An additional bolus of rapid-acting insulin to normalise postprandial cardiovascular risk factors following high-carbohydrate high-fat meal in patients with type 1 diabetes: A randomised controlled trial

M D Campbell, M Walker, R A Ajjan, K M Birch, Javier Gonzalez, D J West

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Abstract

Aim: To evaluate an additional rapid-acting insulin bolus on postprandial lipaemia, inflammation, and pro-coagulation following high-carbohydrate high-fat feeding in people with type 1 diabetes.
Methods: Ten males with type 1 diabetes (HbA1c 52.55.9 mmol/mol [7.00.5%]) underwent three conditions: 1) a low-fat meal with normal bolus insulin (LF), 2), a high-fat meal with normal bolus insulin (HF), 3) a high-fat meal with normal bolus insulin with an additional 30% insulin bolus administered 3-hrs post-meal (HFA). Meals had identical carbohydrate and protein content and bolus insulin dose determined by carbohydrate-counting. Blood was sampled periodically for 6-hr post-meal and analysed for TG, NEFA, APOB48, glucagon, TNF-α, fibrinogen, HTF activity, and PAI-1. Continuous glucose monitoring captured interstitial glucose responses.
Results: TG concentrations following LF remained similar to baseline, whereas TG levels following HF were significantly greater throughout the 6-hour observation period. The additional insulin bolus (HFA) normalised TG similarly to LF 3-6-hrs following the meal.  HF was associated with late postprandial elevations in TNF-α, whereas LF and HFA was not. Fibrinogen, PAI-1, and TFP levels were similar between conditions.
Conclusions: Additional bolus insulin 3-hrs following a high-carbohydrate high-fat meal prevents late rises in postprandial TGs and TNF-α, thus improving cardiovascular risk profile.
Clinical trial registration: clinicaltrials.gov; Reg. no. NCT02595658
Original languageEnglish
Pages (from-to)336-344
Number of pages9
JournalDiabetes and Vascular Disease Research
Volume14
Issue number4
Early online date21 Mar 2017
DOIs
Publication statusPublished - 1 Jul 2017

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Short-Acting Insulin
Type 1 Diabetes Mellitus
Meals
Randomized Controlled Trials
Fats
Carbohydrates
Insulin
Tumor Necrosis Factor-alpha
Plasminogen Activator Inhibitor 1
Fibrinogen
Glucose
Glucagon
Nonesterified Fatty Acids
Observation
Clinical Trials
Inflammation

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title = "An additional bolus of rapid-acting insulin to normalise postprandial cardiovascular risk factors following high-carbohydrate high-fat meal in patients with type 1 diabetes: A randomised controlled trial",
abstract = "Aim: To evaluate an additional rapid-acting insulin bolus on postprandial lipaemia, inflammation, and pro-coagulation following high-carbohydrate high-fat feeding in people with type 1 diabetes. Methods: Ten males with type 1 diabetes (HbA1c 52.55.9 mmol/mol [7.00.5{\%}]) underwent three conditions: 1) a low-fat meal with normal bolus insulin (LF), 2), a high-fat meal with normal bolus insulin (HF), 3) a high-fat meal with normal bolus insulin with an additional 30{\%} insulin bolus administered 3-hrs post-meal (HFA). Meals had identical carbohydrate and protein content and bolus insulin dose determined by carbohydrate-counting. Blood was sampled periodically for 6-hr post-meal and analysed for TG, NEFA, APOB48, glucagon, TNF-α, fibrinogen, HTF activity, and PAI-1. Continuous glucose monitoring captured interstitial glucose responses.Results: TG concentrations following LF remained similar to baseline, whereas TG levels following HF were significantly greater throughout the 6-hour observation period. The additional insulin bolus (HFA) normalised TG similarly to LF 3-6-hrs following the meal.  HF was associated with late postprandial elevations in TNF-α, whereas LF and HFA was not. Fibrinogen, PAI-1, and TFP levels were similar between conditions. Conclusions: Additional bolus insulin 3-hrs following a high-carbohydrate high-fat meal prevents late rises in postprandial TGs and TNF-α, thus improving cardiovascular risk profile.Clinical trial registration: clinicaltrials.gov; Reg. no. NCT02595658",
author = "Campbell, {M D} and M Walker and Ajjan, {R A} and Birch, {K M} and Javier Gonzalez and West, {D J}",
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T1 - An additional bolus of rapid-acting insulin to normalise postprandial cardiovascular risk factors following high-carbohydrate high-fat meal in patients with type 1 diabetes: A randomised controlled trial

