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Randomized Controlled Trial
. 2013 Jan 1;7(1):156-62.
doi: 10.1177/193229681300700119.

Self-adjustment of insulin dose using graphically depicted self-monitoring of blood glucose measurements in patients with type 1 diabetes mellitus

Andreas Reichel  1 , Hannes Rietzsch, Barbara Ludwig, Katrin Röthig, Annette Moritz, Stefan R Bornstein
Affiliations
Randomized Controlled Trial

Self-adjustment of insulin dose using graphically depicted self-monitoring of blood glucose measurements in patients with type 1 diabetes mellitus

Andreas Reichel et al. J Diabetes Sci Technol. .

Abstract

Background: There is a need for patients to be able to adjust their insulin doses accurately and independently during continuous subcutaneous insulin infusion (CSII) therapy in order to avoid glycemic excursions and improve glycemic control. Use of new technology has the potential to aid patients in visualizing their circadian patterns and improving their understanding of data provided by self-monitored blood glucose (SMBG) measurements.

Methods: A 24-week crossover study was performed in 25 patients with type 1 diabetes mellitus using CSII and SMBG. Patients were randomized either to entering blood glucose data into handwritten logbooks or to using the Accu-Chek SmartPix information management system (IMS) coupled with instructions from a training manual to aid interpretation of the IMS readings. Patients analyzed these chart readings every 2 weeks, and outpatient visits were scheduled for both arms every 6 weeks.

Results: There was a significantly lower mean overall blood glucose level with the IMS compared with use of a logbook (139 ± 16.2 versus 150 ± 19.8 mg/dl; Δ = 10.8 mg/dl; p < .01), and a significantly higher proportion of blood glucose values was in the target range compared with use of a logbook (43.6% versus 38.5%; p < .001). Hypoglycemic events were also significantly lower with the IMS compared with logbooks (3.7 fewer events/6 weeks; p < .05). There was no significant difference between groups in the daily frequency of SMBG measurements.

Conclusions: The use of an IMS, coupled with an easily understood training manual, enables patients to improve glycemic control by performing accurate and timely self-adjustments to their insulin regimens.

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Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Accu-Chek Smart Pix IMS day graphs depicting periods of (A) hyperglycemia: treatment suggestion, increase your insulin bolus at breakfast and lunch; (B) hyperglycemia: treatment suggestions, (i) if you eat a meal at this time, increase the insulin bolus for this meal, (ii) if you do not eat a meal, increase your basal rate; and (C) hypoglycemic events: treatment suggestion, reduce the size of insulin bolus used to correct for potential high blood sugar.
Figure 3
Figure 3
Differences between groups in HbA1c levels and proportion of patients achieving glycemic targets. Error bars represent the standard deviation.
See this image and copyright information in PMC

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