Automated insulin dosing guidance to optimise insulin management in patients with type 2 diabetes: a multicentre, randomised controlled trial

Abstract

Background: Insulin therapy is most effective if dosage titrations are done regularly and frequently, which is seldom possible for busy clinicians. The d-Nav® Insulin Guidance System was design to address the insulin titration gap in patients with type 2 diabetes. It relies on the d-Nav handheld device, which is used to measure glucose, determine the glucose patterns and automatically determine the appropriate next insulin dose. It closes the titration gap in a scalable way utilizing the support of dedicated health care professionals (HCP). This multicenter randomized controlled study tested whether the combination of the d-Nav system and HCP support (d-Nav+HCP-S) is superior to HCP support alone (HCP-S).Methods: 181 subjects using insulin with sub-optimally controlled type 2 diabetes were randomized 1:1 to either d-Nav+HCP-S or HCP-S alone. Both groups were contacted 7 times

Outcomes of a feasibility trial using an innovative mobile health programme to assist in insulin dose adjustment

“…As with the mobile insulin titration intervention study, we are now transitioning the mIDA programme to an implementation trial for understanding generalisability and acceptability among patients and providers 16. As technology advances, innovative solutions like patient facing-apps/devices that guide self-titration of insulin through automated prompts with support from healthcare providers will become increasingly available and might be even more cost-effective 6…”

“…Referral to an insulin dose adjustment (IDA) service for either insulin initiation or titration can assist in improving glycaemic control, but it is a resource-intensive and time-consuming process. Previously reported studies have utilised mobile health (mHealth) strategies to improve efficiencies and achieve better glycaemic outcomes over conventional methods 6–8. Of the reported studies, most have targeted basal insulin titration (eg, long-acting insulin) but not a combination of complex insulin regimes that include basal and bolus insulins 7 8.…”

Practical Implementation of Diabetes Technology: Real‐World Use

“…However, the vast numbers of patients with T2D requiring intensive management presents a daunting challenge for a healthcare system already straining to meet increasing demand while at the same time struggling with shrinking visit times and reimbursements. Automated decision support (ADS) systems have the potential to assist clinicians and patients in optimizing insulin therapy; the selected articles highlight the progress and challenges in automating decision support in real world settings (16,17). For T2D management, which involves fewer variables than T1D management, simple algorithms and devices may be effective solutions for automated dose titration based on blood glucose data.…”

“…For T2D management, which involves fewer variables than T1D management, simple algorithms and devices may be effective solutions for automated dose titration based on blood glucose data. The Bergenstal study is particularly noteworthy for including subjects with a wide range of management schemes, from once-daily basal insulin dosing only to more sophisticated multipledose regimens, including both premixed and basal-bolus options (17). Larger-scale implementation of ADS such as the one evaluated in this study appears to be a viable option for T2D and has potential to significantly improve outcomes for large numbers of people without regular access to sophisticated endocrinological care.…”

Efficacy of two telemonitoring systems to improve glycaemic control during basal insulin initiation in patients with type 2 diabetes: The TeleDiab‐2 randomized controlled trial

“…The Welldoc system 14 has shown some metabolic efficacy in subjects with particularly unbalanced T2D, but it does not propose automatic adjustment of insulin doses. Finally, a recent study15…”