Substantial Intra-Individual Variability in Post-Prandial Time to Peak in Controlled and Free-Living Conditions in Children with Type 1 Diabetes

Nutrients. 2021 Nov 19;13(11):4154. doi: 10.3390/nu13114154.

Abstract

The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8-15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs. within-person SD; controlled breakfast 18.5 vs. 38.9 min; FLB 14.1 vs. 49.6 min; FLD 5.7 vs. 64.5 min). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability.

Keywords: CGM; glycaemic control; paediatric diabetes; time to peak; type 1 diabetes; variability.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Blood Glucose / physiology
  • Blood Glucose Self-Monitoring
  • Child
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Female
  • Humans
  • Individuality*
  • Insulin / administration & dosage
  • Linear Models
  • Male
  • Meals / physiology*
  • Postprandial Period / physiology*
  • Prospective Studies
  • Social Conditions
  • Time Factors*

Substances

  • Blood Glucose
  • Insulin