Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians
Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians
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DOI：
10.1111/dom.13408
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发表时间：
2018-10-01
影响因子：
5.8
通讯作者：
Phillip, Moshe
中科院分区：
文献类型：
--
作者：
Nimri, Revital;Dassau, Eyal;Phillip, Moshe
目的：评估医生根据 1 型糖尿病患者的连续血糖监测 (CGM) 对胰岛素泵设置的调整，并将其与自动胰岛素剂量调整进行比较。方法：来自欧洲、以色列和南美洲 16 个中心的总共 26 名医生参与了这项研究。所有人都被要求根据 3 周内收集的 15 名患者（平均年龄 16.2 +/- 4.3 岁，六名女性，平均糖化血红蛋白 8.3 +/- 0.9% [66.8 +/- 7.3 mmol/mol]）的胰岛素泵、CGM 和血糖仪下载来调整胰岛素剂量。对医生和中心之间以及医生和自动算法 Advisor Pro（DreaMed Diabetes Ltd，佩塔提克瓦，以色列）之间的基础、碳水化合物与胰岛素比率 (CR) 和校正因子 (CF) 计划的相对变化的建议进行了比较。研究终点是对胰岛素剂量调整趋势完全一致（相同趋势）、部分一致（增加/减少与无变化）和完全不同意（相反趋势）的比较点的百分比。 结果：医生之间对基础、CR 和 CF 计划的胰岛素调整趋势完全一致的百分比分别为 41 +/- 9%、45 +/- 11% 和 45.5 +/- 13%，完全一致的百分比为 45 +/- 11% 和 45.5 +/- 13%。分歧的比例分别为 12 +/- 7%、9.5 +/- 7% 和 10 +/- 8%。医生和自动算法之间发现了显着相似的结果。算法的胰岛素剂量变化幅度至少等于或小于医生提出的建议。结论：医生根据相同的数据集提供不同的胰岛素剂量建议。 Advisor Pro 的自动建议与医生在胰岛素剂量方向或幅度方面给出的建议没有显着差异。
Aims: To evaluate physicians' adjustments of insulin pump settings based on continuous glucose monitoring (CGM) for patients with type 1 diabetes and to compare these to automated insulin dose adjustments.Methods: A total of 26 physicians from 16 centres in Europe, Israel and South America participated in the study. All were asked to adjust insulin dosing based on insulin pump, CGM and glucometer downloads of 15 patients (mean age 16.2 +/- 4.3 years, six female, mean glycated haemoglobin 8.3 +/- 0.9% [66.8 +/- 7.3 mmol/mol]) gathered over a 3-week period. Recommendations were compared for the relative changes in the basal, carbohydrate to insulin ratio (CR) and correction factor (CF) plans among physicians and among centres and also between the physicians and an automated algorithm, the Advisor Pro (DreaMed Diabetes Ltd, Petah Tikva, Israel). Study endpoints were the percentage of comparison points for which there was full agreement on the trend of insulin dose adjustments (same trend), partial agreement (increase/decrease vs no change) and full disagreement (opposite trend).Results: The percentages for full agreement between physicians on the trend of insulin adjustments of the basal, CR and CF plans were 41 +/- 9%, 45 +/- 11% and 45.5 +/- 13%, and for complete disagreement they were 12 +/- 7%, 9.5 +/- 7% and 10 +/- 8%, respectively. Significantly similar results were found between the physicians and the automated algorithm. The algorithm magnitude of insulin dose change was at least equal to or less than that proposed by the physicians.Conclusions: 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.