Lu JC, Vogrin S, McAuley SA, Lee MH, Paldus B, Bach LA, Burt MG, Clarke PM, Cohen ND, Colman PG, de Bock MI, Jane Holmes-Walker D, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Roem K, Sims C, Stranks SN, Trawley S, Ward GM, Sundararajan V, Jones TW, and O'Neal DN
Aims: To compare meal-time glycaemia in adults with type 1 diabetes mellitus (T1D) managed with multiple daily injections (MDI) vs. insulin pump therapy (IPT), using self-monitoring blood glucose (SMBG), following diabetes education., Methods: Adults with T1D received carbohydrate-counting education and a bolus calculator: MDI (Roche Aviva Expert) and IPT (pump bolus calculator). All then wore 3-weeks of masked-CGM (Enlite, Medtronic). Meal-times were assessed by two approaches: 1) Set time-blocks (breakfast 06:00-10:00hrs; lunch 11:00-15:00hrs; dinner 17:00-21:00hrs) and 2) Bolus-calculator carbohydrate entries signalling meal commencement. Post-meal masked-CGM time-in-range (TIR) 3.9-10.0 mmol/L was the primary outcome., Results: MDI(n = 61) and IPT (n = 59) participants were equivalent in age, sex, diabetes duration and HbA1c. Median (IQR) education time provided did not differ (MDI: 1.1 h (0.75, 1.5) vs. IPT: 1.1 h (1.0, 2.0); p = 0.86). Overall, daytime (06:00-24:00hrs), lunch and dinner TIR did not differ for MDI vs. IPT participants but was greater for breakfast with IPT in both analyses with a mean difference of 12.8%, (95 CI 4.8, 20.9); p = 0.002 (time-block analysis)., Conclusion: After diabetes education, MDI and IPT use were associated with similar day-time glycemia, though IPT users had significantly greater TIR during the breakfast period. With education, meal-time glucose levels are comparable with use of MDI vs. pumps., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Conflicts of Interest JCL reports no potential conflicts of interest relevant to this article. SV reports no potential conflicts of interest relevant to this article. SAM reports speaker honoraria from Roche and that her institution has received research support from Medtronic. BP reports speaker honoraria fees from Medtronic. MBA reports no potential conflicts of interest relevant to this article. MIdB reports no potential conflicts of interest relevant to this article. LAB reports grant funding from AstraZeneca. MGB reports no potential conflicts of interest relevant to this article. NDC reports personal fees from Medtronic and Abbott, grant funds from Ypsomed. PGC reports no potential conflicts of interest relevant to this article. EAD reports no potential conflicts of interest relevant to this article. DJHW reports no potential conflicts of interest relevant to this article. JK reports speaker fees from Novo Nordisk and AstraZeneca, advisory board fees from Abbott Diabetes. RJM reports research grants from Novo Nordisk, Servier, Medtronic, The Rebecca Cooper Medical Research Foundation, St Vincent's Research Foundation, JDRF, Grey Innovations, The Diabetes Australia Research Trust/Program, and The National Health and Medical Research Council of Australia; honoraria for lectures from Eli Lilly, Novo Nordisk, Sanofi Aventis, Astra Zeneca, Merck Sharp & Dohme, Norvartis, and Boehringer Ingelheim; travel support from Novo Nordisk, Sanofi, and Boehringer Ingelheim; is on the advisory boards for Novo Nordisk, Sanofi Aventis, Boehringer Ingelheim-Eli Lilly Diabetes Alliance, and Astra Zeneca, and has been a principal investigator for industry sponsored clinical trials run by Novo Nordisk, Bayer, Johnson-Cilag, and Abbive. ACK reports no potential conflicts of interest relevant to this article. KK reports no potential conflicts of interest relevant to this article. RJM reports no potential conflicts of interest relevant to this article. WMC reports no potential conflicts of interest relevant to this article. CMS reports no potential conflicts of interest relevant to this article. KR reports no potential conflicts of interest relevant to this article. VJS reports no potential conflicts of interest relevant to this article. ST reports non-financial support from Abbott Diabetes. GMW reports no potential conflicts of interest relevant to this article. AJJ has received research support from Medtronic, the National Health and Medical Research Council, JDRF Australia and International, Sanofi-Aventis, Abbott, and Mylan and has served on advisory boards for Medtronic, Sanofi, and Abbott (Diabetes). TWJ reports no potential conflicts of interest relevant to this article. DNO has served on advisory boards for Abbott, Medtronic, MSD, Novo, Roche, and Sanofi; received research support from Medtronic, Novo, Roche, Lilly, and Sanofi; and travel support from Novo and MSD., (Copyright © 2021 Elsevier B.V. All rights reserved.)