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. 2018 Oct;20(10):2458-2466.
doi: 10.1111/dom.13408. Epub 2018 Jul 18.

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

Revital Nimri  1 , Eyal Dassau  2 , Tomer Segall  3 , Ido Muller  3 , Natasa Bratina  4 , Olga Kordonouri  5 , Rachel Bello  1 , Torben Biester  5 , Klemen Dovc  4 , Ariel Tenenbaum  1   6 , Avivit Brener  1 , Marko Šimunović  7 , Sophia D Sakka  8 , Michal Nevo Shenker  1 , Caroline Gb Passone  9 , Irene Rutigliano  10 , Davide Tinti  11 , Clara Bonura  12 , Silvana Caiulo  12 , Anna Ruszala  13 , Barbara Piccini  14 , Dinesh Giri  15 , Ronnie Stein  16 , Ivana Rabbone  11 , Patrizia Bruzzi  17 , Jasna Šuput Omladič  4 , Caroline Steele  18 , Guglielmo Beccuti  19 , Michal Yackobovitch-Gavan  1   6 , Tadej Battelino  4   20 , Thomas Danne  5 , Eran Atlas  3 , Moshe Phillip  1   6
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Free article

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

Revital Nimri et al. Diabetes Obes Metab. 2018 Oct.
Free article

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.

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).

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.

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.

Keywords: Advisor Pro; decision support system; insulin pump settings; non-interventional survey; treatment adjustments.

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