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Ahn DT. Benefits and risks of apps for patients. Curr Opin Endocrinol Diabetes Obes 2022; 29:17-22. [PMID: 34878413 DOI: 10.1097/med.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW As smartphones have become deeply integrated into our daily lives, diabetes apps have emerged as valuable tools for people living with diabetes (PWD's). Whether as standalone apps or companion apps to diabetes devices such as glucose meters or insulin pumps, they aim to help patients better manage their diabetes. However, with almost a half million health apps available, it is important to have a framework for understanding their benefits and disadvantages. RECENT FINDINGS 2020 was the first year that every insulin pump and continuous glucose monitor manufacturer in the United States offered a smartphone companion app for their flagship products. These companion apps enabled cloud-based data synchronization, which in turn proved to be extremely timely as the COVID-19 pandemic shifted many diabetes clinic appointments to the telemedicine format. The American Diabetes Association and European Association for the Study of Diabetes Diabetes Technology Working Group recently published a consensus report highlighting the current state of diabetes digital app technology. SUMMARY While diabetes apps offer unique conveniences and advantages for PWD's, it is equally important to fully understand their potential pitfalls to better inform all diabetes stakeholders: patients, healthcare professionals, regulatory agencies, researchers, and policy makers.
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Affiliation(s)
- David T Ahn
- Hoag Mary & Dick Allen Diabetes Center, California, USA
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Artificial Pancreas Control Strategies Used for Type 1 Diabetes Control and Treatment: A Comprehensive Analysis. APPLIED SYSTEM INNOVATION 2020. [DOI: 10.3390/asi3030031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This paper presents a comprehensive survey about the fundamental components of the artificial pancreas (AP) system including insulin administration and delivery, glucose measurement (GM), and control strategies/algorithms used for type 1 diabetes mellitus (T1DM) treatment and control. Our main focus is on the T1DM that emerges due to pancreas’s failure to produce sufficient insulin due to the loss of beta cells (β-cells). We discuss various insulin administration and delivery methods including physiological methods, open-loop, and closed-loop schemes. Furthermore, we report several factors such as hyperglycemia, hypoglycemia, and many other physical factors that need to be considered while infusing insulin in human body via AP systems. We discuss three prominent control algorithms including proportional-integral- derivative (PID), fuzzy logic, and model predictive, which have been clinically evaluated and have all shown promising results. In addition, linear and non-linear insulin infusion control schemes have been formally discussed. To the best of our knowledge, this is the first work which systematically covers recent developments in the AP components with a solid foundation for future studies in the T1DM field.
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Vallejo Mora MDR, Carreira M, Anarte MT, Linares F, Olveira G, González Romero S. Bolus Calculator Reduces Hypoglycemia in the Short Term and Fear of Hypoglycemia in the Long Term in Subjects with Type 1 Diabetes (CBMDI Study). Diabetes Technol Ther 2017; 19:402-409. [PMID: 28594575 PMCID: PMC5563860 DOI: 10.1089/dia.2017.0019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In a previous study we demonstrated improvement in metabolic control and reduction in hypoglycemia in people with type 1 diabetes on multiple daily injections, after having used a bolus calculator for 4 months. OBJECTIVE To demonstrate whether (1) extending its use (2) or introducing it in the control group, previously subjected to treatment intensification, could further improve metabolic control and related psychological issues. METHODS After the previous clinical trial, in which the subjects were randomized either to treatment with the calculator or to control group for 4 months, both groups used the calculator during an additional 4-month period. RESULTS In the previous control group, after using the device, HbA1c did not improve (7.86% ± 0.87% vs. 8.01% ± 0.93%, P 0.215), although a significant decrease in postprandial hypoglycemia was observed (2.3 ± 2 vs. 1.1 ± 1.2/2 weeks, P 0.002). In the group in which the treatment was extended from 4 to 8 months, HbA1c did not improve either (7.61 ± 0.58 vs. 7.73 ± 0.65, P 0.209); however this group had a greater perceived treatment satisfaction (12.03 ± 4.26 vs. 13.71 ± 3.75, P 0.007) and a significant decrease in fear of hypoglycemia (28.24 ± 8.18 basal vs. 25.66 ± 8.02 at 8 months, P 0.026). CONCLUSIONS The extension in the use of the calculator or its introduction in a previously intensified control group did not improve metabolic control, although it did confirm a decrease in hypoglycemic episodes in the short term, while the extension of its use to 8 months was associated with a reduction in fear of hypoglycemia and greater treatment satisfaction.
