophe,
Feuerriegel Stefan,
Hovorka Roman,
Bally Lia
Publication year - 2021
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14187
Subject(s) - postprandial , insulin , medicine , meal , carbohydrate , type 1 diabetes , endocrinology , type 2 diabetes , diabetes mellitus , closed loop , control engineering , engineering
Fully automated closed‐loop insulin delivery may offer a novel way to manage diabetes in hospital. However, postprandial glycaemic control remains challenging. We aimed to assess the effect of nutritional intake on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully closed‐loop insulin therapy. The effects of different meal types and macronutrient composition on sensor glucose time‐in‐target (TIT, 3.9‐10.0 mmol/L) and mean sensor glucose were assessed with hierarchical linear models using a Bayesian estimation approach. TIT was lower and the mean sensor glucose slightly higher, after breakfast compared with lunch and dinner, whereas the insulin dose was higher. Across meals, when carbohydrates were replaced by fat, or to a lesser extent by protein, postprandial glucose control improved. For breakfast, a 3.9% improvement in TIT was observed when 10% of the energy from carbohydrates was replaced by fat. Improvements were slightly lower during lunch and dinner (3.2% and 3.4%) or when carbohydrates were replaced by protein (2.2 and 2.7%, respectively). We suggest that reducing carbohydrate at the expense of fat or protein, could further improve glucose control during fully closed‐loop insulin therapy in hospital.