Nonadherence to Insulin Therapy Detected by Bluetooth-Enabled Pen Cap Is Associated With Poor Glycemic Control

Munshi, Medha; Slyne, Christine; Greenberg, Jordan; Greaves, Tori; Lee, Ariel; Carl, Sam; Atakov-Castillo, Astrid; Toschi, Elena

doi:10.2337/dc18-1631

Cited by 50 publications

(40 citation statements)

References 5 publications

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“…[1][2][3][4] Difficulties with insulin dosing and inaccurate dose timing have been shown to result in poor glycemic control for people with diabetes. 5,6 The impact of missed insulin injections on HbA 1c levels is well established, [7][8][9][10][11][12] leading to an increasing risk of diabetes-related complications. 13,14 Technological advances offer opportunities to optimize insulin delivery, reduce dosing errors, and improve regimen management.…”

Section: Introductionmentioning

confidence: 99%

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Adolfsson

Hartvig

Kaas

et al. 2020

Diabetes Technology & Therapeutics

111

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Background: This observational study investigated whether the connected NovoPen Ò 6 could influence insulin regimen management and glycemic control in people with type 1 diabetes (T1D) using a basal-bolus insulin regimen and continuous glucose monitoring in a real-world setting. Methods: Participants from 12 Swedish diabetes clinics downloaded pen data at each visit (final cohort: n = 94). Outcomes included time in range (TIR; sensor glucose 3.9-10.0 mmol/L), time in hyperglycemia (>10 mmol/L), and hypoglycemia (L1: 3.0-<3.9 mmol/L; L2: <3.0 mmol/L). Missed bolus dose (MBD) injections were meals without bolus injection within -15 and +60 min from the start of a meal. Outcomes were compared between the baseline and follow-up periods ( ‡5 health care professional visits). Data were analyzed from the first 14 days following each visit. For the TIR and total insulin dose analyses (n = 94), a linear mixed model was used, and for the MBD analysis (n = 81), a mixed Poisson model was used. Results: TIR significantly increased (+1.9 [0.8; 3.0] 95% CI h/day; P < 0.001) from baseline to follow-up period, with a corresponding reduction in time in hyperglycemia (-1.8 [-3.0; -0.6] 95% CI h/day; P = 0.003) and L2 hypoglycemia (-0.3 [-0.6; -0.1] 95% CI h/day; P = 0.005), and no change in time in L1 hypoglycemia. MBD injections decreased by 43% over the study (P = 0.002). Change in MBD injections corresponded to a decrease from 25% to 14% based on the assumption that participants had three main meals per day. Conclusions: Our study highlights the potential benefit on glycemic control and dosing behavior when reliable insulin dose data from a connected pen contribute to insulin management in people with T1D.

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Section: Introductionmentioning

confidence: 99%

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Adolfsson

Hartvig

Kaas

et al. 2020

Diabetes Technology & Therapeutics

111

View full text Add to dashboard Cite

show abstract

“…Another study using a Bluetooth-enabled insulin pen cap (Gocap) evaluated the timing and dosing accuracy of insulin in younger (18-35 years) and older (≥65 years) groups of 75 participants who injected both basal and meal time insulin 2 or more times per day. 29 The Bluetooth-enabled pen cap registered the position of the pen plunger along with confirmation of dose and time. Twenty-four percent of meal-time and correction doses and 36% of basal doses were either not timed or dosed accurately.…”

Section: Missed or Delayed Insulin Dosesmentioning

confidence: 99%

“…The second attachment is Common Sensing's Gocap, 43 which also interfaces with an app. While Gocap was used in research detailed earlier, 29,38 it is not currently commercially available. Based on FDA regulations, insulin attachments and delivery devices go through 1 of several regulatory review pathways that include 510(k) exempt, clearance, or approval.…”

Section: • Tracking Insulin Pens (Stages 1-3)mentioning

confidence: 99%

The Reference Guide to Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education Services

2020

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Purpose More than 7 million Americans who have diabetes use insulin therapy. The majority continue to use syringes and vials or traditional insulin pens to deliver their insulin doses. Using these tools to deliver insulin presents numerous challenges for both the person with diabetes and their clinicians. This article provides an in-depth introduction to a new category of insulin delivery devices and integrated management systems, referred to as smart insulin pens. The article includes information about how these integrated insulin delivery systems can reduce many of the challenges of rapid-acting insulin dosing via injection by enabling easier and more accurate dose recording, dose calculations, and sharing of diabetes management data with clinicians. This article also discusses new roles for diabetes care and education specialists in diabetes data-driven care and practice and addresses how smart insulin pens represent one of many newer digital diabetes management tools that can assist people with diabetes and their clinicians to optimally achieve and deliver quality, data-driven diabetes care. Conclusions Newer and simplified insulin delivery devices with their integrated management systems, such as smart insulin pens, have the potential to minimize the challenges and complexities associated with insulin injection therapy while also providing people with diabetes and their clinicians more complete and integrated data in easily transmitted reports that support more efficient data analysis.

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“…Insulin metrics generated by automated data analysis could be used to identify insulin dosing practices that contribute to suboptimal glucose control. [5][6][7][8][9][10][11] This includes several aspects of insulin dosing behavior such as missed food boluses, delayed boluses, suboptimal meal boluses, dosing to correct hyperglycemia, and insulin dosing practices contributing to hypoglycemia. Connected insulin pens also can provide insights about needle priming practices.…”

Section: Introductionmentioning

confidence: 99%

Insulin Metrics: Need for Development of Consensus Standards for Reporting of Insulin Dosing Data

Wolpert¹,

Polonsky

Rodbard

2021

Diabetes Technology & Therapeutics

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The advent of connected insulin pens will generate an avalanche of digital insulin data, especially in the context of prandial-and multiple daily injection-insulin regimens. There is a need for the diabetes community to develop standards for such data, analogous to what has been achieved using the ambulatory glucose profile and associated metrics for glucose, permitting harmonization of data reporting for multiple devices and facilitating integration of glucose, insulin, food intake, and physical activity data. Several studies have estimated the timing of meals by analyses of glucose excursions but using diverse criteria. There is need for uniform criteria for multiple types of insulin boluses, including premeal, perimeal, delayed, missed, and correction boluses to facilitate research studies and patient care. This article contains a first preliminary proposal for standards regarding reporting of insulin dosing data. Clinical usage of these reports will require sensitive communication between health care providers and patients.

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Nonadherence to Insulin Therapy Detected by Bluetooth-Enabled Pen Cap Is Associated With Poor Glycemic Control

Cited by 50 publications

References 5 publications

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

The Reference Guide to Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education Services

Insulin Metrics: Need for Development of Consensus Standards for Reporting of Insulin Dosing Data

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