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Posted by on Oct 11, 2013 in Diabetes mellitus | 0 comments

In a nutshell

This study investigated the use of an automated bolus advisor and its benefit in controlling blood glucose levels.

Some background

Individuals with diabetes often require several insulin injections a day in order to control blood glucose levels.  The amount of insulin needed with each bolus (each injection) depends on many factors, including the carbohydrate composition of the last (or upcoming) meal, how sensitive each individual is to insulin, the current blood glucose value, physical activities and the general health status of the individual. 

Taking all these factors into account may be a very complex and stressful task. Often, dangerously large doses of insulin are injected as a result. Injections of unnecessarily large doses of insulin may result in hypoglycemia (dangerously low blood glucose levels). In addition, the fear of hypoglycemia often leads patients to inject smaller than needed doses of insulin, resulting in uncontrolled diabetes and an increased risk of serious complications.

Methods & findings

This study investigated the use of an automated system which calculates for the patient how much insulin to inject. The device was built into a standard blood glucose meter, and takes into consideration patient factors such as age and insulin sensitivity (which were individually programmed into the device).

193 diabetic patients with either type 1 or type 2 uncontrolled diabetes participated in this study. 100 patients were assigned to use the automated bolus advisor. The remaining 93 patients formed the control group and continued to calculate the amount of insulin needed for each injection as they had done previously. The aim of the study was to obtain a 0.5% decrease in HgbA1c levels (a measurement of average blood glucose levels used in the assessment of diabetic control).

Results showed that 56.5% of patients in the automated treatment group obtained this level of reduction, compared to only 34.4% of patients in the control group. The rate of hypoglycemic episodes was less than 2% in both groups. In addition, according to patient reports, treatment satisfaction and stress reduction were greater in the automated treatment group compared to the control group.

The bottom line

This study concluded that the use of an automated bolus advisor is safe, and may significantly improve blood glucose control in diabetic patients requiring multiple daily insulin injections.

The fine print

This study included only a small number of patients. Although only patients with poorly controlled diabetes (HgbA1c>7.5%) were included in this study, the use of an automated bolus advisor may also prove beneficial for well controlled patients.

What’s next?

Consult with your physician regarding the calculation of insulin boluses and different aids that may assist in this process.

Published By :

Diabetes Care

Date :

Aug 01, 2013

Original Title :

Use of an Insulin Bolus Advisor Improves Glycemic Control in Multiple Daily Insulin Injection (MDI) Therapy Patients With Suboptimal Glycemic Control: First results from the ABACUS trial.

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