Comparison of Insulin Dose Adjustments Made by Artificial Intelligence-Based Decision Support Systems and by Physicians in People with Type 1 Diabetes Using Multiple Daily Injections Therapy

Revital Nimri, Amir Tirosh, Ido Muller, Yael Shtrit, Ivana Kraljevic, Montserrat Martín Alonso, Tanja Milicic, Banshi Saboo, Asma Deeb, Athanasios Christoforidis, Marieke Den Brinker, Lutgarda Bozzetto, Andrea Mario Bolla, Michal Krcma, Rosa Anna Rabini, Shadi Tabba, Andriani Gerasimidi-Vazeou, Giulio Maltoni, Elisa Giani, Idit DotanIdit F. Liberty, Yoel Toledano, Olga Kordonouri, Natasa Bratina, Klemen Dovc, Torben Biester, Eran Atlas, Moshe Phillip

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Objective: Artificial intelligence-based decision support systems (DSS) need to provide decisions that are not inferior to those given by experts in the field. Recommended insulin dose adjustments on the same individual data set were compared among multinational physicians, and with recommendations made by automated Endo-Digital DSS (ED-DSS). Research Design and Methods: This was a noninterventional study surveying 20 physicians from multinational academic centers. The survey included 17 data cases of individuals with type 1 diabetes who are treated with multiple daily insulin injections. Participating physicians were asked to recommend insulin dose adjustments based on glucose and insulin data. Insulin dose adjustments recommendations were compared among physicians and with the automated ED-DSS. The primary endpoints were the percentage of comparison points for which there was agreement on the trend of insulin dose adjustments. Results: The proportion of agreement and disagreement in the direction of insulin dose adjustment among physicians was statistically noninferior to the proportion of agreement and disagreement observed between ED-DSS and physicians for basal rate, carbohydrate-to insulin ratio, and correction factor (P < 0.001 and P ≤ 0.004 for all three parameters for agreement and disagreement, respectively). The ED-DSS magnitude of insulin dose change was consistently lower than that proposed by the physicians. Conclusions: Recommendations for insulin dose adjustments made by automatization did not differ significantly from recommendations given by expert physicians regarding the direction of change. These results highlight the potential utilization of ED-DSS as a useful clinical tool to manage insulin titration and dose adjustments.

Original languageEnglish
Pages (from-to)564-572
Number of pages9
JournalDiabetes Technology and Therapeutics
Volume24
Issue number8
DOIs
StatePublished - 1 Aug 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Copyright 2022, Mary Ann Liebert, Inc.

Keywords

  • Artificial intelligence
  • Automated decision support
  • Glycemic control
  • Insulin therapy
  • Multiple daily injections
  • Type 1 diabetes

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