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

Revital Nimri; Eyal Dassau; Tomer Segall; Ido Muller; Natasa Bratina; Olga Kordonouri; Rachel Bello; Torben Biester; Klemen Dovc; Ariel Tenenbaum; Avivit Brener; Marko Šimunović; Sophia D. Sakka; Michal Nevo Shenker; Caroline G.B. Passone; Irene Rutigliano; Davide Tinti; Clara Bonura; Silvana Caiulo; Anna Ruszala; Barbara Piccini; Dinesh Giri; Ronnie Stein; Ivana Rabbone; Patrizia Bruzzi; Jasna Šuput Omladič; Caroline Steele; Guglielmo Beccuti; Michal Yackobovitch-Gavan; Tadej Battelino; Thomas Danne; Eran Atlas; Moshe Phillip

doi:10.1111/dom.13408

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

Revital Nimri, Eyal Dassau, Tomer Segall, Ido Muller, Natasa Bratina, Olga Kordonouri, Rachel Bello, Torben Biester, Klemen Dovc, Ariel Tenenbaum, Avivit Brener, Marko Šimunović, Sophia D. Sakka, Michal Nevo Shenker, Caroline G.B. Passone, Irene Rutigliano, Davide Tinti, Clara Bonura, Silvana Caiulo, Anna RuszalaBarbara Piccini, Dinesh Giri, Ronnie Stein, Ivana Rabbone, Patrizia Bruzzi, Jasna Šuput Omladič, Caroline Steele, Guglielmo Beccuti, Michal Yackobovitch-Gavan, Tadej Battelino, Thomas Danne, Eran Atlas, Moshe Phillip

Research output: Contribution to journal › Article › peer-review

47 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	2458-2466
Number of pages	9
Journal	Diabetes, Obesity and Metabolism
Volume	20
Issue number	10
DOIs	https://doi.org/10.1111/dom.13408
State	Published - Oct 2018
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2018 John Wiley & Sons Ltd

Funding

R.N. received honoraria for participation on the speaker's bureau of Novo Nordisk, Pfizer, Eli Lilly and Sanofi. R.N. owns DreaMed stock. R.N. reports two patent applications. E.D has received consulting fees from Animas, Insulet, Eli Lily and Company, has received research support from Dexcom, Animas, Insulet, Roche, Tandem, Lifescan and Xeris, and receives royalty payments on intellectual property related to closed-loop algorithms. T.S., I.M. are employees of DreaMed Diabetes. I.M. owns DreaMed stocks. N.B. received honoraria for participation on the speaker's bureau of Medtronic and Roche. N.B. owns DreaMed stock. O.K. has received honoraria for sitting on the advisory board of Novo Nordisk, and speaker's honoraria from Eli Lilly and Sanofi. O.K. owns DreaMed stocks. T. Biester has received honoraria for participation in the speaker's bureau of Medtronic, DexCom, YpsoMed, travel support from NovoNordisk, DexCom, AstraTeneca, and sitting on the DexCom Advisory Board. R.B, D.K, A.T, A.B, M.S, S.D.S, M.N.S, C.P, I.R, D.T, C.B, S.C, A.R, B.P, D.G, R.S, Iv.R, P.B, J.S.O, C.S, G.B and M.Y.G have no conflict of interest related to this study. T. Battelino served on the advisory boards of Novo Nordisk, Sanofi, Eli Lilly, Boehringer, Medtronic, DreaMed Diabetes and Bayer Health Care. T. Battelino's institution received research grant support, with receipt of travel and accommodation expenses in some cases, from Abbott, Medtronic, Novo Nordisk, GluSense, Sanofi, Sandoz and Dia-myd. T. Battelino received honoraria for participating on the speaker's bureau of Eli Lilly, Bayer, Novo Nordisk, Medtronic, Sanofi and Roche. T. Battelino owns DreaMed stock. T.D has received research support/ consulting fees from Abbott Diabetes Care Inc., AstraZeneca, Novo Nordisk A/S, Eli Lilly and Company, Boehringer Ingelheim GmbH, BD Medical-Diabetes Care, Lexicon, Medtronic MiniMed, Inc., Lexicon Pharmaceuticals, Inc., Roche Diagnostics, Sanofi-Aventis Deutschland GmbH, Johnson & Johnson. T.D. owns DreaMed stock. E.A is employee of DreaMed Diabetes. E.A owns DreaMed stock. M.P. is a member of the Advisory Board of AstraZeneca, Sanofi, Animas, Med-tronic, Bayer Health Care and Board Member of C.G.M.3 Ltd., Consultant of Bristol-Myers Squibb, D-medical, Ferring Pharmaceuticals, Andromeda Biotech. The Institute headed by M.P. received research support from Medtronic, Novo Nordisk, Abbott Diabetes Care, Eli Lilly, Roche, Dexcom, Sanofi, Insulet Corporation, Animas, Andromeda, and Macrogenics. M.P. has been paid lecture fees by Sanofi, Novo Nordisk, Roche, and Pfizer. He is a stock/shareholder of C.G.M.3 Ltd. and DreamMed Diabetes. M.P. reports two patent applications.

