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Region Hovedstaden - en del af Københavns Universitetshospital
E-pub ahead of print

Efficacy of a bolus calculator and advanced carbohydrate counting in type 2 diabetes: A randomized clinical trial

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BACKGROUND: Carbohydrate counting and use of automated bolus calculators (ABCs) can help reduce HbA1c in type 1 diabetes but only limited evidence exists in type 2 diabetes. We evaluated the efficacy of advanced carbohydrate counting (ACC) and use of an ABC compared with manual insulin bolus calculation (MC) in persons with type 2 diabetes.

MATERIALS AND METHODS: A 24-week open-label, randomised clinical study was conducted in 79 persons with type 2 diabetes treated with basal-bolus insulin (mean age 62.5±9.6 years, HbA1c 8.7±1.0% (72±11 mmol/mol), diabetes duration 18.7±7.6 years). Participants were randomised 1:1 into two groups: ABC group received training in ACC and use of an ABC; MC group received training in ACC and manual calculation of insulin bolus. Participants wore blinded continuous glucose monitors (CGM) for six days at baseline and at study end. Primary endpoint was change in HbA1c.

RESULTS: After 24 weeks HbA1c decreased 0.8% (8.8 mmol/mol) in ABC group and 0.8% (9.0 mmol/mol) in MC group with no between-group difference (P=0.96) and without increase in time in hypoglycaemic range (Sensor glucose (SG)<3.9 mmol/L). Glycaemic variability decreased significantly in both groups whereas the total insulin dose and BMI remained unchanged during the study. Treatment satisfaction increased significantly in both groups after 24 weeks.

CONCLUSION: ACC is an effective, low-cost tool to reduce HbA1c and glycaemic variability in persons with basal-bolus insulin treated type 2 diabetes without increase in hypoglycaemia or BMI. Similar effects were seen with use of an ABC and with use of manual bolus calculation.

OriginalsprogEngelsk
TidsskriftDiabetes Technology & Therapeutics
ISSN1520-9156
DOI
StatusE-pub ahead of print - 26 aug. 2020

ID: 60792824