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Randomized Controlled Trial
. 2023 Feb 23;20(5):3945.
doi: 10.3390/ijerph20053945.

A Head-to-Head Comparison of Two Algorithms for Adjusting Mealtime Insulin Doses Based on CGM Trend Arrows in Adult Patients with Type 1 Diabetes: Results from an Exploratory Study

Martina Parise  1 , Sergio Di Molfetta  2 , Roberta Teresa Graziano  3 , Raffaella Fiorentino  4 , Antonio Cutruzzolà  5 , Agostino Gnasso  5 , Concetta Irace  1
Affiliations
Randomized Controlled Trial

A Head-to-Head Comparison of Two Algorithms for Adjusting Mealtime Insulin Doses Based on CGM Trend Arrows in Adult Patients with Type 1 Diabetes: Results from an Exploratory Study

Martina Parise et al. Int J Environ Res Public Health. .

Abstract

Background: Continuous glucose monitoring (CGM) users are encouraged to consider trend arrows before injecting a meal bolus. We evaluated the efficacy and safety of two different algorithms for trend-informed bolus adjustments, the Diabetes Research in Children Network/Juvenile Diabetes Research Foundation (DirectNet/JDRF) and the Ziegler algorithm, in type 1 diabetes.

Methods: We conducted a cross-over study of type 1 diabetes patients using Dexcom G6. Participants were randomly assigned to either the DirectNet/JDRF or the Ziegler algorithm for two weeks. After a 7-day wash-out period with no trend-informed bolus adjustments, they crossed to the alternative algorithm.

Results: Twenty patients, with an average age of 36 ± 10 years, completed this study. Compared to the baseline and the DirectNet/JDRF algorithm, the Ziegler algorithm was associated with a significantly higher time in range (TIR) and lower time above range and mean glucose. A separate analysis of patients on CSII and MDI revealed that the Ziegler algorithm provides better glucose control and variability than DirectNet/JDRF in CSII-treated patients. The two algorithms were equally effective in increasing TIR in MDI-treated patients. No severe hypoglycemic or hyperglycemic episode occurred during the study.

Conclusions: The Ziegler algorithm is safe and may provide better glucose control and variability than the DirectNet/JDRF over a two-week period, especially in patients treated with CSII.

Keywords: bolus; bolus adjustment; continuous glucose monitoring; glucose variability; time in range; trend arrows; type 1 diabetes.

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Conflict of interest statement

The authors declare no conflict of interest.

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