Presentation
International Conference on Advanced Technologies & Treatments for Diabetes
Date
February 2018
Authors
Bruce Bode, John Clarke, Andrew Rhinehart, Robby Booth
BACKGROUND
Effective basal bolus insulin therapy requires dose titration to identify the right doses for each individual patient. Self-monitoring of blood glucose (SMBG) provides the requisite data to make dose titration successful. The intention of our study was to compare A1C improvement in two groups: a group that SMBG less than half of the prescribed 4 times/day vs. a group that SMBG more than half of the prescribed 4 times/day.
METHODS
This retrospective study evaluated 68 patients with type 1 and type 2 diabetes mellitus who had their basal and bolus insulin doses adjusted by a healthcare professional that utilized Glucommander diabetes therapy management software (DTMS) to analyze blood glucose data and calculate each dose titration of their basal and nutritional insulin. We compared the A1C reduction at three months of patients that SMBG <2 times/day to those that SMBG >=2 times/day.
| Patient Characteristics | SMBG <2/Day | SMBG >=2/Day |
|---|---|---|
| Average Age | 55 | 58 |
| Male, n (%) | 56% | 63% |
| Average Initial BMI | 31.7 | 31.7 |
| Average Initial Weight (kg) | 92.4 | 96.5 |
| Average Weight at 3 months (kg) | 93.5 | 99.6 |
| Weight Change (kg) | 1.1 | 3.1 |
| Average Final Weight (kg) | 96.0 | 25.0 |
| Type 2 DM | 78% | 78% |
| Type 1 DM | 22% | 22% |
| Average Years with DM | 18.2 | 13.0 |
RESULTS
The 27 patients that tested <2 times/day had a starting A1C of 10.4%, tested 1.1 times/day and had a 1.5% A1C reduction. The 41 patients that tested >=2 times/day had a starting A1C of 10.5%, tested 3.1 times/day and had a 3.0% A1C reduction.
| A1c at Baseline vs. 3 Months | SMBG <2/Day | p Value | SMBG >=2/Day |
|---|---|---|---|
| A1c at Baseline | 10.4% | 10.5% | |
| A1c at 3 Months | 8.9% | < 0.00004 | 7.5% |
| A1c Difference | 1.5% | < 0.0018 | 3.0% |
CONCLUSIONS
The use of diabetes therapy management software (DTMS) for the titration of basal bolus insulin therapy has been shown to be effective; however, more frequent SMBG renders the DTMS even more effective. For patients reluctant to SMBG two or more times daily, the use of continuous glucose monitoring during the time of titration may be an effective alternative to fingerstick SMBG in order to better inform a DTMS decision support tool.
