TY - JOUR
T1 - A Methodology to Compare Insulin Dosing Recommendations in Real-Life Settings
AU - Groat, Danielle
AU - Grando, Maria
AU - Thompson, Bithika
AU - Neto, Pedro
AU - Soni, Hiral
AU - Boyle, Mary E.
AU - Bailey, Marilyn
AU - Cook, Curtiss B.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: iDE-CIDE: Patient-centered decision support based on device data (1U54HL108460), funded by NLM.
Publisher Copyright:
© 2017, © 2017 Diabetes Technology Society.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - 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.
AB - 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.
KW - alcohol
KW - bolus calculator
KW - exercise
KW - insulin pump
KW - postprandial blood glucose
KW - retrospective analysis
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U2 - 10.1177/1932296817704444
DO - 10.1177/1932296817704444
M3 - Article
C2 - 28406039
AN - SCOPUS:85032807538
SN - 1932-2968
VL - 11
SP - 1174
EP - 1182
JO - Journal of Diabetes Science and Technology
JF - Journal of Diabetes Science and Technology
IS - 6
ER -