OBJECTIVE Insulin dosing in type 1 diabetes (T1D) is oftentimes complicated by fluctuating insulin requirements driven by metabolic and psychobehavioral factors impacting individuals' insulin sensitivity (IS). In this context, smart bolus calculators that automatically tailor prandial insulin dosing to the metabolic state of a person can improve glucose management in T1D. RESEARCH DESIGN AND METHODS Fifteen adults with T1D using continuous glucose monitors (CGMs) and insulin pumps completed two 24-h admissions in a hotel setting. During the admissions, participants engaged in an early afternoon 45-min aerobic exercise session, after which they received a standardized dinner meal. The dinner bolus was computed using a standard bolus calculator or smart bolus calculator informed by real-time IS estimates. Glucose control was assessed in the 4 h following dinner using CGMs and was compared between the two admissions. RESULTS The IS-informed bolus calculator allowed for a reduction in postprandial hypoglycemia as quantified by the low blood glucose index (2.02 vs. 3.31, P = 0.006) and percent time <70 mg/dL (8.48% vs. 15.18%, P = 0.049), without increasing hyperglycemia (high blood glucose index: 3.13 vs. 2.09, P = 0.075; percent time >180 mg/dL: 13.24% vs. 10.42%, P = 0.5; percent time >250 mg/dL: 2.08% vs. 1.19%, P = 0.317). In addition, the number of hypoglycemia rescue treatments was reduced from 12 to 7 with the use of the system. CONCLUSIONS The study shows that the proposed IS-informed bolus calculator is safe and feasible in adults with T1D, appropriately reducing postprandial hypoglycemia following an exercise-induced IS increase.

中文翻译：

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使用由实时胰岛素敏感性评估提供信息的智能推注计算器可减少 1 型糖尿病患者在有氧运动后的餐后低血糖。

目标 1 型糖尿病 (T1D) 的胰岛素剂量通常因影响个体胰岛素敏感性 (IS) 的代谢和心理行为因素驱动的胰岛素需求波动而复杂化。在这种情况下，智能推注计算器可以根据一个人的代谢状态自动调整膳食胰岛素剂量，可以改善 T1D 患者的葡萄糖管理。研究设计和方法 15 名使用连续血糖监测仪 (CGM) 和胰岛素泵的 T1D 成人在酒店环境中完成了两次 24 小时入院。在入院期间，参与者在下午早些时候进行了 45 分钟的有氧运动，之后他们接受了标准化的晚餐。晚餐推注是使用标准推注计算器或实时 IS 估计通知的智能推注计算器计算的。在晚餐后 4 小时内使用 CGM 评估血糖控制，并在两次入院之间进行比较。结果 根据低血糖指数（2.02 与 3.31，P = 0.006）和时间百分比 <70 mg/dL（8.48% 与 15.18%，P = 0.049），但不增加高血糖（高血糖指数：3.13 与 2.09，P = 0.075；百分比时间 >180 mg/dL：13.24% 与 10.42%，P = 0.5；百分比时间 >250 mg/dL：2.08%对比 1.19%，P = 0.317）。此外，使用该系统后，低血糖抢救治疗的次数从 12 次减少到 7 次。结论 该研究表明，拟议的 IS 告知推注计算器在患有 T1D 的成人中是安全可行的，可适当减少运动引起的 IS 增加后的餐后低血糖。