Issues and Ideas in Bolus Advisor Research With Commentary on "A Methodology to Compare Insulin Dosing Algorithms in Real-Life Settings".

The accompanying article by Groat et al in this issue presents a methodology to compare glucose outcomes from insulin bolus dose recommendations observed retrospectively from a novel iDecide bolus calculator with glucose outcomes from the prospective bolus recommendations provided by a current insulin pump. The methodology in this article evaluates a bolus calculator algorithm and also evaluates calculations for two additional lifestyle behaviors, exercise and alcohol intake, that are modifiable risk factors associated with diabetes. This methodology for evaluation of glycemic outcomes from bolus calculators could be expanded further using much larger existing bolus calculator databases. This would complement current verifications done through in-silico testing with the University of Virginia/Padua 300 patient type 1 diabetes simulator. This approach merits serious consideration, yet the actual dose recommendations provided by the iDecide calculator introduce wider lessons on how bolus calculator glucose outcomes might be better optimized.