A Computer Program, Directed by Clinicians for Outpatients, Which Re-adjusts Subcutaneous Multiple Daily Injections (MDI) of Insulin, Achieves an Improvement of 2.6 A1c% Points
Presentation
International Hospital Diabetes Meeting
Date
October 2012
Authors
PC Davidson,1 BW Bode,1 HR Hebblewhite,2 R Booth2
PURPOSE
This study examines the performance of a computerized algorithm for adjusting subcutaneous basal-bolus MDI insulin regimens for outpatients.
ALGORITHM
This algorithm determines the meal bolus for a meal by applying an adjustment to the previous day’s same-time meal bolus based upon the subsequent BG response. Basal doses are adjusted in a similar manner based upon the lower of pre-breakfast BG or any immediately preceding nighttime lower BG tested earlier on the same day.
DATA COMMUNICATIONS
The patients reported their BGs by text-messaging, email, telephone or the Telcare real-time cell-based meter system. Adjusted dosing information was relayed to the patient.
STATISTICAL METHODS
Glycemic Control:
All the subjects were started on the Glucommander SubQ algorithm at the beginning of the study. The statistics followed a paired before-and-after design.
- Method 1: For patients treated for >60 days, each patient’s pre-study A1c was compared to his/her post-study A1c.
- Method 2: For all patients, the mean of the last 12 BGs of each patient was converted to an A1c value using the ADA-approved correlation. This value was compared to the pre-study A1c.
Hypoglycemia:
- The BG readings below threshold were counted for thresholds of 40, 50, and 60 mg/dL.
- The patients with at least one BG < threshold were counted for 40, 50, and 60 mg/dL.
RESULTS
Glycemic Control:
Method 1 (Patients treated for >60 days)
| Patients | Pre-Study A1c | Post-Study Mean BG | Post-Study A1c | Significance |
|---|---|---|---|---|
| 21 | 10.1% | — | 7.5% | P <0.0004 |
Method 2 (All patients)
| Patients | Pre-Study A1c | Post-Study Mean BG | Post-Study A1c | Significance |
|---|---|---|---|---|
| 21 | 10.2% | 134 | 6.3% | P <0.00001 |
Hypoglycemia:
| Metrics | <40 mg/dL | <50 mg/dL | <60 mg/dL |
|---|---|---|---|
| Total # BGs: 5,811 |
0.0% BGs | 0.4% BGs | 1.0% BGs |
| Total # Patients: 30 |
0.0% Patients | 17.0% Patients | 38% Patients |
CONCLUSION
This algorithm (Glucommander SubQ) showed itself to be a valuable tool for adjusting subcutaneous MDI regimens. The algorithm is incorporated into a web-based platform for continuous, ongoing dosing guidance.
Affiliations
- Atlanta Diabetes Associates, Atlanta, Georgia.
- Glytec, Greenville, South Carolina.
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