Can a Tool That Automates Insulin Titration Be a Key to Diabetes Management?
Can a Tool That Automates Insulin Titration Be a Key to Diabetes Management?
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DOI：
10.1089/dia.2011.0303
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发表时间：
2012-08-01
影响因子：
5.4
通讯作者：
Hodish, Israel
中科院分区：
文献类型：
--
作者：
Bergenstal, Richard M.;Bashan, Eran;Hodish, Israel
背景：大多数使用胰岛素的患者不能达到最佳的血糖控制，并容易发生并发症。许多临床试验表明，频繁的胰岛素剂量滴定是实现血糖控制的必要条件。不幸的是，这种范例的实现通常是不切实际的。我们假设糖尿病胰岛素指导系统（DIGS（TM））（DIGEIA，Inc.，安阿伯，MI）软件，它自动建议患者调整胰岛素剂量，将提供安全和有效的每周胰岛素剂量adjustments.Subjects和方法：在一项可行性研究中，我们招募了1型和2型糖尿病患者，用各种胰岛素治疗方案和次优血糖控制。12周的干预期之后是4周的基线导入期。在干预期间，DIGS处理患者的血糖读数，并每周提供胰岛素剂量调整。如果研究小组批准，则将调整后的胰岛素剂量传达给患者。研究期间未改变胰岛素制剂。主要结果是由研究小组批准的DIGS剂量调整的分数，次要结果是改善血糖控制。DIGS软件推荐了1，734次胰岛素剂量调整，其中1，731次（99.83%）获得批准。在导入期内，每周平均血糖稳定在174.2 +/-36.7 mg/dL（9.7 +/-2.0 mmol/L）。在接下来的12周内，DIGS剂量调整导致平均葡萄糖逐渐改善至163.3 +/-35.1 mg/dL（9.1 +/-1.9 mmol/L）（P <0.03）。平均糖化血红蛋白从8.4 ± 0.8%降至7.9 ± 0.9%（P <0.05）。结论：DIGS软件为患者提供了安全有效的每周胰岛素剂量调整方法。广泛实施DIGS可改善结局并降低实施有效胰岛素治疗的成本。
Background: Most patients who use insulin do not achieve optimal glycemic control and become susceptible to complications. Numerous clinical trials have shown that frequent insulin dosage titration is imperative to achieve glycemic control. Unfortunately, implementation of such a paradigm is often impractical. We hypothesized that the Diabetes Insulin Guidance System (DIGS (TM)) (Hygieia, Inc., Ann Arbor, MI) software, which automatically advises patients on adjustment of insulin dosage, would provide safe and effective weekly insulin dosage adjustments.Subjects and Methods: In a feasibility study we enrolled patients with type 1 and type 2 diabetes, treated with a variety of insulin regimens and having suboptimal glycemic control. The 12-week intervention period followed a 4-week baseline run-in period. During the intervention, DIGS processed patients' glucose readings and provided insulin dosage adjustments on a weekly basis. If approved by the study team, the adjusted insulin dosage was communicated to the patients. Insulin formulations were not changed during the study. The primary outcome was the fraction of DIGS dosage adjustments approved by the study team, and the secondary outcome was improved glycemic control.Results: Forty-six patients were recruited, and eight withdrew. The DIGS software recommended 1,734 insulin dosage adjustments, of which 1,731 (99.83%) were approved. During the run-in period the weekly average glucose was stable at 174.2 +/- 36.7 mg/dL (9.7 +/- 2.0 mmol/L). During the following 12 weeks, DIGS dosage adjustments resulted in progressive improvement in average glucose to 163.3 +/- 35.1 mg/dL (9.1 +/- 1.9 mmol/L) (P < 0.03). Mean glycosylated hemoglobin decreased from 8.4 +/- 0.8% to 7.9 +/- 0.9% (P < 0.05). Concomitantly, the frequency of hypoglycemia decreased by 25.2%.Conclusions: The DIGS software provided patients with safe and effective weekly insulin dosage adjustments. Widespread implementation of DIGS may improve the outcome and reduce the cost of implementing effective insulin therapy.