Benefits of a bolus calculator in pre‐ and postprandial glycaemic control and meal flexibility of paediatric patients using continuous subcutaneous insulin infusion (CSII)

Shashaj, Blegina; Busetto, E.; Sulli, N.

doi:10.1111/j.1464-5491.2008.02549.x

Cited by 89 publications

(67 citation statements)

References 17 publications

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“…Contemporary insulin pumps offer programming of multiple basal insulin infusion rates, profiling of boluses, suspension or temporary rate program of insulin delivery, and additional features enabling calculation of the insulin doses for the carbohydrate content of meals and for the correction of glycemic levels outside of target ranges [9]. These options were shown to improve the efficacy of pump use [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Insulin Pump Therapy is Equally Effective and Safe in Elderly and Young Type 1 Diabetes Patients

Matejko¹,

Cyganek²,

Katra³

et al. 2011

Rev Diabet Stud

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■ Abstract OBJECTIVES:It is generally accepted that in adult type 1 diabetes patients (T1D) continuous subcutaneous insulin infusion (CSII) via a personal pump is more effective than the multiple daily injections (MDI) model. However, it is not clear whether all age groups of adult T1D patients may equally benefit from CSII therapy. We aimed to compare the glycemic control and use of selected pump tools in T1D subjects using CSII over the age of 50 (50+ T1D) with patients younger than 50 years of age. METHODS: The last available insulin pump/blood glucose meter downloads and last available HbA1c levels of 124 adult T1D subjects using CSII were reviewed. We divided our cohort into two subgroups: 50+ T1D patients (n = 13) and younger patients (n = 111). RESULTS: There were no differences in glycemic control achieved with CSII treatment in 50+ T1D patients vs. younger subjects. HbA1c levels were 7.01 ± 0.67% and 7.34 ± 1.24% (p = 0.46), and the mean glycemia based on glucometer downloads was 141.8 ± 17.7 mg/dl and 150.8 ± 35.7 mg/dl (p = 0.69), respectively. Also, there were no differences with respect to the use of important personal pump options and tools. CONCLUSION: In conclusion, insulin pump therapy appears to be effective and safe in T1D patients regardless of age.

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Section: Introductionmentioning

confidence: 99%

Insulin Pump Therapy is Equally Effective and Safe in Elderly and Young Type 1 Diabetes Patients

Matejko¹,

Cyganek²,

Katra³

et al. 2011

Rev Diabet Stud

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“…[2][3][4][5] Current literature also shows that additional novel insulin dosing algorithms are being researched and developed. [17][18][19][20] After an extensive literature research (see the appendix) and case study exploration, my opinion on this topic is as follows: clearer guidance is needed to assist both the manufacturers creating these algorithms and the regulatory agencies that will ultimately review them.…”

Section: Discussionmentioning

confidence: 99%

“…Current literature has shown that integration of BAs into insulin pump software may help individuals more accurately meet prandial insulin dosage requirements, improve postprandial glycemic excursions, and achieve optimal glycemic control. [2][3][4][5] However, evidence is sparse regarding the specifics of risk management for algorithms such as those used in BAs. In addition, there is no worldwide standard of care for diabetes, which complicates the development of software and/or devices intended to optimize glycemic control.…”

Section: Original Articlementioning

confidence: 99%

Recommendations for Insulin Dose Calculator Risk Management

Rees

2014

J Diabetes Sci Technol

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Several studies have shown the usefulness of an automated insulin dose bolus advisor (BA) in achieving improved glycemic control for insulin-using diabetes patients. Although regulatory agencies have approved several BAs over the past decades, these devices are not standardized in their approach to dosage calculation and include many features that may introduce risk to patients. Moreover, there is no single standard of care for diabetes worldwide and no guidance documents for BAs, specifically. Given the emerging and more stringent regulations on software used in medical devices, the approval process is becoming more difficult for manufacturers to navigate, with some manufacturers opting to remove BAs from their products altogether. A comprehensive literature search was performed, including publications discussing: diabetes BA use and benefit, infusion pump safety and regulation, regulatory submissions, novel BAs, and recommendations for regulation and risk management of BAs. Also included were country-specific and international guidance documents for medical device, infusion pump, medical software, and mobile medical application risk management and regulation. No definitive worldwide guidance exists regarding risk management requirements for BAs, specifically. However, local and international guidance documents for medical devices, infusion pumps, and medical device software offer guidance that can be applied to this technology. In addition, risk management exercises that are algorithm-specific can help prepare manufacturers for regulatory submissions. This article discusses key issues relevant to BA use and safety, and recommends risk management activities incorporating current research and guidance.

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“…The "Bolus Wizard" then advises the user on appropriate premeal insulin bolus dose based on the patient's planned carbohydrate intake and IOB. This not only allows for greater accuracy, but by discounting the residual insulin that is still around, it avoids stacking of insulin doses and therefore reduces the risk of hypoglycemia (Shashaj et al, 2008). Figure 2 Example of insulin delivery with pump therapy.…”

Section: The Principles and Advantages Of Csii Therapymentioning

confidence: 99%

Insulin Pump Therapy in Type 1 Diabetes-Merging Technology with Diabetes Care

Thabit¹

2012

American Medical Journal

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Abstract:The use of insulin pump therapy has been increasing over the past number of years in many countries. The Diabetes Control and Complications Trial (DCCT) have proven that better glycaemic control with fewer hypoglycemic events is achievable with insulin pump therapy. The delivery of subcutaneous insulin through an insulin pump mimics physiological insulin delivery better than Multiple Daily Injection of insulin (MDI). Insulin pump therapy is an attractive therapeutic option for many patients with T1DM with the potential to improve glycaemic control and quality of life. Technological developments over the past few years have enhanced the functional capabilities and appearance of modern insulin pumps. Careful patient selection for insulin pump therapy by health care professionals is still important, to optimize its benefit and to lessen the associated risk. In this review article, the clinical evidence for insulin pumps, its advantages and disadvantages, as well as patient selection criteria for insulin pumps are outlined. Examples of insulin pump devices that are currently available, including the advent of newer devices and technology in this field are also reviewed.

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Benefits of a bolus calculator in pre‐ and postprandial glycaemic control and meal flexibility of paediatric patients using continuous subcutaneous insulin infusion (CSII)

Cited by 89 publications

References 17 publications

Insulin Pump Therapy is Equally Effective and Safe in Elderly and Young Type 1 Diabetes Patients

Insulin Pump Therapy is Equally Effective and Safe in Elderly and Young Type 1 Diabetes Patients

Recommendations for Insulin Dose Calculator Risk Management

Insulin Pump Therapy in Type 1 Diabetes-Merging Technology with Diabetes Care

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