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Nimri R, Dassau E, Segall T, Muller I, Bratina N, Kordonouri O, Bello R, Biester T, Dovc K, Tenenbaum A, Brener A, Šimunović M, Sakka SD, Nevo Shenker M, Passone CG, Rutigliano I, Tinti D, Bonura C, Caiulo S, Ruszala A, Piccini B, Giri D, Stein R, Rabbone I, Bruzzi P, Omladič JŠ, Steele C, Beccuti G, Yackobovitch-Gavan M, Battelino T, Danne T, Atlas E, Phillip M. Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians. Diabetes Obes Metab 2018; 20:2458-2466. [PMID: 29885025 DOI: 10.1111/dom.13408] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/27/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Revital Nimri
- 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
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | - Ido Muller
- DreaMed Diabetes Ltd, Petah Tikva, Israel
| | - Natasa Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Rachel Bello
- 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
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, Auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Ariel Tenenbaum
- 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
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- 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
| | - Marko Šimunović
- Department of Pediatrics, University Hospital Centre Split, Split, Croatia
| | - Sophia D Sakka
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, London, UK
| | - Michal Nevo Shenker
- 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
| | | | - Irene Rutigliano
- Pediatrics IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Davide Tinti
- Centre of Pediatric Diabetes, Department of Pediatrics, University of Turin, Turin, Italy
| | - Clara Bonura
- San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Silvana Caiulo
- San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Ruszala
- Department of Pediatric and Adolescent Endocrinology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Piccini
- Diabetology Unit, Meyer Children's Hospital, Florence, Italy
| | - Dinesh Giri
- Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, UK
| | - Ronnie Stein
- Paediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Sourasky Medical Centre, Tel Aviv, Israel
| | - Ivana Rabbone
- Centre of Pediatric Diabetes, Department of Pediatrics, University of Turin, Turin, Italy
| | - Patrizia Bruzzi
- Departments of Medical and Surgical Sciences of Mothers, Children and Adults, Azienda Ospedaliero-Univeristaria of Modena Policlinico, Paediatric Unit, Modena, Italy
| | - Jasna Šuput Omladič
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Caroline Steele
- Paediatric Endocrinology and Diabetes, Leeds Children's Hospital, Leeds, UK
| | - Guglielmo Beccuti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michal Yackobovitch-Gavan
- 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
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Eran Atlas
- DreaMed Diabetes Ltd, Petah Tikva, Israel
| | - Moshe Phillip
- 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
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Luo X, Fang F, Sun J, Xie J, Lee A, Zhang Q, Yu C, Breithardt O, Schiessl S, Schmid M, Seltmann M, Klinghammer L, Zeissler C, Kuechle M, Daniel W, Ege M, Guray U, Guray Y, Demirkan B, Kisacik H, Kim SE, Hong JY, Lee JH, Park DG, Han KR, Oh DJ, Ege M, Demirkan B, Guray U, Guray Y, Tufekcioglu O, Kisacik H, Cozma DC, Mornos C, Ionac A, Petrescu L, Tutuianu C, Dragulescu SI, Guimaraes L, Tavares G, Rodrigues A, Nagamatsu C, Fischer C, Vieira M, Oliveira W, Wilberg T, Cordovil A, Morhy S, Muraru D, Peluso M, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Pizzuti A, Mabritto B, Derosa C, Tomasello A, Rovere M, Parrini I, Conte M, Lareva N, Govorin A, Cooper R, Sharif J, Somauroo JD, Hung JD, Porcelli V, Skevington R, Shahzad A, Scott S, Lindqvist P, Soderberg S, Gonzalez M, Tossavainen E, Henein M, Nciri N, Saad H, Nawas S, Ali A, Youssufzay A, Safi A, Faruk S, Yurdakul S, Erdemir V, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Gurel M, 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A, Lopez Ayerbe J, Ferrer E, Vallejo N, Gomez Denia E, Bayes Genis A, Spethmann S, Schattke S, Baldenhofer G, Stangl V, Laule M, Baumann G, Stangl K, Knebel F, Labata C, Vallejo N, Gomez Denia E, Garcia Alonso C, Ferrer E, Gual F, Lopez Ayerbe J, Teis A, Nunez