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A “Slide Rule” to Adjust Insulin Dose Using Trend Arrows in Adults with Type 1 Diabetes: Test in Silico and in Real Life

INTRODUCTION: In persons with type 1 diabetes (T1D) insulin dosing can be adjusted based on trend arrows derived from continuous glucose monitoring (CGM). We propose a slide rule with narrower blood glucose intervals and more classes of insulin sensitivity than are available in current models. METHO...

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Detalles Bibliográficos
Autores principales: Bruttomesso, Daniela, Boscari, Federico, Lepore, Giuseppe, Noaro, Giulia, Cappon, Giacomo, Girelli, Angela, Bozzetto, Lutgarda, Tumminia, Andrea, Grassi, Giorgio, Sparacino, Giovanni, Laviola, Luigi, Facchinetti, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099956/
https://www.ncbi.nlm.nih.gov/pubmed/33725276
http://dx.doi.org/10.1007/s13300-021-01020-2
Descripción
Sumario:INTRODUCTION: In persons with type 1 diabetes (T1D) insulin dosing can be adjusted based on trend arrows derived from continuous glucose monitoring (CGM). We propose a slide rule with narrower blood glucose intervals and more classes of insulin sensitivity than are available in current models. METHODS: The slide rule was tested in silico, in which a meal was simulated in 100 virtual subjects and the insulin bolus was calculated either in the standard way based on the insulin-to-carbohydrate ratio and the correction factor or according to the slide rule, following which the percentage time spent in range (70–180 mg/dl; %T(IR)), hypoglycemia (< 70 mg/dl; %T(HYPO)), and hyperglycemia (> 180 mg/dl; %T(HYPER)) was compared between the methods during the 4 h after the meal. Slide rule performance was also tested in real life by analyzing the same variables at during the 4 h postprandial period in 27 individuals with T1D. Only meals starting while the rate of change was at least 1 mg/dl per minute (increasing or decreasing) were considered for analysis. RESULTS: In silico, when the preprandial trend arrow was increasing, our slide rule reduced %T(HYPER) and increased %T(IR) (p < 0.05), whereas when the preprandial trend arrow was decreasing, it reduced %T(HYPO) and slightly increased %T(HYPER) (p < 0.05). In real life, our slide rule kept subjects on target for 70.8 and 91.6% of postprandial time when preprandial trend arrows were increasing or decreasing, respectively. CONCLUSION: The proposed slide rule performed well both in silico and in real life, suggesting that it could be safely adopted by individuals with T1D to improve glucose control.