AU - Campbell, M D

AU - Walker, M

AU - Ajjan, R A

AU - Birch, K M

AU - Gonzalez, Javier

AU - West, D J

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Aim: To evaluate an additional rapid-acting insulin bolus on postprandial lipaemia, inflammation, and pro-coagulation following high-carbohydrate high-fat feeding in people with type 1 diabetes. Methods: Ten males with type 1 diabetes (HbA1c 52.55.9 mmol/mol [7.00.5%]) underwent three conditions: 1) a low-fat meal with normal bolus insulin (LF), 2), a high-fat meal with normal bolus insulin (HF), 3) a high-fat meal with normal bolus insulin with an additional 30% insulin bolus administered 3-hrs post-meal (HFA). Meals had identical carbohydrate and protein content and bolus insulin dose determined by carbohydrate-counting. Blood was sampled periodically for 6-hr post-meal and analysed for TG, NEFA, APOB48, glucagon, TNF-α, fibrinogen, HTF activity, and PAI-1. Continuous glucose monitoring captured interstitial glucose responses.Results: TG concentrations following LF remained similar to baseline, whereas TG levels following HF were significantly greater throughout the 6-hour observation period. The additional insulin bolus (HFA) normalised TG similarly to LF 3-6-hrs following the meal.  HF was associated with late postprandial elevations in TNF-α, whereas LF and HFA was not. Fibrinogen, PAI-1, and TFP levels were similar between conditions. Conclusions: Additional bolus insulin 3-hrs following a high-carbohydrate high-fat meal prevents late rises in postprandial TGs and TNF-α, thus improving cardiovascular risk profile.Clinical trial registration: clinicaltrials.gov; Reg. no. NCT02595658

AB - Aim: To evaluate an additional rapid-acting insulin bolus on postprandial lipaemia, inflammation, and pro-coagulation following high-carbohydrate high-fat feeding in people with type 1 diabetes. Methods: Ten males with type 1 diabetes (HbA1c 52.55.9 mmol/mol [7.00.5%]) underwent three conditions: 1) a low-fat meal with normal bolus insulin (LF), 2), a high-fat meal with normal bolus insulin (HF), 3) a high-fat meal with normal bolus insulin with an additional 30% insulin bolus administered 3-hrs post-meal (HFA). Meals had identical carbohydrate and protein content and bolus insulin dose determined by carbohydrate-counting. Blood was sampled periodically for 6-hr post-meal and analysed for TG, NEFA, APOB48, glucagon, TNF-α, fibrinogen, HTF activity, and PAI-1. Continuous glucose monitoring captured interstitial glucose responses.Results: TG concentrations following LF remained similar to baseline, whereas TG levels following HF were significantly greater throughout the 6-hour observation period. The additional insulin bolus (HFA) normalised TG similarly to LF 3-6-hrs following the meal.  HF was associated with late postprandial elevations in TNF-α, whereas LF and HFA was not. Fibrinogen, PAI-1, and TFP levels were similar between conditions. Conclusions: Additional bolus insulin 3-hrs following a high-carbohydrate high-fat meal prevents late rises in postprandial TGs and TNF-α, thus improving cardiovascular risk profile.Clinical trial registration: clinicaltrials.gov; Reg. no. NCT02595658

UR - http://dx.doi.org/10.1177/1479164117698918

U2 - 10.1177/1479164117698918

DO - 10.1177/1479164117698918

M3 - Article

VL - 14

SP - 336

EP - 344

JO - Diabetes and Vascular Disease Research

JF - Diabetes and Vascular Disease Research

SN - 1479-1641

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ER -