Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy

Objective To investigate carbohydrate ( CARB ) and supplementary fat/protein ( CFP ) counting using normal and dual‐wave bolus in pump therapy of children and young people with type 1 diabetes ( T1D ). Study design and methods A randomized clinical trial was conducted in 42 patients (age 6–21 yr) with T1D for at least 1 yr (5.2 ± 3.1 yr, mean ± SD ) and pump therapy for at least 3 months (3.3 ± 1.8 yr). Standardized test meals (pizza‐salami; 50% carbohydrate, 34% fat, 16% protein; corresponding to 33% of age‐adjusted daily energy requirement) were given at lunch time on four different days with normal and dual‐wave bolus using CARB and CFP counting in a randomized sequence. Sensor‐augmented pumps were used for continuous glucose monitoring of 6‐h postprandial glucose profiles. Intra‐individual comparisons of glucose parameters [area under the curve ( AUC ) mg/dL ×6 h; average glucose, AV mg/dL] were performed. Results Using CFP counting, 6‐h postprandial glucose AUC (805 ± 261) and AV (137.8 ± 46.2) were significantly lower than AUC (926 ± 285) and AV (160.5 ± 51.9) by CARB counting (p < 0.001, each). CFP counting led to significantly lower postprandial glucose parameters independently from the kind of bolus (normal bolus: Δ AUC 169, p < 0.001; Δ AV 30.6, p < 0.001/dual‐wave bolus: Δ AUC 73, p = 0.045, Δ AV 14.8, p = 0.033). Postprandial hypoglycemia episodes (<70 mg/dL) occurred more frequently in CFP than in CARB counting (35.7% vs. 9.5%, p < 0.001). No severe hypoglycemia was reported. Conclusion In patients with long‐term T1D , meal‐related insulin dosing based on carbohydrate plus fat/protein counting reduces the postprandial glucose levels ( ClinicalTrials.gov NCT01400659 ).