Demystifying the Pizza Bolus: The Effect of Dough Fermentation on Glycemic Response - A Sensor-Augmented Pump Intervention Trial in Children with Type 1 Diabetes Mellitus

Angela Zanfardino, Santino Confetto, Stefano Curto, Alessandra Cocca, Assunta Serena Rollato, Francesco Zanfardino, Antonio Dario Troise, Veronica Testa, Oriana Bologna, Michela Stanco, Alessia Piscopo, Ohad Cohen, Emanuele Miraglia Del Giudice, Paola Vitaglione, Dario Iafusco

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Glycemia following pizza consumption is typically managed with a dual-wave insulin bolus. This study evaluated the effect of a simple bolus on glycemia following consumption of traditionally prepared pizzas with long (24 h) or short (8 h) dough fermentation periods. Research Design and Methods: On two separate evenings, children with type 1 diabetes (n = 38) receiving sensor-integrated pump therapy consumed traditionally prepared pizza with either short (pizza A) or long (pizza B) dough fermentation, and blood glucose was monitored over 11 h. A simple insulin bolus was administered 15 min preprandially. The carbohydrate and amino acid contents of the two types of pizza were analyzed by liquid chromatography and high-resolution mass spectrometry (LC-HRMS). Results: The mean (±standard deviation) time in range 3.9-10.0 mmol/L was 73.2% ± 23.2%, and 50.8% ± 26.7% of glucose measurements were within the range 3.9-7.8 mmol/L. However, during the 2 h after bolus administration, the mean time in range 3.9-7.8 mmol/L was significantly greater with pizza B than with pizza A (73.3% ± 31.5% vs. 51.8% ± 37.4%, respectively, P = 0.009), and the time in hyperglycemia (>10 mmol/L) was significantly shorter (mean percentage 6.1% ± 19.0% vs. 17.7% ± 29.8%, respectively, P = 0.019). LC-HRMS analysis showed that long fermentation was associated with a lower carbohydrate content in the pizza, and a higher amino acid content. Conclusions: Glycemia following consumption of traditionally prepared pizza can be managed using a simple bolus 15 min before eating. Glycemic control can be further improved by increasing the dough fermentation time. Study registration: NCT03748251, Clinicaltrials.gov

Original languageEnglish
Pages (from-to)721-726
Number of pages6
JournalDiabetes Technology and Therapeutics
Volume21
Issue number12
DOIs
StatePublished - Dec 2019

Keywords

  • Continuous subcutaneous insulin infusion
  • Diet
  • Hyperglycemia
  • Hypoglycemia
  • Pizza

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