Insulin Management for Type 1 Diabetic Patients During Social Alcohol Consumption: The SPRITZ Study

Curr Diabetes Rev. 2020;16(6):619-627. doi: 10.2174/1573399815666190507121332.

Abstract

Background: There is no data available on the best insulin treatment to counteract the effects of glucose excursions due to a moderate alcohol intake associated with portions of slight fat and protein-containing food, as often the case during social happenings or "happy hours".

Introduction: This study analyzes the glycemic control and quality of life in 8 adult type 1 diabetic (T1D) patients on insulin-pump therapy which were invited to consume a traditional Italian aperitif ("Spritz" and chips).

Methods: Patients consumed Spritz aperitif twice: using their habitual bolus, based on carbohydrates (CHO) counting (V1), or with a personalized, advanced bolus (V2) calculated from insulin/Kcal derived from Fats and Proteins (FPU). Post-prandial glucose was continuously monitored; glucose incremental areas (iAUC), glucose peak and time to peak, and estimated change from V1 to V2 from repeated- measures models were computed. Each patient fulfilled validated questionnaires on quality of life, knowledge about diabetes and CHO counting.

Results: After the educational program, a reduced iAUC (0-80 min: -306, p=ns; 40-80 min: -400, p=0.07) due to greater (p=0.03) and prolonged double-wave insulin boluses was observed. Blood glucose peak and time to peak were also reduced. Moreover, improvements in the psycho-affective dimension, as well as in the alimentary knowledge were detected.

Conclusion: Therefore, a personalized educational program on CHO + FPU counting together with insulin bolus management can improve glycemic control during social consumption of alcohol, with positive reflections on the psycho-affective dimension. Further studies are mandatory to confirm such preliminary results.

Keywords: CHO counting; Fat and Protein derived insulin units; Type 1 diabetes; alcohol consumption; continuous glucose monitoring; pump therapy..

MeSH terms

  • Adult
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / metabolism*
  • Alcohol Drinking / psychology
  • Blood Glucose / analysis
  • Cross-Over Studies
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 1 / psychology
  • Dietary Carbohydrates / analysis
  • Dietary Fats / analysis
  • Dietary Proteins / analysis
  • Female
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Insulin / administration & dosage*
  • Insulin Infusion Systems
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Postprandial Period
  • Quality of Life
  • Young Adult

Substances

  • Blood Glucose
  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Proteins
  • Hypoglycemic Agents
  • Insulin