Abstract
Abstract Aim To test whether weight‐based treatment is more effective than usual care in people with Type 1 diabetes receiving continuous subcutaneous insulin infusion therapy with regard to both hypoglycaemia and avoiding excessive rebound hyperglycaemia. Methods Children and adults on continuous subcutaneous insulin infusion were enrolled into a study with a crossover design. Each episode of hypoglycaemia (defined as capillary glucose <4.0 mmol/l) was randomly assigned one of two treatment protocols using glucose tablets: either 0.3 g/kg body weight or usual treatment with 15 g (adults) or 10 g (children) for capillary glucose levels 3–3.9 mmol/l or twice these doses for capillary glucose levels <3 mmol/l. All participants received each treatment in random order for up to 10 hypoglycaemic episodes. Glucose levels were re‐tested 10 min after treatment, with a repeat dose if still <4 mmol/l. Results Of the 37 participants enrolled, 35 (aged 6–68 years) completed the study. Twenty‐four participants completed all treatment episodes, while 10 participants had <10 hypoglycaemic episodes and two withdrew without data. The mean glucose difference between weight‐based and usual treatment after 10 min was 0.33 mmol/l (95% CI 0.005 to 0.66; P =0.047) in adults and 0.45 (95% CI 0.18 to 0.72; P =0.001) in children. The odds ratios for resolution of hypoglycaemia at 10 min with a single treatment using weight‐based compared with usual treatment were 3.12 (95% CI 1.38 to 7.02; P =0.0070) in adults and 2.61 (95% CI 1.19 to 5.74; P =0.017) in children. Conclusions Weight‐based treatment using 0.3 g/kg glucose was more effective for symptomatic hypoglycaemia in children and adults with Type 1 diabetes who were using continuous subcutaneous insulin infusion than treatment based on current international recommendations.
What's new? We showed that weight‐based treatment based on 0.3 g/kg body weight of glucose was more effective in resolving hypoglycaemia than standard treatment recommended in international guidelines in children and adults with Type 1 diabetes using insulin pump therapy. Weight‐based treatment did not result in excessive rebound hyperglycaemia. When initial capillary glucose levels are <3.0 mmol/l, double initial glucose treatment doses should be considered in management protocols.