New Tool Reveals How Emerging Adults with Type 1 Diabetes Use Mealtime Insulin

Researchers have developed a tool called the BOLUS score—short for mealtime insulin bolus score—that measures how often someone with Type 1 diabetes takes insulin at meals based on data from their insulin pump. The score provides an objective, numbers-based way to track a real behavior that matters for blood sugar control: whether a person is actually taking their mealtime insulin doses.

Until now, the BOLUS score had been tested and validated primarily in children and teenagers. A new study published in Diabetes Technology & Therapeutics examined whether this tool works equally well for emerging adults—people aged 18-22—a group that has rarely been the focus of mealtime insulin research.

Researchers analyzed insulin pump data and blood sugar metrics from 347 emerging adults with Type 1 diabetes, all between ages 18 and 22. They calculated each participant's BOLUS score and then looked at how those scores related to two key measures of blood sugar control: HbA1c (a three-month average) and metrics from continuous glucose monitors (CGMs), which track real-time blood sugar patterns.

The results were clear: participants with higher BOLUS scores—meaning they took mealtime insulin more consistently—had better outcomes. Specifically, higher scores were linked to lower HbA1c levels, greater time spent in their target blood sugar range, and less time above that range.

While the study confirmed that the BOLUS score works well in emerging adults, it uncovered a concerning pattern: the average BOLUS score for this age group (1.17) was substantially lower than previously reported averages for teenagers. In other words, young adults are taking mealtime insulin boluses less frequently than adolescents do—even though the connection between taking those doses and better blood sugar control is just as strong.

This shift during the emerging adult years aligns with what many people with Type 1 diabetes experience during this developmental period: managing diabetes while navigating independence, college, work, and changing social routines can make consistent self-care more challenging.

The BOLUS score offers doctors and patients a concrete, objective way to assess mealtime insulin behavior—something that's harder to judge from memory or self-report alone. For emerging adults working with their healthcare teams, this tool could help identify specific areas where mealtime insulin engagement is slipping and open conversations about practical barriers and support.

The study also underscores that mealtime insulin engagement matters just as much for young adults as it does for teenagers. Even small improvements in taking mealtime boluses consistently can contribute to better blood sugar control during a life stage when diabetes management often becomes more complicated.

Source: Diabetes technology & therapeutics. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.