Hybrid closed-loop insulin pump therapy (artificial pancreas system), represents a significant advancement in management for individuals with Type 1 Diabetes (T1D). This technology integrates an insulin pump, continuous glucose monitoring (CGM) device, and a sophisticated control algorithm to automate insulin delivery. By continuously monitoring glucose levels in real-time, the system dynamically adjusts insulin dosing to optimise glycaemic control, reducing the burden of frequent manual adjustments and minimising the risk of hyper-and hypoglycaemia.
While this system is automated, it requires the user to announce the consumption of carbohydrates; ideally 15–20 minutes prior to consumption. Missed mealtime boluses or inaccurate bolusing impacts system functioning and can result in inappropriately high or low blood glucose levels. The average pump user in the UK records 4-5 daily mealtime boluses and approximately 158 grams of carbohydrates consumed. If a person misses a mealtime bolus, blood glucose levels will run higher until the system can adequately increase insulin administration–approximately 4 hours. There is limited evidence to show how many missed mealtime boluses or carbohydrates these new systems can accommodate before impacting time in range or HbA1c.
Consistently inaccurate carbohydrate entries can undermine the system’s effectiveness, compromising glycaemic control and increasing the risk of acute and long-term complications.
The aim of this project is to determine the effect of the number of meals a person boluses for and the amount of carbohydrates the person boluses for (measured in grams) on their glycaemic control (measured using time in range, HbA1c, etc.).
Upon completion of the project, we will provide patients with this information, to better assist their decision making surrounding their pump usage.
Hypothesis: People living with T1D with less mealtime boluses and lower grams of carbohydrates recorded will have lower time in range and higher HbA1c as they are not bolusing for all of their meals.