Does meal‐time insulin dosing based on fat‐protein counting give positive results in postprandial glycaemic profile after a high protein‐fat meal in adolescents with type 1 diabetes: a randomised controlled trial

Abstract

BackgroundThe present study investigated the effects of fat‐protein (CFP) counting in addition to carbohydrate (CARB) counting for calculating prandial insulin dosage on blood glucose profile in patients with type 1 diabetes (T1D) on basal‐bolus insulin therapy.MethodsIn this single centre, cross‐over, randomised, controlled study, control meal (SM: standard meal using a carbohydrate counting method) and three test meals (HPM: high protein meal using a carbohydrate counting method; HPFM‐a: high protein‐fat meal using a carbohydrate counting method; HPFM‐b: high protein‐fat meal using a carbohydrate and fat‐protein counting method) were compared on postprandial early (0–120 min), late (120–240 min) and total (0–240 min) glucose response in 30 patients with T1D, aged 16–18 years.ResultsThe glucose levels of 0–90 min did not change after different meal consumptions (P > 0.05), whereas 120–240 min glucose levels were higher after HPFM‐a consumption compared to HPFM‐b consumption (P < 0.05). There were no significant differences between meals with respect to the early postprandial glucose response (0–120 min) (P = 0.405). In late response (120–240 min), HPFM‐b [area under the curve (AUC) = 20 609 (582) mg dL−1 × dk] was significantly lower than SM [AUC = 24 092 (9015) mg dL−1 × dk], HPM [AUC = 24 072 (5853) mg dL−1 × dk] and HPFM‐a [AUC = 25 986 (6979) mg dL−1 × dk] (P = 0.032).ConclusionsMeal‐related insulin dosing based on carbohydrate plus fat/protein counting has given positive results in the postprandial glycaemic profile as a result of lower postprandial glycaemic levels compared to conventional carbohydrate counting in patients with T1D after a high protein‐fat meal.

Insulin strategies for dietary fat and protein in type 1 diabetes: A systematic review

“…The majority of studies were conducted in the clinic (n = 12). 5,[13][14][15][16][17][18][19][20][21][22][23] Seven of the included studies were carried out in adults (>18 years), [13][14][15]17,18,21 one in adolescents (12-18 years), 5 three in children and adolescents (4-17 years), [24][25][26] three in adolescents and adults (13-28 years) 16,20,23 and four in children, adolescents and adults (6-21 years). 19,22,27,28…”

“…15,29 The remaining three studies included participants only using multiple daily injection (MDI) therapy. 21,23,28 All studies used rapid-acting meal insulin. Twelve of the included studies reported optimising participants' insulin doses prior to starting the study.…”

“…To measure postprandial glucose levels six studies used continuous glucose monitoring, 17,[25][26][27][28][29] three used venous blood testing, 5,15,18 six used capillary blood testing 13,14,[20][21][22][23] and a further three studies used a combination of continuous glucose monitoring and capillary blood testing. 16,19,24 Studies measured glucose for 3, 14,16…”

The comparison of two mealtime insulin dosing algorithms for high and low glycaemic index meals in adolescents with type 1 diabetes

“…Carbohydrates have been accepted as the predominant macronutrient affecting postprandial blood glucose and the major factor for calculating meal‐time insulin doses in type 1 diabetes. Nonetheless, emerging evidence from numerous studies have shown that other dietary factors, including protein, fat and GI, may importantly affect postprandial blood glucose 7,9,21‐24 . Since prandial insulin dose is a major determinant of postprandial glycaemia, choosing the effective insulin algorithm is an important clinical issue 4 .…”

Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes

“…Based on these findings, new methods to establish a more accurate need of insulin that would consider the complexity of the meal were required. Indeed, some studies showed a better glycemic control when using algorithms for calculating insulin dose that account also for protein and fat intake, besides carbohydrate [ 39 , 40 ]. However, more frequent episodes of hypoglycemia were reported when using supplementary fat/protein counting than CC [ 39 ].…”