Introduction:
In type 2 diabetes (T2D), prandial insulin is often initiated at the largest meal. This proof-of-concept study evaluated whether meal size variability should also guide meal selection for insulin dosing to optimize glycemic outcomes.
Methods:
- Simulation: UVLab T2D simulator, two 14-day scenarios
- Meals:
- Breakfast: 39 ± 11 g
- Lunch: 48 ± 12 g (Scenario 1), 48 ± 23 g (Scenario 2 with increased variability)
- Dinner: 21 ± 2.5 g
- Dosing Strategy: Prandial insulin initiated at each meal to determine the largest safe bolus without causing hypoglycemia. Glycemic metrics compared across meals and scenarios.
Results:
- Scenario 1 (Lunch variability 25%): Highest Time-in-Range (TIR) achieved by dosing lunch (71%), followed by breakfast (66%) and dinner (55%).
- Scenario 2 (Lunch variability increased to 47%): Highest TIR achieved by dosing breakfast (68%), followed by lunch (59%) and dinner (55%).
|
Scenario |
Metric |
No Prandial Insulin |
Breakfast Dosing |
Lunch Dosing |
Dinner Dosing |
|
1 |
TIR (%) |
53 |
66 |
71 |
55 |
|
TAR (%) |
47 |
34 |
29 |
45 |
|
|
TBR (%) |
0 |
0 |
0 |
0 |
|
|
GMI (%) |
7.3 |
6.9 |
6.7 |
7.1 |
|
|
Daily basal (U) |
84 |
84 |
84 |
84 |
|
|
Daily bolus (U) |
0 |
10 |
11 |
7 |
|
|
2 |
TIR (%) |
52 |
68 |
59 |
55 |
|
TAR (%) |
48 |
32 |
41 |
45 |
|
|
TBR (%) |
0 |
0 |
0 |
0 |
|
|
GMI (%) |
7.3 |
6.9 |
7.1 |
7.2 |
|
|
Daily basal (U) |
84 |
84 |
84 |
84 |
|
|
Daily bolus (U) |
0 |
10 |
4 |
2 |
Conclusion:
Prandial insulin dosing based solely on meal size is optimal only when meal sizes are consistent. When meal sizes are variable, dosing meals with greater size consistency, even if smaller, may yield better glycemic control. A personalized approach considering both meal size and variability is recommended for prandial insulin initiation in T2D.
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