The Use of Insulin Pumps With Meal Bolus Alarms in Children With Type 1 Diabetes to Improve Glycemic Control

Abstract

OBJECTIVE—The aim of this study was to determine whether the use of meal bolus alarms would result in fewer missed meal boluses per week in youth with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) therapy. RESEARCH DESIGN AND METHODS—This was a randomized trial of 48 youth using CSII, who were in suboptimal glycemic control with HbA1c (A1C) values ≥8.0%. Twenty-four subjects were randomized to use a Deltec Cozmo insulin pump with meal bolus alarms (experimental group), while the other 24 subjects continued use of their current insulin pumps (control group) without meal bolus alarms. RESULTS—After 3 months of study, the number of missed meal boluses per week was significantly lower in the experimental group (from 4.9 ± 3.7 to 2.5 ± 2.5; P = 0.0005) but not significantly lower in the control group (from 4.3 ± 2.7 to 4.2 ± 3.9; P = 0.7610). Also after 3 months, the mean A1C value of the experimental group declined significantly (from 9.32 ± 1.12 to 8.86 ± 1.10; P = 0.0430). No significant decline in A1C was present for the control group (from 8.93 ± 1.04 to 8.67 ± 1.17; P = 0.1940). After 6 months of study, the significant decline in A1C from baseline in the experimental group was no longer present. Pooling of all available data from the control and experimental groups showed that at baseline and 3 and 6 months, the number of missed meal boluses per week was significantly correlated with A1C values. CONCLUSIONS—While meal bolus alarms may have the potential to improve suboptimal glycemic control in youth using CSII, our results demonstrated that these alarms had only a transient, modest effect in doing so.

Computerized Automated Reminder Diabetes System (CARDS): E-Mail and SMS Cell Phone Text Messaging Reminders to Support Diabetes Management

“…In a study of technology involving automated pump alerts, youths 8-20 years old received reminder alarms to bolus insulin. 42 Similarly, by the third month of that trial, many participants were ignoring the reminder alarms such that the positive impact of the bolus reminders on the decrement in HbA1c was lost from month 3 to month 6. The pump reminders led to an initial increase in mealtime insulin bolus dosing that waned after 3 months.…”

Comparison of a Novel Insulin Bolus-Patch with Pen/Syringe Injection to Deliver Mealtime Insulin for Efficacy, Preference, and Quality of Life in Adults with Diabetes: A Randomized, Crossover, Multicenter Study

“…8 Missed bolus doses per week have been shown to correlate significantly with HbA1c (r = 0.6) (P < 0.0001) with a 0.92% increase in HbA1c for every four meal boluses missed per week. 9 The aim of this feasibility study was to compare efficacy, device satisfaction, and quality of life (QOL) in people with type 1 or 2 diabetes delivering mealtime insulin using a novel insulin bolus-patch (Finesse Ô , Calibra Medical, Inc., Redwood City, CA) versus current devices that deliver bolus insulin (pen/syringe). The insulin bolus-patch (henceforth referred to as bolus-patch) is classified as a new Food and Drug Administration product code, OPP, under 21 CFR 880.5725.…”

Use of CoZmonitor®in youth with type 1 diabetes

“…Subject questionnaires, as described in a previous study (9), were also administered at each of the follow‐up visits. Two additional questions were added (experimental group only) to evaluate the subject’s satisfaction and perception of bulkiness of the CoZmonitor while attached to the insulin pump.…”