Application of novel dual wave meal bolus and its impact on glycated hemoglobin A1c level in children with type 1 diabetes
Open accessAbstract
BACKGROUND: An insulin pump is an advanced technology offering new options of bolus - normal (N), dual wave (D-W) or square wave (S-W) bolus to deliver mealtime insulin. OBJECTIVES: To assess the impact of D-W/S-W boluses on metabolic control (glycated haemoglobin A1c, HbA1c) and to estimate the paediatric patients compliance with implementation of this system in daily practice. METHODS: The cross-sectional study included 499 records of patients aged 0-18 yr. Data from the insulin pump memory provided information on the number of D-W/S-W boluses during a 2-wk period, the insulin requirement (U/kg/d) and the percentage of basal insulin. The HbA1c value (%) and the patient's weight were determined during medical examinations. Mealtime dose of insulin in D-W/S-W bolus was calculated based on the amount of carbohydrate and fat/protein products. RESULTS: The number of applied D-W/S-W boluses was 16.6 +/- 0.77/14 d (ranged 0-95), while 18.8% of patients did not program D-W/S-W boluses. The lowest HbA1c value was found in the group using two and/or more D-W/S-W boluses per day (p = 0.001) compared with the group administrating less than one D-W/S-W bolus/d. Patients with HbA1c level <7.5% had a statistically higher relevant number of D-W/S-W boluses, 19.55 (95% CI: 17.44-21.65) vs. 12.42 (95% CI: 10.22-14.61) (p < 0.001), while there was no correlation between the number of boluses and HbA1c in patients in the remission phase (<0.5 IU/kg/d) (r = 0.012, p = 0.930). CONCLUSIONS: Patients using at least one D-W/S-W bolus per day achieved a recommended level of HbA1c. Paediatric patients with type 1 diabetes mellitus were found to be able to apply D-W/S-W boluses in daily self-treatment process based on food counting.
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Sensor‐augmented pump systems (SAP) enable adaptive insulin delivery, including dual‐wave or square‐wave boluses, which distribute insulin over several hours and better match the slow and prolonged glucose absorption typical of DGP, particularly in high‐fat or high‐protein meals.
“Sensor‑augmented pump systems (SAP) enable adaptive insulin delivery, including dual‑wave or square‑wave boluses, which distribute insulin over several hours and better match the slow and prolonged glucose absorption typical of DGP [54, 112, 132, 148, 149], particularly in high‑fat or high‑protein meals [150–152].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [149]
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Diabetic gastroparesis: pathophysiology and impact on insulin timing choices
Galeano, F., Tumminia, A., Oteri, V., Le Moli, R., Piticchio, T., Scilletta, S., Di Marco, M., Di Pino, A., & Frasca, F. (2026) · Endocrine · doi:10.1007/s12020-026-04693-6
“…pump systems (SAP) enable adaptive insulin delivery, including dual-wave or square-wave boluses, which distribute insulin over several hours and better match the slow and prolonged glucose absorption typical of DGP [54, 112, 132, 148, 149], particularly in high-fat or high-protein meals [150–152].”
- Authors
- Pańkowska, E., Szypowska, A., Lipka, M., Szpotańska, M., Błazik, M., & Groele, L.
- Affiliations
- Medical University of Warsaw (PL)
- Corresponding author
- Pańkowska, Ewa
- Venue
- Pediatric Diabetes
- Publisher
- Hindawi Limited
- Published
- 2009-08
- Volume
- 10
- Issue
- 5
- Pages
- 298-303
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- OpenAlex
- W2027259690
- Cited by
- 88
- References
- 2
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 1 · 2019: 5 · 2018: 9 · 2017: 9 · 2016: 6 · 2015: 5 · 2014: 6 · 2013: 1 · 2012: 9
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, insulin pump therapy, mealtime insulin, HbA1c, glycemic control, children, medication adherence, insulin dose calculation
- MeSH terms
- Adolescent, Blood Glucose, Body Weight, Child, Child, Preschool, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Eating, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Infant, Infant, Newborn, Insulin, Insulin Infusion Systems, Male, Patient Compliance, Infusion Pumps, Implantable, Treatment Outcome, Insulin, Long-Acting, Drug Dosage Calculations
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