A novel approach to optimise glycaemic control in insulin users

Abstract

Insulin therapy has been available for almost a century. However, its success rate is still disappointing where the majority of users sustain harmfully elevated glycated haemoglobin (HbA1c) levels. The key element essential for effective and safe insulin therapy is frequent dosage titration to overcome constant variations in insulin requirements. In reality, dosage titration is done sporadically during clinic visits. A scalable solution to this problem is being reviewed. A diabetes nurses service improves glycaemic control without overburdening the health system. The service relies on a handheld device, which provides patients with an insulin dose recommendation for each injection while using the device to monitor glucose. Similar to the approach providers use during clinical encounters, the device analyses stored glucose trends and constantly titrates insulin dosage without care providers' supervision. In this report, we describe the logic behind the technology by providing examples from users.

Economic Burden of Contraception Management in Spain

“…14,[16][17][18] Dose titration, with frequent adjustments, has been shown to maximize treatment utility because metabolisms vary over time, beyond daily fluctuations in energy balance. 14,16,[19][20][21][22] However, the current structure of the health care system does not encourage (or in many cases permit) such frequent review of glucose data and corresponding timely insulin dosage modification. 19 In usual practice, insulin dose adjustments are done every 90 to 180 days during an outpatient clinic visit.…”

“…14,16,[19][20][21][22] However, the current structure of the health care system does not encourage (or in many cases permit) such frequent review of glucose data and corresponding timely insulin dosage modification. 19 In usual practice, insulin dose adjustments are done every 90 to 180 days during an outpatient clinic visit. 16 According to Khunti et al, "For most patients requiring insulin therapy, dose titration is carried out by physicians; however, evidence suggests that this process may not provide optimal glycemic management for patients."…”

“…The d-Nav ® Insulin Guidance Service was designed to optimize insulin therapy by providing safe and effective personalized insulin dosage recommendations to T2D patients without increasing the workload of referring physicians. 19,23 This service is a combination of dedicated health care professionals and technology designed to simplify and enhance insulin therapy. Patients referred to the service receive training and support from a clinical team to help them use the accompanying d-Nav device, followed by ongoing supervision of the process, including clinical triaging to alert referring physicians in the case of abnormal disease progression.…”

“…In several studies, the d-Nav Insulin Guidance Service has been shown to improve glycemic control, reduce hypoglycemia frequency, and reduce costs. 19,24 As of May 2016, 727 patients have been referred to the service in Northern Ireland, and 533 patients have used it as of mid-May 2016. Among these active users, 47 patients have used the service for more than three years, and 103 have used it for more than two years.…”

Impact of a Novel Insulin Management Service on Non-insulin Pharmaceutical Expenses

“… 14 , 16 – 18 Dose titration, with frequent adjustments, has been shown to maximize treatment utility because metabolisms vary over time, beyond daily fluctuations in energy balance. 14 , 16 , 19 – 22 However, the current structure of the health care system does not encourage (or in many cases permit) such frequent review of glucose data and corresponding timely insulin dosage modification. 19 In usual practice, insulin dose adjustments are done every 90 to 180 days during an outpatient clinic visit.…”