Funders	Funder number
GluSense
Sandoz and Dia-myd
Abbott Laboratories
Eli Lilly and Company
Roche
Sanofi
Medtronic
Abbott Diabetes Care
Novo Nordisk

Keywords

Advisor Pro
decision support system
insulin pump settings
non-interventional survey
treatment adjustments

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/dom.13408

Cite this

Nimri, R., Dassau, E., Segall, T., Muller, I., Bratina, N., Kordonouri, O., Bello, R., Biester, T., Dovc, K., Tenenbaum, A., Brener, A., Šimunović, M., Sakka, S. D., Nevo Shenker, M., Passone, C. G. B., Rutigliano, I., Tinti, D., Bonura, C., Caiulo, S., ... Phillip, M. (2018). Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians. Diabetes, Obesity and Metabolism, 20(10), 2458-2466. https://doi.org/10.1111/dom.13408

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abstract = "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.",

keywords = "Advisor Pro, decision support system, insulin pump settings, non-interventional survey, treatment adjustments",

author = "Revital Nimri and Eyal Dassau and Tomer Segall and Ido Muller and Natasa Bratina and Olga Kordonouri and Rachel Bello and Torben Biester and Klemen Dovc and Ariel Tenenbaum and Avivit Brener and Marko {\v S}imunovi{\'c} and Sakka, {Sophia D.} and {Nevo Shenker}, Michal and Passone, {Caroline G.B.} and Irene Rutigliano and Davide Tinti and Clara Bonura and Silvana Caiulo and Anna Ruszala and Barbara Piccini and Dinesh Giri and Ronnie Stein and Ivana Rabbone and Patrizia Bruzzi and Omladi{\v c}, {Jasna {\v S}uput} and Caroline Steele and Guglielmo Beccuti and Michal Yackobovitch-Gavan and Tadej Battelino and Thomas Danne and Eran Atlas and Moshe Phillip",

note = "Publisher Copyright: {\textcopyright} 2018 John Wiley & Sons Ltd",

year = "2018",

month = oct,

doi = "10.1111/dom.13408",

language = "אנגלית",

volume = "20",

pages = "2458--2466",

journal = "Diabetes, Obesity and Metabolism",

issn = "1462-8902",

publisher = "John Wiley and Sons Inc.",

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Nimri, R, Dassau, E, Segall, T, Muller, I, Bratina, N, Kordonouri, O, Bello, R, Biester, T, Dovc, K, Tenenbaum, A, Brener, A, Šimunović, M, Sakka, SD, Nevo Shenker, M, Passone, CGB, Rutigliano, I, Tinti, D, Bonura, C, Caiulo, S, Ruszala, A, Piccini, B, Giri, D, Stein, R, Rabbone, I, Bruzzi, P, Omladič, JŠ, Steele, C, Beccuti, G, Yackobovitch-Gavan, M, Battelino, T, Danne, T, Atlas, E & Phillip, M 2018, 'Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians', Diabetes, Obesity and Metabolism, vol. 20, no. 10, pp. 2458-2466. https://doi.org/10.1111/dom.13408

TY - JOUR

T1 - Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring

T2 - Variations among countries and physicians

AU - Nimri, Revital

AU - Dassau, Eyal

AU - Segall, Tomer

AU - Muller, Ido

AU - Bratina, Natasa

AU - Kordonouri, Olga

AU - Bello, Rachel

AU - Biester, Torben

AU - Dovc, Klemen

AU - Tenenbaum, Ariel

AU - Brener, Avivit

AU - Šimunović, Marko

AU - Sakka, Sophia D.

AU - Nevo Shenker, Michal

AU - Passone, Caroline G.B.

AU - Rutigliano, Irene

AU - Tinti, Davide

AU - Bonura, Clara

AU - Caiulo, Silvana

AU - Ruszala, Anna

AU - Piccini, Barbara

AU - Giri, Dinesh

AU - Stein, Ronnie

AU - Rabbone, Ivana

AU - Bruzzi, Patrizia

AU - Omladič, Jasna Šuput

AU - Steele, Caroline

AU - Beccuti, Guglielmo

AU - Yackobovitch-Gavan, Michal

AU - Battelino, Tadej

AU - Danne, Thomas

AU - Atlas, Eran

AU - Phillip, Moshe

PY - 2018/10

Y1 - 2018/10

N2 - 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.

AB - 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.

KW - Advisor Pro

KW - decision support system

KW - insulin pump settings

KW - non-interventional survey

KW - treatment adjustments

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DO - 10.1111/dom.13408

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C2 - 29885025

AN - SCOPUS:85050484581

SN - 1462-8902

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JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

IS - 10

ER -

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

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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