Aragon R, Bayes Genis A, Satendra M, Sargento L, Sousa C, Lousada N, Palma Reis R, Vasile AI, Dorobantu M, Iorgulescu C, Bogdan S, Constantinescu D, Caldararu C, Tautu O, Vatasescu R, Badran H, Elnoamany MF, Ayad M, Elshereef A, Farhan A, Nassar Y, Yacoub M, Costabel J, Avegliano G, Elissamburu P, Thierer J, Castro F, Huguet M, Frangi A, Ronderos R, Prinz C, Van Buuren F, Faber L, Bitter T, Bogunovic N, Burchert W, Horstkotte D, Kasprzak JD, Smialowski A, Rudzinski T, Lipiec P, Krzeminska-Pakula M, Wierzbowska-Drabik K, Trzos E, Kurpesa M, Motoki H, Hana M, Marwick T, Allan K, Vazquez-Alvarez M, Medrano Lopez C, Granja Da Silva S, Marcos C, Rodriguez-Ogando A, Alvarez M, Camino M, Centeno M, Maroto E, Feltes Guzman G, Serra Tomas V, Acevedo O, Calli A, Barba M, Pintos G, Valverde V, Zamorano Gomez J, Marchel M, Kochanowski J, Piatkowski R, Madej A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Malev E, Zemtsovsky E, Reeva S, Timofeev E, Pshepiy A, Mihaila S, Rimbas R, Mincu R, Dulgheru R, Mihaila R, Badiu C, Cinteza M, Vinereanu D, Rodrigues A, Guimaraes L, Lira E, Lebihan D, Monaco C, Cordovil A, Oliveira W, Vieira M, Fischer C, Morhy S, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Pena M, Puentes M, Santisteban M, Lopez Granados A, Arizon Del Prado J, Suarez De Lezo J, Tsai WC, Shih JY, Huang TS, Liu YW, Huang YY, Tsai LM, Cho E, Choi K, Kwon B, Kim D, Jang S, Park C, Jung H, Jeon H, Youn H, Kim J, Rieck AE, Cramariuc D, Lonnebakken M, Lund B, Gerdts E, Moceri P, Doyen D, Cerboni P, Ferrari E, Li W, Silva D, Goncalves S, Ribeiro S, Santos L, Sargento L, Vinhais De Sousa G, Almeida AG, Nunes Diogo A, Hernandez Garcia C, De La Rosa Hernandez A, Arroyo Ucar E, Jorge Perez P, Barragan Acea A, Lacalzada Almeida J, Jimenez Rivera J, Duque Garcia A, Laynez Cerdena I, Arhipov O, Sumin AN, Campens L, Renard M, Trachet B, Segers P, De Paepe A, De Backer J, Purvis JA, Sharma D, Hughes SM, Marek D, Vindis D, Kocianova E, Taborsky M, Yoon H, Kim K, Ahn Y, Chung M, Cho J, Kang J, Rha W, Ozcan O, Sezgin Ozcan D, Candemir B, Aras M, Dincer I, Atak R, Gianturco L, Turiel M, Atzeni F, Tomasoni L, Bruschi E, Epis O, Sarzi-Puttini P, Aggeli C, Poulidakis E, Felekos I, Sideris S, Dilaveris P, Gatzoulis K, Stefanadis C, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Lipiec P, Peruga J, Krecki R, Kasprzak J, Ishii K, Suyama T, Kataoka K, Furukawa A, Nagai T, Maenaka M, Seino Y, Musca F, De Chiara B, Moreo A, Epis O, Bruschi E, Cataldo S, Parolini M, Parodi O, Bombardini T, Faita F, Picano E, Park SJ, Kil JH, Kim SJ, Jang SY, Chang SA, Choi JO, Lee SC, Park S, Park P, Oh J, Cikes M, Velagic V, Biocina B, Gasparovic H, Djuric Z, Bijnens B, Milicic D, Huqi A, Klas B, He A, Paterson I, Irween M, Ezekovitz J, Choy J, 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EG, Patrianakos AP, Goudis C, Solidakis G, Parthenakis F, Vardas P, Nestaas E, Stoylen A, Fugelseth D, Vitarelli A, Capotosto L, Bernardi M, Conde Y, Caranci F, Placanica G, Dettori O, Vitarelli M, De Chiara S, De Cicco V, Ancona R, Comenale Pinto S, Caso P, Severino S, Cavallaro M, Ferro' M, Calabro' R, Apostolakis S, Chalikias G, Tziakas D, Stakos D, Thomaidi A, Konstantinides S, Vitarelli A, Caranci F, Capotosto L, Iorio G, Rucos R, Continanza G, De Cicco V, D Ascanio M, Alessandroni L, Saponara M, Berry M, Nahum J, Zaghden O, Monin J, Couetil J, Lairez O, Macron L, Dubois Rande J, Gueret P, Lim P, Cameli M, Giacomin E, Lisi M, Benincasa S, Righini F, Menci D, Focardi M, Mondillo S, Bonello B, Fouilloux V, Philip E, Gorincour G, Fraisse A, Bellsham-Revell H, Bell AJ, Miller OI, Beerbaum P, Razavi R, Greil G, Simpson JM, Ann S, Youn H, Jung H, Kim T, Lee J, Chin J, Kim T, Cabeza Lainez P, Escolar Camas V, Gheorghe L, Fernandez Garcia P, Vazquez Garcia R, Gargani L, Caiulo V, Caiulo S, Fisicaro A, Moramarco F, Latini G, Sicari R, Picano E, Seale A, Carvalho J, Gardiner H, Roughton M, Simpson J, Tometzki A, Uzun O, Webber S, Daubeney P, Elnoamany MF, Dawood A, Dwivedi G, Mahadevan G, Jiminez D, Steeds R, Frenneaux M, Attenhofer Jost CH, Knechtle B, Bernheim A, Pfyffer M, Linka A, Faeh-Gunz A, Seifert B, De Pasquale G, Zuber M, Simova I, Hristova K, Georgieva S, Kostova V, Katova T, Tomaszewski A, Kutarski A, Tomaszewski M. Poster Session 2: Thursday 8 December 2011, 14:00-18:00 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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