Missed Insulin Meal Boluses and Elevated Hemoglobin A1c Levels in Children Receiving Insulin Pump Therapy
Abstract
Objective. To identify possible causes of suboptimal glycemic control (ascertained by hemoglobin A1c [HbA1c] level) in youths using insulin pump therapy. Methods. Forty-eight youths who were receiving insulin pump therapy for ≥6 months, and who were using insulin pumps and blood glucose meters with data that could be downloaded at our facility, are included in this cross-sectional study. Possible causes of suboptimal glycemic control were evaluated by using 4 information sources: 1) insulin pump data downloads; 2) glucose meter data downloads; 3) patient/family questionnaire about insulin bolusing habits, eating habits, exercise, and blood glucose testing habits; and 4) a physician questionnaire. Physicians completed the questionnaire during the patient interview after reviewing the downloaded information and discussing these results with the patient/family. Results. The mean (± standard deviation) age of participants was 15.3 (±3.0) years (range: 7–20 years), and the mean (± standard deviation) duration of type 1 diabetes and continuous subcutaneous insulin infusion was 8.2 (±4.0) and 1.9 (±1.0) years, respectively. Patients who missed <1 bolus per week had a mean (95% confidence interval) HbA1c level of 8.0% (7.7, 8.3), whereas those who missed ≥1 mealtime boluses per week had a mean HbA1c level (95% confidence interval) of 8.8% (8.6, 9.1). No significant relationships were found between HbA1c levels in males and females, the amount of exercise per week, or bolusing before insulin pump disconnection for exercise. Although not significant, a trend was found for those who missed <1 bolus per week to perform more blood glucose tests per day and for those who bolused before a meal rather than after to have lower HbA1c levels. Significant correlations were found between HbA1c levels and the number of missed mealtime boluses per week (r = .414) and mean blood glucose levels (r = .70). Conclusion. Missed mealtime insulin boluses seem to be the major cause of suboptimal glycemic control in youths with diabetes receiving continuous subcutaneous insulin infusion therapy.
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Missed bolus insulin doses correlate with higher HbA1c levels in patients with T1D.
“This is consistent with other studies of patients with T1D that have demonstrated that missed bolus insulin doses correlate with higher HbA1c levels.24,25”
From Smart Pen Exposes Missed Basal Insulin Injections and Reveals the Impact on Glycemic Control in Adults With Type 1 Diabetes (2024) · cites this paper as [25]
Studies have found significant correlations between HbA1c levels and the number of missing bolus injections.
“Studies have found significant correlations between HbA1c levels and the number of missing bolus injections.7,39”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [39]
In a study of youths receiving insulin pump therapy, two missed bolus injections each week was associated with an increase in HbA1c of 0.5% (5 mmol/mol).
“In a study of youths receiving insulin pump therapy, two missed bolus injections each week was associated with an increase in HbA1c of 0.5% (5 mmol/mol).39”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [39]
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Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes
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Adherence to insulin treatment in diabetes: can it be improved?糖尿病患者使用胰岛素治疗的依从性：它能够得到改善吗？
Doggrell, S. A., & Chan, V. (2015) · Journal of Diabetes · doi:10.1111/1753-0407.12212 · Cited by 29 · see citing works
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Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy
Spaans, E., van Hateren, K. J. J., Groenier, K. H., Bilo, H. J. G., Kleefstra, N., & Brand, P. L. P. (2018) · European Journal of Pediatrics · doi:10.1007/s00431-018-3256-1 · Cited by 13 · see citing works
- Authors
- Burdick, J., Chase, H. P., Slover, R. H., Knievel, K., Scrimgeour, L., Maniatis, A. K., & Klingensmith, G. J.
- Affiliations
- University of Colorado Health (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2004-03-01
- Volume
- 113
- Issue
- 3
- Pages
- e221-e224
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2152984950
- Cited by
- 227
- References
- 5
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 9 · 2023: 8 · 2022: 9 · 2021: 10 · 2020: 13 · 2019: 6 · 2018: 11 · 2017: 12 · 2016: 12 · 2015: 12 · 2014: 18 · 2013: 5 · 2012: 15
- FWCI
- 4.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (M01RR000069)
- 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, glycemic control, HbA1c, adolescents, blood glucose monitoring
- MeSH terms
- Adolescent, Blood Glucose, Child, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Insulin, Insulin Infusion Systems, Male
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