Towards a better understanding of postprandial hyperglycemic episodes in people with diabetes: impact on daily functioning

Heller, Simon; Meneghini, Luigi; Nikolajsen, Annie; Kragh, Nana; Lewis, Heather; Saretsky, T.; Kosmas, Charlotte E; Lloyd, Andrew

doi:10.1080/03007995.2018.1525344

Cited by 4 publications

(2 citation statements)

References 42 publications

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“…12 In a large study of patients with type 1 diabetes and type 2 diabetes (n = 1200), Heller et al found that increased severity and frequency of acute postprandial hyperglycemia is associated with greater burden and experience of symptoms and can negatively impact daily functioning of patients. 13 CGM-based measures such as TIR provide additional information that patients can use to understand how their insulin, meals, and exercise affect glycemic control. TIR was also identified as one of the ''biggest drivers of improved diabetes management and mindset,'' and ranked only behind food choice as having the biggest impact on daily life in a survey of 3461 people with type 1 diabetes or type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Ultra-Rapid Lispro Improves Postprandial Glucose Control and Time in Range in Type 1 Diabetes Compared to Lispro: PRONTO-T1D Continuous Glucose Monitoring Substudy

Małecki

Cao

Liu

et al. 2020

Diabetes Technology & Therapeutics

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Background: This study evaluated glucose control by continuous glucose monitoring (CGM) during treatment with ultra-rapid lispro (URLi) or lispro used in combination with insulin glargine or degludec in adults with type 1 diabetes in a substudy of the PRONTO-T1D study. Methods: Ambulatory glucose profiles were evaluated in 269 patients from PRONTO-T1D assigned to doubleblind URLi (n = 97) or lispro (n = 99) given 0-2 min before the start of the meal (mealtime), or open-label URLi (n = 73) given 20 min after the meal (postmeal URLi). Blinded CGM was used for up to 14 days before baseline and the 26-week primary endpoint. The primary objective was to compare mealtime URLi and lispro with respect to incremental area under the serum glucose concentration versus time curve from 0 to 2 h (iAUC 0-2h) after breakfast. Results: Mealtime URLi was superior in reducing the iAUC 0-2h when compared to lispro for breakfast (least squares mean [LSM] difference-28.1 mg$h/L, P = 0.048) and for all meals combined. iAUC 0-3h and iAUC 0-4h were also reduced. Postmeal URLi resulted in similar postprandial glucose (PPG) control to mealtime lispro, but less optimal PPG control compared to mealtime URLi. Mealtime URLi increased daytime time in range (71-180 mg/dL [3.9-10.0 mmo/L]) (LSM difference = +43.6 min, P = 0.020) and decreased nighttime time in hypoglycemia (LSM difference £70 mg/dL [3.9 mmol/L] =-11.5 min, P = 0.009) compared to mealtime lispro. Conclusions: Results of this CGM substudy support the improved PPG control seen with mealtime URLi in the PRONTO-T1D study and show that mealtime URLi resulted in improved daytime time in target range.

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Section: Discussionmentioning

confidence: 99%

Ultra-Rapid Lispro Improves Postprandial Glucose Control and Time in Range in Type 1 Diabetes Compared to Lispro: PRONTO-T1D Continuous Glucose Monitoring Substudy

Małecki

Cao

Liu

et al. 2020

Diabetes Technology & Therapeutics

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“…Early (1 h) post-prandial hyperglycemic spikes emerge as better determinant of metabolic dysregulation and vascular alterations than later (2 h) glycemic values (3). Post-prandial hyperglycemia also worsens quality of life and is associated with loss of productivity (4)(5)(6). Therefore, mitigating post-prandial hyperglycemia is one of the aims of T1D glycemic management.…”

Section: Introductionmentioning

confidence: 99%

Glycemic control after switching to faster aspart in adults with type 1 diabetes

Fadini

Boscari

Falaguasta

et al. 2022

J Endocrinol Invest

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Aims Post-prandial hyperglycemia remains an unmet need in the management of type 1 diabetes (T1D). In randomized trials, faster insulin aspart (FIA) showed modest but significant reductions of glycemic spikes after meals. Whether such benefit is evident in routine clinical practice is unclear. Methods We analyzed data of patients with T1D at the time they switched from a prior bolus insulin to FIA and at the first available follow-up. The primary endpoint was the change in the time spent in hyperglycemia > 250 mg/dl during daytime from flash glucose monitoring (FGM). Secondary outcomes included the change in HbA1c, body weight, insulin dose and other FGM metrics. Results We included 117 patients with T1D on multiple daily injections who switched to FIA, 57 of whom had data from FGM. Patients were 41-year-old, 51.3% men, with 19.3 years diabetes duration and a baseline HbA1c of 7.7% (60 mmol/mol). Mean observation time was 4.3 months. After switching to FIA, HbA1c declined by 0.1% (1 mmol/mol) only in patients with baseline HbA1c > 7.0% (53 mmol/mol). Time spent in hyperglycemia > 250 mg/dl during daytime was significantly reduced from 14.8 to 11.9% (p = 0.006). Time in range improved from 48.3 to 51.0% (p = 0.028). Results were consistent across various patient characteristics. Conclusions Under routine care, patients with T1D who switched to FIA experienced a reduction in the time spent in hyperglycemia > 250 mg/dl during daytime and an increase in time in range. These improvements may be due to better control of post-prandial hyperglycemia, as observed in trials.

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Are New Ultra-Rapid-Acting Insulins Associated with Improved Glycemic Control and Reduced Hypoglycemia in Comparison to Conventional Rapid-Acting Insulins for Individuals with Type 1 and Type 2 Diabetes? A Systematic Review and Meta-Analysis

Villar-Taibo,

Galdón Sanz-Pastor,

Fernández-Rubio

et al. 2024

Diabetes Technology & Therapeutics

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Towards a better understanding of postprandial hyperglycemic episodes in people with diabetes: impact on daily functioning

Abstract: Increased severity and frequency of aPPHG episodes in patients with insulin-treated diabetes is associated with greater burden and experience of symptoms, and can negatively impact daily functioning.

Cited by 4 publications

References 42 publications

Ultra-Rapid Lispro Improves Postprandial Glucose Control and Time in Range in Type 1 Diabetes Compared to Lispro: PRONTO-T1D Continuous Glucose Monitoring Substudy

Ultra-Rapid Lispro Improves Postprandial Glucose Control and Time in Range in Type 1 Diabetes Compared to Lispro: PRONTO-T1D Continuous Glucose Monitoring Substudy

Glycemic control after switching to faster aspart in adults with type 1 diabetes

Are New Ultra-Rapid-Acting Insulins Associated with Improved Glycemic Control and Reduced Hypoglycemia in Comparison to Conventional Rapid-Acting Insulins for Individuals with Type 1 and Type 2 Diabetes? A Systematic Review and Meta-Analysis

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