Automated insulin pump system does not alter energy, nutrient intake in T1D patients

Use of the automated insulin delivery (AID) system delivers better glycaemic control in people with type 1 diabetes (T1D). However, switching to the Minimed 780G insulin pump system does not lead to notable changes in energy and nutrient intake in this population, according to a study.

Furthermore, “this real-world follow-up study suggests that children, adolescents, and young adults with T1D consume saturated fat above and fibre intake lower than recommendations independent of the use of an advanced hybrid closed-loop system (a-HCLS), the researchers said.

Twenty-nine individuals with T1D who initiated the use of MiniMed 780G were enrolled in this study. The research team analysed the participants’ 3-day food diaries and glycaemic outcomes at baseline and after switching to an a-HCL at months 3 and 6.

At baseline, participants had a mean carbohydrate intake (energy %) of 49.1, mean protein intake of 17.8, and mean fat intake of 33.0. No statistically significant differences were observed during the follow-up period. [Eur J Clin Nutr 2024;78:615-621]

However, fibre intake was low (<14 g/1,000 kcal) and saturated fat intake was high (>10 energy %) among individuals with T1D, both at baseline and follow-up.

Auto-correction

The median auto-correction bolus ratios were as follows: 14.0 (9.5) percent at auto mode after 14 days, 18.0 (11.0) percent at month 3, and 19.0 (7.5) percent at month 6 (p<0.05). A negative association was seen between auto-correction boluses and time in range (TIR) in both the third (r, –0.747; p<0.01) and sixth month (r, –395; p<0.05).

These findings on auto-correction boluses were similar to those of previous studies. [Diabetes Technol Ther 2022;24:113-119; Pediatr Diabetes 2022;23:1647-1655]

“This negative correlation between TIR and auto boluses could be clarified by the fact that auto-correction intervenes when the user is inaccurate in counting carbohydrates at meals or when meal boluses are skipped/forgotten,” the researchers said. 

“As an unrealistic expectation, users expect from the system that there is no need to announce carbohydrates,” they added. 

These individuals would derive the most benefit from targeted educational interventions during follow-up, according to the researchers, noting that an auto-correction bolus threshold could aid in identifying and monitoring these people.

Threshold

For optimal macronutrient distribution, the International Society of Pediatric and Adolescent Diabetes recommends carbohydrate intake of 40 percent to 50 percent of total daily energy intake, fat intake of 30 percent to 40 percent (saturated fat <10 percent), and protein intake of 15 percent to 25 percent. [Pediatr Diabetes 2022;23:1297-1321]

“In our study, the participants’ carbohydrate, fat, and protein intakes met the recommended levels of national and international guidelines, both at baseline and during the follow-up,” the researchers said. [Pediatr Diabetes 2022;23:1297-1321].

The current findings regarding low fibre and high saturated fat intake in children with T1D, both baseline and follow-up period, are also consistent with those of previous studies. [J Paediatr Child Health 2019;55:1188-1193; J Acad Nutr Diet 2012;112:1728-1735; Nutr Res 2014;34:428-435]

"These findings associated with participants’ high saturated fat intake have potential implications for clinical practice and nutritional education ingredients,” the researchers said. 

“To maintain a healthy intake, consumption of foods high in saturated fat should be limited, and children and adolescents with T1D should be supported in consuming legumes, fruits and vegetables, and whole grains containing fibre,” they added.