A Methodology to Compare Insulin Dosing Recommendations in Real-Life Settings. (November 2017)

• Record Type: Journal Article
• Authors: Groat, Danielle; Grando, Maria A.; Thompson, Bithika; Neto, Pedro; Soni, Hiral; Boyle, Mary E.; Bailey, Marilyn; Cook, Curtiss B.
• Is Part Of: Journal of diabetes science and technology. Volume 11:Number 6(2017:Nov.)
• Page Start: 1174
• Page End: 1182
• Publication Date: 2017-11
• Subjects: alcohol -- bolus calculator -- exercise -- insulin pump -- postprandial blood glucose -- retrospective analysis; Diabetes -- Periodicals; Medical technology -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1177/1932296817704444
• Languages: English
• ISSNs: 1932-2968

Abstract

Background: We propose a methodology to analyze complex real-life glucose data in insulin pump users. Methods: Patients with type 1 diabetes (T1D) on insulin pumps were recruited from an academic endocrinology practice. Glucose data, insulin bolus (IB) amounts, and self-reported alcohol consumption and exercise events were collected for 30 days. Rules were developed to retrospectively compare IB recommendations from the insulin pump bolus calculator (IPBC) against recommendations from a proposed decision aid (PDA) and for assessing the PDA's recommendation for exercise and alcohol. Results: Data from 15 participants were analyzed. When considering instances where glucose was below target, the PDA recommended a smaller dose in 14%, but a larger dose in 13% and an equivalent IB in 73%. For glucose levels at target, the PDA suggested an equivalent IB in 58% compared to the subject's IPBC, but higher doses in 20% and lower in 22%. In events where postprandial glucose was higher than target, the PDA suggested higher doses in 25%, lower doses in 13%, and equivalent doses in 62%. In 64% of all alcohol events the PDA would have provided appropriate advice. In 75% of exercise events, the PDA appropriately advised an IB, a carbohydrate snack, or neither. Conclusions: This study provides a methodology to systematically analyze real-life data generated by insulin pumps and allowed a preliminary analysis of the performance of the PDA for insulin dosing. Further testing of the methodological approach in a broader diabetes population and prospective testing of the PDA are needed.