A Novel Insulin Unit Calculator for the Management of Type 1 Diabetes

Maurizi, Anna Rita; Lauria, Angelo; Maggi, Daria; Palermo, Andrea; Fioriti, Elvira; Manfrini, Silvia; Pozzilli, Paolo

doi:10.1089/dia.2010.0190

Cited by 26 publications

(37 citation statements)

References 10 publications

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“…14,[22][23][24][25][26][27] The devices differentiate by look, ease of use, degree of automation, and not least by algorithms. Consequently, direct comparisons of studies of the various stand-alone BCs should be conducted with care.…”

Section: Stand-alone Bolus Calculatorsmentioning

confidence: 99%

Bolus Calculators

Schmidt

Nørgaard

2014

J Diabetes Sci Technol

137

109

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Matching meal insulin to carbohydrate intake, blood glucose, and activity level is recommended in type 1 diabetes management. Calculating an appropriate insulin bolus size several times per day is, however, challenging and resource demanding. Accordingly, there is a need for bolus calculators to support patients in insulin treatment decisions. Currently, bolus calculators are available integrated in insulin pumps, as stand-alone devices and in the form of software applications that can be downloaded to, for example, smartphones. Functionality and complexity of bolus calculators vary greatly, and the few handfuls of published bolus calculator studies are heterogeneous with regard to study design, intervention, duration, and outcome measures. Furthermore, many factors unrelated to the specific device affect outcomes from bolus calculator use and therefore bolus calculator study comparisons should be conducted cautiously. Despite these reservations, there seems to be increasing evidence that bolus calculators may improve glycemic control and treatment satisfaction in patients who use the devices actively and as intended.

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Section: Stand-alone Bolus Calculatorsmentioning

confidence: 99%

Bolus Calculators

Schmidt

Nørgaard

2014

J Diabetes Sci Technol

137

109

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“…8 Many current insulin pump systems feature bolus advisor capability, which automatically calculates insulin boluses to address carbohydrate intake and out-of-range BG levels. Use of an automated bolus advisor (BA) can address many of the obstacles associated with intensive insulin therapy by reducing the burden of intensive insulin regimens,increasing treatment satisfaction, 3,9,10 addressing deficits in numeracy and carbohydrate counting, 1,3,9,11 and improving glycemic outcomes. 8,12,13 However, because insulin pump use has not been widely adopted due to perceived complexity of insulin pumps and the extensive training required, 14,15 individuals treated with multiple daily insulin injections (MDIs) do not benefit from automated BA technology in their self-management regimens.…”

mentioning

confidence: 99%

Safe and Efficacious Use of Automated Bolus Advisors in Individuals Treated With Multiple Daily Insulin Injection (MDI) Therapy

Parkin¹,

Barnard

Hinnen

2015

J Diabetes Sci Technol

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A key challenge for many patients with diabetes who are treated with intensive insulin therapy is calculating accurate bolus insulin dosages.1,2 Bolus insulin calculation requires individuals to utilize several factors, including insulin-tocarbohydrate (I:CHO) ratios, insulin sensitivity factors (ISFs), target blood glucose (BG) range, current BG values, anticipated physical activity, and general health status. 3Making these calculations is especially problematic in individuals with deficits in literacy and numeracy, which are common in many societies and, thus, among individuals with diabetes. 4 Another obstacle is lack of competency in carbohydrate counting; several studies have shown that inaccuracy in carbohydrate counting is widespread among children and adults. 3,[5][6][7] Because these dosage calculations can be both complex and time-consuming, individuals often rely on empirical estimates of their insulin needs, which can limit their ability to achieve optimal glycemic control. 8Many current insulin pump systems feature bolus advisor capability, which automatically calculates insulin boluses to address carbohydrate intake and out-of-range BG levels. Use of an automated bolus advisor (BA) can address many of the obstacles associated with intensive insulin therapy by reducing the burden of intensive insulin regimens,increasing treatment satisfaction, 3,9,10 addressing deficits in numeracy and carbohydrate counting, 1,3,9,11 and improving glycemic outcomes. 8,12,13 However, because insulin pump use has not been widely adopted due to perceived complexity of insulin pumps and the extensive training required, 14,15 individuals treated with multiple daily insulin injections (MDIs) do not benefit from automated BA technology in their self-management regimens.Although a growing number of smartphone apps and devices with BA technology are in development, none of the apps are FDA-approved, and only 2 stand-alone devices with integrated BG monitoring capability are commercially AbstractNumerous studies have shown that use of integrated automated bolus advisors (BAs) provides significant benefits to individuals using insulin pump devices, including improved glycemic control and greater treatment satisfaction. Within the past few years, BA devices have been developed specifically for individuals treated with multiple daily insulin injection (MDI) therapy; however, many clinicians who treat these individuals may be unfamiliar with insulin pump therapy and, thus, BA use. Findings from the Automated Bolus Advisor Control and Usability Study (ABACUS) revealed that BA use can be efficacious and clinically meaningful in MDI therapy, and that most patients are willing and able to use this technology appropriately when adequate clinical support is provided. The purpose of this article is to review key learnings from ABACUS and provide practical advice for initiating BA use and monitoring therapy.

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“…Hypoglycemia after ABC was no different in three studies [5][6][7] and increased in one study. 4 QoL was reported in two RCTs and found to be better with ABC.…”

Section: 7mentioning

confidence: 86%

“…Of note is that all the trials did not report all of the end points. HbA1c was observed to be significantly decreased in three RCTs 4,5,7 and unchanged in one study. 6 Postprandial glucose control was measured with SMBG but not continuous glucose monitoring (CGM) and showed improvement in two studies 4,6 and no change in the other two.…”

mentioning

confidence: 90%

“…To date, ABC use has been tested in MDItreated patients with T1D in several randomized clinical trials (RCTs). [4][5][6][7] Except for one study, 4 the others have not periodically refined bolus advice based on recent data. End points of interest in these studies include HbA1c, postprandial glucose control, hypoglycemia, quality of life (QoL), and errors in insulin doses.…”

mentioning

confidence: 99%

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