Insulin Management for Type 1 Diabetic Patients During Social Alcohol Consumption: The SPRITZ Study

Author(s): Elisa Cipponeri*, Cesare Blini, Christian Lamera, Valentina De Mori, Giovanni Veronesi, Antonio Carlo Bossi*

Journal Name: Current Diabetes Reviews

Volume 16 , Issue 6 , 2020

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Background: There is no data available on the best insulin treatment to counteract the effects of glucose excursions due to a moderate alcohol intake associated with portions of slight fat and protein-containing food, as often the case during social happenings or “happy hours”.

Introduction: This study analyzes the glycemic control and quality of life in 8 adult type 1 diabetic (T1D) patients on insulin-pump therapy which were invited to consume a traditional Italian aperitif (“Spritz” and chips).

Methods: Patients consumed Spritz aperitif twice: using their habitual bolus, based on carbohydrates (CHO) counting (V1), or with a personalized, advanced bolus (V2) calculated from insulin/Kcal derived from Fats and Proteins (FPU). Post-prandial glucose was continuously monitored; glucose incremental areas (iAUC), glucose peak and time to peak, and estimated change from V1 to V2 from repeated- measures models were computed. Each patient fulfilled validated questionnaires on quality of life, knowledge about diabetes and CHO counting.

Results: After the educational program, a reduced iAUC (0-80 min: -306, p=ns; 40-80 min: -400, p=0.07) due to greater (p=0.03) and prolonged double-wave insulin boluses was observed. Blood glucose peak and time to peak were also reduced. Moreover, improvements in the psycho-affective dimension, as well as in the alimentary knowledge were detected.

Conclusion: Therefore, a personalized educational program on CHO + FPU counting together with insulin bolus management can improve glycemic control during social consumption of alcohol, with positive reflections on the psycho-affective dimension. Further studies are mandatory to confirm such preliminary results.

Keywords: Type 1 diabetes, pump therapy, continuous glucose monitoring, CHO counting, Fat and Protein derived insulin units, alcohol consumption.

