Revital Nimri1, Eyal Dassau2, Tomer Segall3, Ido Muller3, Natasa Bratina4, Olga Kordonouri5, Rachel Bello1, Torben Biester5, Klemen Dovc4, Ariel Tenenbaum1,6, Avivit Brener1, Marko Šimunović7, Sophia D Sakka8, Michal Nevo Shenker1, Caroline Gb Passone9, Irene Rutigliano10, Davide Tinti11, Clara Bonura12, Silvana Caiulo12, Anna Ruszala13, Barbara Piccini14, Dinesh Giri15, Ronnie Stein16, Ivana Rabbone11, Patrizia Bruzzi17, Jasna Šuput Omladič4, Caroline Steele18, Guglielmo Beccuti19, Michal Yackobovitch-Gavan1,6, Tadej Battelino4,20, Thomas Danne5, Eran Atlas3, Moshe Phillip1,6. 1. Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. 2. Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts. 3. DreaMed Diabetes Ltd, Petah Tikva, Israel. 4. Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia. 5. Diabetes Centre for Children and Adolescents, Auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany. 6. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 7. Department of Pediatrics, University Hospital Centre Split, Split, Croatia. 8. Department of Endocrinology and Diabetes, Evelina London Children's Hospital, London, UK. 9. Instituto da Criança - HCFMUSP, University of Sao Paulo, Sao Paulo, Brazil. 10. Pediatrics IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 11. Centre of Pediatric Diabetes, Department of Pediatrics, University of Turin, Turin, Italy. 12. San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy. 13. Department of Pediatric and Adolescent Endocrinology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland. 14. Diabetology Unit, Meyer Children's Hospital, Florence, Italy. 15. Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, UK. 16. Paediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Sourasky Medical Centre, Tel Aviv, Israel. 17. Departments of Medical and Surgical Sciences of Mothers, Children and Adults, Azienda Ospedaliero-Univeristaria of Modena Policlinico, Paediatric Unit, Modena, Italy. 18. Paediatric Endocrinology and Diabetes, Leeds Children's Hospital, Leeds, UK. 19. Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy. 20. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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.
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.
Authors: Revital Nimri; Tadej Battelino; Lori M Laffel; Robert H Slover; Desmond Schatz; Stuart A Weinzimer; Klemen Dovc; Thomas Danne; Moshe Phillip Journal: Nat Med Date: 2020-09-09 Impact factor: 53.440
Authors: Nicole Y Xu; Kevin T Nguyen; Ashley Y DuBord; John Pickup; Jennifer L Sherr; Hazhir Teymourian; Eda Cengiz; Barry H Ginsberg; Claudio Cobelli; David Ahn; Riccardo Bellazzi; B Wayne Bequette; Laura Gandrud Pickett; Linda Parks; Elias K Spanakis; Umesh Masharani; Halis K Akturk; John S Melish; Sarah Kim; Gu Eon Kang; David C Klonoff Journal: J Diabetes Sci Technol Date: 2022-05-02