BACKGROUND: The introduction of insulin pumps with bolus calculators (BCs) has improved glycemic outcomes and quality of life for those with type 1 diabetes. Despite the increased reliance on BCs, the formulas used to derive recommended boluses are not standardized. Our objective was to examine whether recommendations from different pump BCs vary significantly for identical clinical scenarios. METHODS: Three commercially available insulin pump BCs were programmed with identical settings and then presented with combinations of blood glucose (BG) and carbohydrates (CHOs) to generate a 4-unit bolus. At one- and two-hour time points, while there was insulin-on-board (IOB) present, we simulated various BG and CHO scenarios in order to compare BC-recommended doses. RESULTS: Differences in suggested doses were noted between BCs, as well as within the same brand. The greatest variation was apparent when BG was below target. Doses suggested by one BC varied depending on whether the IOB resulted from a previous dose given for BG or CHO, while the other two BCs adjusted for total IOB regardless of the source. CONCLUSIONS: In this simulation study, there were large differences in recommended doses between BCs due to the unique way each manufacturer incorporates IOB into their formulas as well as the pharmacokinetics used to derive the IOB amount. Providers should be aware that identical pump settings will result in a different dose recommendation for each pump brand and advise patients accordingly.
BACKGROUND: The introduction of insulin pumps with bolus calculators (BCs) has improved glycemic outcomes and quality of life for those with type 1 diabetes. Despite the increased reliance on BCs, the formulas used to derive recommended boluses are not standardized. Our objective was to examine whether recommendations from different pump BCs vary significantly for identical clinical scenarios. METHODS: Three commercially available insulin pump BCs were programmed with identical settings and then presented with combinations of blood glucose (BG) and carbohydrates (CHOs) to generate a 4-unit bolus. At one- and two-hour time points, while there was insulin-on-board (IOB) present, we simulated various BG and CHO scenarios in order to compare BC-recommended doses. RESULTS: Differences in suggested doses were noted between BCs, as well as within the same brand. The greatest variation was apparent when BG was below target. Doses suggested by one BC varied depending on whether the IOB resulted from a previous dose given for BG or CHO, while the other two BCs adjusted for total IOB regardless of the source. CONCLUSIONS: In this simulation study, there were large differences in recommended doses between BCs due to the unique way each manufacturer incorporates IOB into their formulas as well as the pharmacokinetics used to derive the IOB amount. Providers should be aware that identical pump settings will result in a different dose recommendation for each pump brand and advise patients accordingly.
Authors: Daniel J DeSalvo; Kellee M Miller; Julia M Hermann; David M Maahs; Sabine E Hofer; Mark A Clements; Eggert Lilienthal; Jennifer L Sherr; Martin Tauschmann; Reinhard W Holl Journal: Pediatr Diabetes Date: 2018-07-01 Impact factor: 4.866
Authors: Tadej Battelino; Thomas Danne; Richard M Bergenstal; Stephanie A Amiel; Roy Beck; Torben Biester; Emanuele Bosi; Bruce A Buckingham; William T Cefalu; Kelly L Close; Claudio Cobelli; Eyal Dassau; J Hans DeVries; Kim C Donaghue; Klemen Dovc; Francis J Doyle; Satish Garg; George Grunberger; Simon Heller; Lutz Heinemann; Irl B Hirsch; Roman Hovorka; Weiping Jia; Olga Kordonouri; Boris Kovatchev; Aaron Kowalski; Lori Laffel; Brian Levine; Alexander Mayorov; Chantal Mathieu; Helen R Murphy; Revital Nimri; Kirsten Nørgaard; Christopher G Parkin; Eric Renard; David Rodbard; Banshi Saboo; Desmond Schatz; Keaton Stoner; Tatsuiko Urakami; Stuart A Weinzimer; Moshe Phillip Journal: Diabetes Care Date: 2019-06-08 Impact factor: 19.112
Authors: Rodolfo J Galindo; Guillermo E Umpierrez; Robert J Rushakoff; Ananda Basu; Suzanne Lohnes; James H Nichols; Elias K Spanakis; Juan Espinoza; Nadine E Palermo; Dessa Garnett Awadjie; Leigh Bak; Bruce Buckingham; Curtiss B Cook; Guido Freckmann; Lutz Heinemann; Roman Hovorka; Nestoras Mathioudakis; Tonya Newman; David N O'Neal; Michaela Rickert; David B Sacks; Jane Jeffrie Seley; Amisha Wallia; Trisha Shang; Jennifer Y Zhang; Julia Han; David C Klonoff Journal: J Diabetes Sci Technol Date: 2020-09-28