Carbohydrate Tolerance Threshold for Unannounced Snacks in Children and Adolescents With Type 1 Diabetes Using an Advanced Hybrid Closed-Loop System

Abstract

OBJECTIVE To find a carbohydrate (CHO) tolerance threshold for unannounced snacks to avoid the 2 h increase in glycemia (difference between pre-and postmeal blood glucose [DBG]) ‡50 mg/dL in advanced hybrid closed-loop (a-HCL) users. RESEARCH DESIGN AND METHODS Fourteen children and adolescents with type 1 diabetes (7 females; mean age [± SD] 14.5 ± 3.6 years), users of the Medtronic MiniMed 780G, participated in the study. For 12 days, they did not perform insulin bolus before breakfasts, with defined different quantities and types of CHO, with or without fats, performing blood glucose (BG) before and 2 h after the meal. RESULTS A cutoff of 19.8 g of total CHO was found to determine a DBG of 50 mg/dL. BG never exceeded 250 mg/dL. Mean time in range was ‡70% in the 2 h following each snack. CONCLUSIONS Unannounced snacks of up to 20 g of CHO can avoid DBG ‡50 mg/dL in MiniMed 780G users, although unannounced meals of up to 30 g of CHO are safe.