A Novel Method for Assessing Insulin Dose Adjustments by Patients with Diabetes

Abstract

Background:Insulin treated diabetic patients often do not adjust their insulin doses. We developed a method to provide a quantitative and qualitative assessment of this behavior. Methods:Fourteen patients provided logbook pages of their self-monitoring of blood glucose (SMBG) data and insulin doses. We compared the actual decisions of patients in real-life to what they would decide on the same SMBG, as an a posteriori exercise. We also compared these decisions and those proposed by 6 diabetologists on the same sets of data to the recommendations made by HumaLink, an automated insulin dosage system. Results:1) Patients in real-life modified their insulin doses least often. However, given a chance to make these decisions a posteriori, they modified their insulin doses more often. HumaLink proposed changes even more often, and diabetologists were the most aggressive in changing insulin doses. 2) The decisions proposed by the patients in real-life or a posteriori and by the diabetologists were compared to the recommendations made by HumaLink, using a decisions analysis grid (DAG). For these three groups, full disagreement with HumaLink (patient or physician increases while HumaLink decreases and the opposite) was observed for less than 5% of the cases. 3) By comparison to HumaLink, patient decisions seemed guided by the desire to avoid hypoglycemia. By contrast, decisions by diabetologists seemed often to be guided by the desire to avoid hyperglycemia. Conclusion:These methods provide an objective evaluation of insulin dose adjustments by patients with diabetes and may be useful to assess the effectiveness of educational programs. J Diabetes Sci Technol 2007; 1:3-7 Journal of Diabetes Science and Technology

Association of HbA1c to BOLUS Scores Among Youths with Type 1 Diabetes

“…Problems with carbohydrate counting accuracy and with deviations from the prescribed insulin bolus regimen have been well documented among patients with T1D. 26,27 Use of a bolus advisor appears to modestly reduce HbA1c and glycemic variability in a longitudinal observational study, but the degree to which accurate carbohydrate counting and accurate bolusing relate to overall glycemic control remains to be determined. 28 Finally, the present study only evaluated the relationship between BOLUS and mean glycemic control, with no attention given to glycemic variability, which has been the subject of much interest as a potential predictor for acute and chronic complications in T1D.…”

Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective

“…Choosing a dose also involves including a self-monitored glucose level to calculate any correction dose. The complexity of choosing and calculating premeal doses by accounting for variations in meal sizes and composition and for physical activity is often overwhelming and can be compounded by fears of hypoglycemia (21).…”

Bolus Insulin Dose Error Distributions Based on Results From Two Clinical Trials Comparing Blood Glucose Monitoring Systems

“…These ADA guidelines note the particular importance of SMBG for people with diabetes who use multiple-dose insulin or insulin pump therapy, 13 as they use SMBG results to adjust their insulin dose. 14 In the past, a number of analyses have demonstrated that inaccurate BGMS results can lead to errors in insulin dosing. 3,4,7 As more recently published, errors in blood glucose readings may result in contraindicated treatment decisions.…”