Application of novel dual wave meal bolus and its impact on glycated hemoglobin A1c level in children with type 1 diabetes

Pediatr Diabetes. 2009 Aug;10(5):298-303. doi: 10.1111/j.1399-5448.2008.00471.x. Epub 2008 Oct 20.

Abstract

Background: An insulin pump is an advanced technology offering new options of bolus - normal (N), dual wave (D-W) or square wave (S-W) bolus to deliver mealtime insulin.

Objectives: To assess the impact of D-W/S-W boluses on metabolic control (glycated haemoglobin A1c, HbA1c) and to estimate the paediatric patients compliance with implementation of this system in daily practice.

Methods: The cross-sectional study included 499 records of patients aged 0-18 yr. Data from the insulin pump memory provided information on the number of D-W/S-W boluses during a 2-wk period, the insulin requirement (U/kg/d) and the percentage of basal insulin. The HbA1c value (%) and the patient's weight were determined during medical examinations. Mealtime dose of insulin in D-W/S-W bolus was calculated based on the amount of carbohydrate and fat/protein products.

Results: The number of applied D-W/S-W boluses was 16.6 +/- 0.77/14 d (ranged 0-95), while 18.8% of patients did not program D-W/S-W boluses. The lowest HbA1c value was found in the group using two and/or more D-W/S-W boluses per day (p = 0.001) compared with the group administrating less than one D-W/S-W bolus/d. Patients with HbA1c level <7.5% had a statistically higher relevant number of D-W/S-W boluses, 19.55 (95% CI: 17.44-21.65) vs. 12.42 (95% CI: 10.22-14.61) (p < 0.001), while there was no correlation between the number of boluses and HbA1c in patients in the remission phase (<0.5 IU/kg/d) (r = 0.012, p = 0.930).

Conclusions: Patients using at least one D-W/S-W bolus per day achieved a recommended level of HbA1c. Paediatric patients with type 1 diabetes mellitus were found to be able to apply D-W/S-W boluses in daily self-treatment process based on food counting.

MeSH terms

  • Adolescent
  • Blood Glucose / metabolism
  • Body Weight / physiology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Dietary Carbohydrates / administration & dosage
  • Dietary Carbohydrates / analysis
  • Dietary Fats / administration & dosage
  • Dietary Fats / analysis
  • Dietary Proteins / administration & dosage
  • Dietary Proteins / analysis
  • Drug Dosage Calculations
  • Eating / physiology
  • Female
  • Glycated Hemoglobin A / analysis
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / therapeutic use
  • Infant
  • Infant, Newborn
  • Infusion Pumps, Implantable
  • Insulin / administration & dosage*
  • Insulin / analogs & derivatives
  • Insulin / therapeutic use
  • Insulin Infusion Systems*
  • Insulin, Long-Acting
  • Male
  • Patient Compliance
  • Treatment Outcome

Substances

  • Blood Glucose
  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Proteins
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • Insulin, Long-Acting