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Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians.

Authors :
Nimri R
Dassau E
Segall T
Muller I
Bratina N
Kordonouri O
Bello R
Biester T
Dovc K
Tenenbaum A
Brener A
Šimunović M
Sakka SD
Nevo Shenker M
Passone CG
Rutigliano I
Tinti D
Bonura C
Caiulo S
Ruszala A
Piccini B
Giri D
Stein R
Rabbone I
Bruzzi P
Omladič JŠ
Steele C
Beccuti G
Yackobovitch-Gavan M
Battelino T
Danne T
Atlas E
Phillip M
Source :
Diabetes, obesity & metabolism [Diabetes Obes Metab] 2018 Oct; Vol. 20 (10), pp. 2458-2466. Date of Electronic Publication: 2018 Jul 18.
Publication Year :
2018

Abstract

Aims: To evaluate physicians' adjustments of insulin pump settings based on continuous glucose monitoring (CGM) for patients with type 1 diabetes and to compare these to automated insulin dose adjustments.<br />Methods: A total of 26 physicians from 16 centres in Europe, Israel and South America participated in the study. All were asked to adjust insulin dosing based on insulin pump, CGM and glucometer downloads of 15 patients (mean age 16.2 ± 4.3 years, six female, mean glycated haemoglobin 8.3 ± 0.9% [66.8 ± 7.3 mmol/mol]) gathered over a 3-week period. Recommendations were compared for the relative changes in the basal, carbohydrate to insulin ratio (CR) and correction factor (CF) plans among physicians and among centres and also between the physicians and an automated algorithm, the Advisor Pro (DreaMed Diabetes Ltd, Petah Tikva, Israel). Study endpoints were the percentage of comparison points for which there was full agreement on the trend of insulin dose adjustments (same trend), partial agreement (increase/decrease vs no change) and full disagreement (opposite trend).<br />Results: The percentages for full agreement between physicians on the trend of insulin adjustments of the basal, CR and CF plans were 41 ± 9%, 45 ± 11% and 45.5 ± 13%, and for complete disagreement they were 12 ± 7%, 9.5 ± 7% and 10 ± 8%, respectively. Significantly similar results were found between the physicians and the automated algorithm. The algorithm magnitude of insulin dose change was at least equal to or less than that proposed by the physicians.<br />Conclusions: Physicians provide different insulin dose recommendations based on the same datasets. The automated advice of the Advisor Pro did not differ significantly from the advice given by the physicians in the direction or magnitude of the insulin dosing.<br /> (© 2018 John Wiley & Sons Ltd.)

Details

Language :
English
ISSN :
1463-1326
Volume :
20
Issue :
10
Database :
MEDLINE
Journal :
Diabetes, obesity & metabolism
Publication Type :
Academic Journal
Accession number :
29885025
Full Text :
https://doi.org/10.1111/dom.13408