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2.
Diabetes Technol Ther ; 22(1): 19-24, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31483167

RESUMO

Background: Timing of insulin administration in persons using multiple daily injections (MDI) is self-reported. New technology enabling tracking and logging of insulin doses, combined with continuous glucose monitoring (CGM), may provide insight into the relationship between insulin administration and glucose levels. Methods: We performed a prospective observational study using Bluetooth-enabled pen caps, along with CGM, in participants with type 1 diabetes (T1D) on MDI to objectively assess the relationship between the timing of insulin administration and its impact on pre- and postprandial glucose levels for a 2-week period. Results: We evaluated 50 participants (age 40.3 ± 19 years; A1c 8.2% ± 1.5%, duration of T1D 20 ± 15 years). Thirty-seven percent of total boluses resulted in persistent hyperglycemia (glucose >180 mg/dL 3 h postprandially), while 10% resulted in clinically significant hypoglycemia (glucose <55 mg/dL 3 h postprandially) on CGM. Preprandial glucose levels at the time of the bolus did not correlate with postprandial glucose levels. Late boluses, defined as a rise in glucose of ≥50 mg/dL before a bolus, were seen two times/patient/week. Missed boluses, defined as a rise in glucose of ≥50 mg/dL without a bolus within 2 h, occurred 17 times/patient/week. Late and missed boluses were associated with worse glycemic control (A1c; R2 = 0.1, P = 0.02; R2 = 0.1, P = 0.02). Conclusions: The use of Bluetooth-enabled pen caps, with CGM, in persons with T1D on MDI can illustrate the relationship between insulin bolus timing and postprandial glucose. These data may help clinicians and patients understand the impact of timing of insulin doses on glucose levels and glycemic control.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Período Pós-Prandial , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
3.
Diabetes Care ; 42(6): 1129-1131, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30862650

RESUMO

OBJECTIVE: To objectively evaluate adherence to timing and dosing of insulin by using Bluetooth pen caps and examine factors related to adherence. RESEARCH DESIGN AND METHODS: Bluetooth-enabled insulin pen caps were used in younger (ages 18-35 years) and older (ages ≥65 years) adults on two or more insulin injections per day. RESULTS: We evaluated 75 participants with diabetes, 42 younger (29 ± 4 years) and 33 older (73 ± 7 years). Nonadherence was found in 24% of bolus (Apidra) doses and 36% of basal (Lantus) doses. We divided participants into tertiles on the basis of overall adherence, with the most adherent tertile having 85% dose adherence compared with 49% in the least adherent tertile (P < 0.001). Participants in the most adherent tertile had better glycemic control than those in the least adherent tertile (7.7 ± 1.1% [61 ± 12 mmol/mol] vs. 8.6 ± 1.5% [70 ± 16.4 mmol/mol], P < 0.03). CONCLUSIONS: Nonadherence to insulin dosing and timing can be objectively assessed by Bluetooth pen caps and is associated with poor glycemic control.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Injeções , Insulina Glargina/administração & dosagem , Insulina/análogos & derivados , Adesão à Medicação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/efeitos dos fármacos , Estudos de Coortes , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Sistemas de Liberação de Medicamentos/instrumentação , Sistemas de Liberação de Medicamentos/métodos , Sistemas de Liberação de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Masculino , Adesão à Medicação/estatística & dados numéricos , Adulto Jovem
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