Previous meta-analyses have suggested that people with type 1 diabetes achieve better glycaemic control using insulin pumps than multiple daily injections (MDI); however, it has been proposed that this effect may be due to higher rates of carbohydrate counting education and use of bolus calculators in pump users. Therefore, this post hoc, cross-sectional analysis sought to evaluate glycaemic control, assessed using masked continuous glucose monitoring, in pump and MDI users who were given the same one-to-one carbohydrate counting education and use of a bolus calculator.
A total of 120 participants were evaluated (61 MDI, 59 pump users). The pump group all used the bolus calculator incorporated in their insulin pump, while MDI users were provided with a glucometer that incorporated a bolus calculator. All participants used finger-prick testing to assess their blood glucose levels.
Over the three-week study period, there was no significant difference between the MDI and pump groups in terms of time in, below or above range over 24 hours. Blood glucose levels were also similar in the post-lunch and post-dinner periods. However, post-breakfast, MDI users had 8.5% less time in range, 0.8 mmol/L higher peak glucose and a 71% greater area under the curve for glucose >10 mmol/L compared with pump users.
Notably, only 10% of pump users used advanced functions such as dual/extended wave boluses, and the authors point out that greater use of these functions might have led to a larger difference in glycaemia between pump and MDI users.
The authors conclude that, although post-breakfast glucose levels remain higher in MDI users, in general users of the two insulin delivery methods can achieve similar postprandial control if given sufficient carbohydrate counting education and use of bolus calculation tools.
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