Evidence map›Paper›PMID 23193216›Full record

ArticleDiabetes care2013

Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management.

Howard A Wolpert, Astrid Atakov-Castillo, Stephanie A Smith, Garry M Steil

2 registry-linked trialsOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes care, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 80 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
80citing papers in PubMed, 3 pooled it
7.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05152121 nacompletednot on this mapstarted 2017, after this paper: background citation

The Effect of Fat - Protein Counting on Glycemic Variability in Children and Adolescents With Type 1 Diabetes Mellitus

TypeinterventionalSponsorEge UniversityRan2017 to 2019Enrolled20ConditionsType 1 Diabetes, AdolescentArmsCarb and fat counting
NCT07278063 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Effect of Gender and Meal Composition on the Postprandial Glycemic Response in People With Type 1 Diabetes: Impact of Fat Content and Menstrual Cycle Phases

TypeinterventionalSponsorInstituto de Investigacion Sanitaria La FeRan2026 to 2028Enrolled50ConditionsType 1 Diabetes Mellitus, Glycemic Variability, Sex Characteristics, Menstrual CycleArmsLow Fat Mixed Meal, High Fat Mixed Meal
3 · Its place in the literature

Who cites it

80 citing papers in PubMed, 3 syntheses or guidelines pooled it, 190 citations in OpenAlex.

  1. Pooled it
  2. Optimal prandial timing of bolus insulin in diabetes management: a review.Diabetic medicine : a journal of the British Diabetic Association · 2018
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  18. Bolus Estimation--Rethinking the Effect of Meal Fat Content.Diabetes technology & therapeutics · 2015
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20 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Howard A WolpertJoslin Diabetes Center, Boston, Massachusetts, USA. howard.wolpert@joslin.harvard.edu
Astrid Atakov-Castillo
Stephanie A Smith
Garry M Steil
Harvard University · USJoslin Diabetes Center · US

Funding

NCRR NIH HHS UL1 RR025758
6 · The paper itself

Abstract

objectiveCurrent guidelines for intensive treatment of type 1 diabetes base the mealtime insulin bolus calculation exclusively on carbohydrate counting. There is strong evidence that free fatty acids impair insulin sensitivity. We hypothesized that patients with type 1 diabetes would require more insulin coverage for higher-fat meals than lower-fat meals with identical carbohydrate content. RESEARCH DESIGN AND

methodsWe used a crossover design comparing two 18-h periods of closed-loop glucose control after high-fat (HF) dinner compared with low-fat (LF) dinner. Each dinner had identical carbohydrate and protein content, but different fat content (60 vs. 10 g).

resultsSeven patients with type 1 diabetes (age, 55 ± 12 years; A1C 7.2 ± 0.8%) successfully completed the protocol. HF dinner required more insulin than LF dinner (12.6 ± 1.9 units vs. 9.0 ± 1.3 units; P = 0.01) and, despite the additional insulin, caused more hyperglycemia (area under the curve >120 mg/dL = 16,967 ± 2,778 vs. 8,350 ± 1,907 mg/dL⋅min; P < 0001). Carbohydrate-to-insulin ratio for HF dinner was significantly lower (9 ± 2 vs. 13 ± 3 g/unit; P = 0.01). There were marked interindividual differences in the effect of dietary fat on insulin requirements (percent increase significantly correlated with daily insulin requirement; R(2) = 0.64; P = 0.03).

conclusionsThis evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation. These findings point to the need for alternative insulin dosing algorithms for higher-fat meals and suggest that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes.

Indexed as

AdultAgedBlood GlucoseCross-Over StudiesDiabetes Mellitus, Type 1Dietary FatsFemaleHumansInsulinMaleMiddle AgedBlood GlucoseDietary FatsInsulin

Identifiers

PMID23193216
PMCPMC3609492
OpenAlexW1976019463

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.