Maiorino MI, Bellastella G, Casciano O, et al. The effects of subcutaneous insulin infusion versus multiple insulin injections on glucose variability in young adults with type 1 diabetes: the 2-year follow-up of the observational METRO study. Diabetes Technol Ther 2018; 20(2): 117-26.
Kulkarni KD. Carbohydrate counting: a practical meal-planning option for people with diabetes. Clin Diabetes 2005; 23: 120-2.
Shapira G, Yodfat O, HaCohen A. Bolus guide: a novel insulin bolus dosing decision support tool based on selection of carbohydrate ranges. J Diabetes Sci Technol 2010; 4(4): 893-902.
Yamada E, Okada S, Nakajima Y, et al. Effect of carbohydrate counting using bolus calculators on glycemic control in type 1 diabetes patients during continuous subcutaneous insulin infusion. J Diabetes Investig 2017; 8(4): 496-500.
Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes: a position of the American Diabetes Association. Diabetes Care 2008; 31(Suppl. 1): S61-78.
DAFNE Study Group.Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002; 325(7367): 746.
Lowe J, Linjawi S, Mensch M. Flexible eating and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course. Diabetes Res Clin Pract 2008; 80(3): 439-43.
Laurenzi A, Bolla AM, Panigoni G, et al. Effects of carbohydrate counting on glucose control and quality of life over 24 weeks in adult patients with type 1 diabetes on continuous subcutaneous insulin infusion: a randomized, prospective clinical trial (GIOCAR). Diabetes Care 2011; 34(4): 823-7.
Grant L, Lawton J, Hopkins D, et al. Type 1 diabetes structured education: What are the core self-management behaviours? Diabet Med 2013; 30(6): 724-30.
Anderson RM, Funnell MM, Butler PM. Patient empowerment. Results of a randomized controlled trial. Diabetes Care 1995; 18: 943-9.
Wolpert HA, Atakov-Castillo A, Smith SA. Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care 2013; 36(4): 810-6.
Wolever TMS, Mullan YM. Sugars and fat have different effects on postprandial glucose responses in normal and type 1 diabetic subjects. Nutr Metab Cardiovasc Dis 2011; 21: 719-25.
Bell KJ, Toschi E, Steil GM. Mealtime insulin dosing for fat and protein in type 1 diabetes: application of a model-based approach to derive insulin doses for open-loop diabetes management. Diabetes Care 2016; 39(9): 1631-4.
García-López JM, González-Rodriguez M, Pazos-Couselo M. Should the amounts of fat and protein be taken into consideration to calculate the lunch prandial insulin bolus? Results from a randomized crossover trial. Diabetes Technol Ther 2013; 15(2): 166-71.
Hibbert-Jones E. Fat and protein counting in type 1 diabetes. Pract Diabetes 2016; 33(7): 243-7.
Paterson M, Bell KJ, O’Connell SM. the role of dietary protein and fat in glycaemic control in type 1 diabetes: implications for intensive diabetes management. Curr Diab Rep 2015; 15(9): 61.
Bell KJ, Smart CE, Steil GM. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care 2015; 38(6): 1008-15.
Pańkowska E, Błazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther 2012; 14(1): 16-22.
Blazik M, Pańkowska E. The effect of bolus and food calculator Diabetics on glucose variability in children with type 1 diabetes treated with insulin pump: the results of RCT. Pediatr Diabetes 2012; 13(7): 534-9.
Pańkowska E, Błazik M. Bolus calculator with nutrition database software, a new concept of prandial insulin programming for pump users. J Diabetes Sci Technol 2010; 4(3): 571-6.
Groat D, Soni H, Grando MA. Self-reported compensation techniques for carbohydrate, exercise, and alcohol behaviors in patients with type 1 diabetes on insulin pump therapy. J Diabetes Sci Technol 2018; 12(2): 412-4.
Grando MA, Groat D, Soni H, et al. Characterization of exercise and alcohol self-management behaviors of type 1 diabetes patients on insulin pump therapy. J Diabetes Sci Technol 2017; 11(2): 240-6.
Avogaro A, Beltramello P, Gnudi L, et al. Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycemia in IDDM patients. Diabetes 1993; 42(11): 1626-34.
Tetzschner R, Nørgaard K, Ranjan A. Diabetes Effects of alcohol on plasma glucose and prevention of alcohol-induced hypoglycemia in type 1 diabetes-A systematic review with GRADE. Diabetes Metab Res Rev 2018; 34(3)
Kerr D, Macdonald IA, Heller SR. Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 (insulin-dependent) diabetes. Diabetologia 1990; 33(4): 216-21.
Koivisto VA, Tulokas S, Toivonen M. Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 1993; 16(12): 1612-4.
Plougmann S, Hejlesen O, Turner B. Modelling the effect of alcohol in Type 1 diabetes. Stud Health Technol Inform 2002; 90: 66-71.
Plougmann S, Hejlesen OK, Cavan DA. DiasNet--a diabetes advisory system for communication and education via the internet. Int J Med Inform 2001; 64(2-3): 319-30.
Indelicato L, Mariano V, Galasso S, et al. Influence of health locus of control and fear of hypoglycaemia on glycaemic control and treatment satisfaction in people with Type 1 diabetes on insulin pump therapy. Diabet Med 2017; 34(5): 691-7.
McGuire BE, Morrison TG, Hermanns N, et al. Short-form measures of diabetes-related emotional distress: the Problem Areas in Diabetes Scale (PAID)-5 and PAID-1. Diabetologia 2010; 53(1): 66-9.
Quandt SA, Ip EH, Kirk JK, et al. Assessment of a short diabetes knowledge instrument for older and minority adults. Diabetes Educ 2014; 40(1): 68-76.
Bozzetto L, Alderisio A, Giorgini M, et al. Extra-virgin olive oil reduces glycemic response to a high-glycemic index meal in patients with type 1 diabetes: a randomized controlled trial. Diabetes Care 2016; 39: 518-24.
Reference: Available from: Spritz_(alcoholic_beverage) Accessed 2018, October 29th
MacNaught N, Holt P. Type 1 diabetes and alcohol consumption. Nurs Stand 2015; 29(50): 41-7.
Ismail D, Gebert R, Vuillermin PJ, et al. Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemia. Diabet Med 2016 2006; 23(8): 830-3.

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Year: 2020
Page: [619 - 627]
Pages: 9
DOI: 10.2174/1573399815666190507121332
Price: $65

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