Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians

Nimri, Revital; Dassau, Eyal; Segall, Tomer; Muller, Ido; Bratina, Nataša; Kordonouri, Olga; Bello, Rachel; Biester, Torben; Dovč, Klemen; Tenenbaum, Ariel; Brener, Avivit; Šimunović, Marko; Sakka, Sophia; Shenker, Michal Nevo; Passone, Caroline; Rutigliano, Irene; Tinti, Davide; Bonura, Clara; Caiulo, Silvana; Ruszała, Anna; Piccini, Barbara; Giri, Dinesh; Stein, Ronnie; Rabbone, Ivana; Bruzzi, Patrizia; Omladic, Jasna Suput; Steele, Caroline; Beccuti, Guglielmo; Yackobovitch‐Gavan, Michal; Battelino, Tadej; Danne, Thomas; Atlas, Eran; Phillip, Moshe

doi:10.1111/dom.13408

Cited by 51 publications

(43 citation statements)

References 28 publications

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“…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.…”

Section: Commentmentioning

confidence: 99%

“…In contrast, the sheer volume of data and multitude of choices available to clinicians attempting to adjust therapy in patients with T1D using pumps and sensors makes development of ADS systems for this population a much more complex and challenging project. This interesting study by Nimri highlights the fact that there is little agreement or consistency among physicians regarding recommendations for insulin dosing changes for patients using pumps and sensors, lending credence to the old adage of medicine being as much an art as a science (16). The good news is that this at a very broad level, the particular ADS system under study, the Advisor Pro, seemed to agree with doctors as much as doctors agree with doctors.…”

Section: Commentmentioning

confidence: 99%

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Practical Implementation of Diabetes Technology: Real‐World Use

Messer

Weinzimer

2020

Diabetes Technology & Therapeutics

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IntroductionT he purpose of the practical implementation article of the ATTD Yearbook is to characterize the current diabetes technology landscape around the globe, focusing on emerging trends in device uptake, clinical utility and guidance, access to devices, educational strategies, and perceived benefit and burden of device use (1). Articles selected for this review were published between July 2018 and June 2019 and contained original research related to diabetes technology use in the real world rather than a structured research setting. Keyword searches included ''education, access, economics, cost effectiveness, real world, behavior, barriers, registry, outcomes, implementation, decision support, and technology.'' A total of 42 articles were retrieved, and 10 were selected for review here.This year's article starts with highlighting new data from the Type 1 Diabetes (T1D) Exchange Registry from 2016 to 2018, which provides relevant insight into diabetes technology trends in the United States (2). As highlighted below, technology uptake has rapidly expanded in the past decade. This is most notable in use of continuous glucose monitoring (CGM), with a five-fold increase in reported use compared with 8 years prior, and a 10-fold increase in use for children <12 years old. Insulin pump use has slightly increased as well. Technophiles can celebrate this trend.The second major point is more sobering: despite this increase in diabetes technology utilization, glycemic control has not improved overall. Glycemic data mirror the data from 8 years prior, with an actual worsening of glycemic control in adolescents. This paradox suggests a more nuanced picture of technology effectiveness, a picture that must include individual factors, clinical factors, and system factors all contributing to the ''real-world'' glycemic benefits of technology.This year's article therefore focuses on extra-technological factors that support or hinder efforts of individuals using diabetes technology to manage diabetes. First, access, insurance coverage, and cost-effectiveness data on sensor augmented pump (SAP) and hybrid closed loop (HCL) are reviewed. Next, new data from educational randomized control trials (RCT) are presented to emphasize the essential place for education in all diabetes self-management. Finally, two studies of automated decision support are reviewed in order to illustrate some of the potential benefits and challenges of bringing this technology to the clinical environment.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Practical Implementation of Diabetes Technology: Real‐World Use

Messer

Weinzimer

2020

Diabetes Technology & Therapeutics

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“…Some may be concerned that an ADS system running without physician oversight may provide unsafe recommendations to patients. The foundation for this concern has been addressed in a novel study by Nimri et al 17 This study evaluated the insulin dosing adjustments made by 26 physicians from 16 centers across Europe, Israel, and South America for pump settings based on CGM data. These adjustments were compared against the DreaMed Advisor Pro (DreaMed Diabetes Ltd., Petah Tikva, Israel).…”

Section: Rationale For Ads Technologymentioning

confidence: 99%

“…Earlier we discussed the Nimri study on the DreaMed advisor and its directional agreement with a diverse group of clinicians. 17 Herrero conducted an in silico validation of a basal insulin ADS tool for patients on CSII therapy. 26 This virtual study showed that use of the ADS tool could significantly improve time in target range and reduce hypoglycemia over a 4-month period.…”

Section: Studies On Ads Technologymentioning

confidence: 99%

Use of Artificial Intelligence to Improve Diabetes Outcomes in Patients Using Multiple Daily Injections Therapy

Forlenza

2019

Diabetes Technology & Therapeutics

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“…Számukat jelenleg több mint egymillióra becsülik világszerte. 8 Az inzulinpumpák két főbb kategóriába sorolha- Mindkét esetben javasolt három-hatnaponta cserélni a kanült. Egy nemrégiben elvégzett átfogó vizsgálat eredménye nem mutatott ki szignifikáns különbséget az egyes gyártók és típusok közötti HbA 1c -értékek tekintetében.…”

Section: A Napjainkban Alkalmazott Inzulinpumpákunclassified

Mesterséges hasnyálmirigy – A cukorbetegség automatikus kezelése mérnöki megközelítéssel

Kovács¹,

Eigner²,

Czakó³

et al. 2019

Diabetologia Hungarica

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Összefoglalás A közlemény rövid naprakész áttekintést ad a mesterséges hasnyálmirigy (artificial pancreas: AP) felépítésével és működésével kapcsolatban, amelynek segítségével automatizált módon lehet a cukorbetegségben szenvedő betegeket kezelni. Ez az interdiszciplináris megközelítés ötvözi az orvosi tudományokat, a mérnöki irányításelméletet, valamint az egészségügyi mérnöki területeket. A folyamatos glukózmonitorozás, valamint az inzulinpumpák megjelenésének segítségével az AP hatékony megoldást nyújthat a jövőben több millió diabeteses beteg kezelése során. Ezen felül a félautomata AP képes garantálni a páciens megfelelő vércukorszintjét. A jelen dolgozatban bemutatjuk az AP általános működését, valamint ismertetünk néhány praktikus modellezési, valamint szabályozási megoldást is. ■ Kulcsszavak: mesterséges hasnyálmirigy, diabetes mellitus Artificial pancreas-an engineering approach of diabetes treatment Summary: The paper gives a short review on the artificial pancreas (AP), which can be used for automated treatment of diabetic patients. This highly interdisciplinary concept involves beyond medical sciences, control engineering and biomedical engineering knowledge. Having already developed continuous glucose sensor devices and highly performant insulin pumps, the AP can be an efficient solution for millions of people living with diabetes for accurate metabolic conditions management. Furthermore, as a semi-automatic device, AP can guarantee tight blood glucose control. In this paper, we summarize not just the AP concept, but give a short review on the modeling and control solutions as well.

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Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians

Abstract: Physicians provide different insulin dose recommendations based on the same datasets. The automated advice of the Advisor Pro did not differ significantly from the advice given by the physicians in the direction or magnitude of the insulin dosing.

Cited by 51 publications

References 28 publications

Practical Implementation of Diabetes Technology: Real‐World Use

Practical Implementation of Diabetes Technology: Real‐World Use

Use of Artificial Intelligence to Improve Diabetes Outcomes in Patients Using Multiple Daily Injections Therapy

Mesterséges hasnyálmirigy – A cukorbetegség automatikus kezelése mérnöki megközelítéssel

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