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Affiliation(s)
- María del Rosario Vallejo Mora
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mónica Carreira
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- Personality, Evaluation and Psychological Treatment, School of Psychology, Málaga Spain
| | - María Teresa Anarte
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- Personality, Evaluation and Psychological Treatment, School of Psychology, Málaga Spain
| | - Francisca Linares
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Gabriel Olveira
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Stella González Romero
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
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Bailey TS, Stone JY. A novel pen-based Bluetooth-enabled insulin delivery system with insulin dose tracking and advice. Expert Opin Drug Deliv 2017; 14:697-703. [PMID: 28359171 DOI: 10.1080/17425247.2017.1313831] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Diabetes is growing in prevalence internationally. As more individuals require insulin as part of their treatment, technology evolves to optimize delivery, improve adherence, and reduce dosing errors. Insulin pens outperform vial and syringe in simplicity, dosing accuracy, and user preference. Bolus advisors improve dosing confidence and treatment adherence. The InPen System offers a novel approach to treatment via a wireless pen that syncs to a mobile application featuring a bolus advisor, enabling convenient insulin dose tracking and more accurate bolus advice among other features. Areas covered: Existing technology for insulin delivery and bolus advice are reviewed. The mechanics and functionality of the InPen device are delineated. Findings from formative testing and usability studies of the InPen system are reported. Future directions for the InPen system in the treatment of diabetes are discussed. Expert opinion: Diabetes management is complex and largely data-driven. The InPen System offers a promising new opportunity to avail insulin pen-users of features known to improve treatment efficacy, which have otherwise primarily been available to those using pumps. Given that the majority of insulin users do not use insulin pumps, the InPen System is poised to improve glucose control in a significant portion of the diabetes population.
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Vallejo-Mora MDR, Carreira-Soler M, Linares-Parrado F, Olveira G, Rojo-Martínez G, Domínguez-López M, Ruiz-de-Adana-Navas MS, González-Romero MS. The Calculating Boluses on Multiple Daily Injections (CBMDI) study: A randomized controlled trial on the effect on metabolic control of adding a bolus calculator to multiple daily injections in people with type 1 diabetes. J Diabetes 2017; 9:24-33. [PMID: 26848934 DOI: 10.1111/1753-0407.12382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/05/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Although the insulin bolus calculator is increasingly being used by people with type 1 diabetes (T1D) on multiple daily injection (MDI) therapy, few studies have investigated its effects on glycemic control. The aim of this study was to determine whether adding this device to therapeutic intensification could further improve metabolic control. METHODS A 4-month randomized controlled clinical trial was performed comparing subjects undergoing therapeutic intensification and either using the bolus calculator (Cb group) or not (active control [Co] group). Metabolic control, fear of hypoglycemia, and treatment acceptance were evaluated. RESULTS In all, 70 people completed the study (42 in the Cb group, 28 in the Co group). There was a significant decrease in HbA1c in both the Cb and Co groups (-7 mmol/mol [-0.7 %] vs -4 mmol/mol [-0.4 %], respectively). There were no significant differences in HbA1c at baseline or the end of the study, or in the decrease in HbA1c, glycemia, or changes in blood glucose levels at the end of the study between the two groups. There was a significant increase in the number of participants with good metabolic control (HbA1c <58 mmol/mol [7.5 %]) in the Cb group (from 16.7 % to 40.5 %), but not in the Co group. The incidence of hypoglycemic events was reduced slightly but significantly only in the Cb group. There was no change in the fear of hypoglycemia at the end of the study. The bolus calculator was well accepted. CONCLUSIONS In T1D, adding a bolus calculator to intensive MDI resulted in a significant improvement in metabolic control and slightly decreased the number of hypoglycemic episodes. Metabolic control also improved in the Co group.
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Affiliation(s)
- María Del Rosario Vallejo-Mora
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- Medicine and Dermatology Department, School of Medicine, Málaga University, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
- Health District of Primary Care, Sevilla, Spain
| | - Mónica Carreira-Soler
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- Personality, Evaluation and Psychological Treatment, School of Psychology, Barcelona, Spain
| | - Francisca Linares-Parrado
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Gabriel Olveira
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- Medicine and Dermatology Department, School of Medicine, Málaga University, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Gemma Rojo-Martínez
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Marta Domínguez-López
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
| | - María Soledad Ruiz-de-Adana-Navas
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - María Stella González-Romero
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
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Joshi M, Choudhary P. Multiple Daily Injections OR Insulin Pump Therapy: Choosing the Best Option for Your Patient-An Evidence-based Approach. Curr Diab Rep 2015; 15:81. [PMID: 26338287 DOI: 10.1007/s11892-015-0644-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Achieving optimal glucose control with minimal hypoglycemia and minimizing the impact of diabetes on quality of life are the aims of management of type 1 diabetes. The main therapeutic options for patients include multiple daily injections (MDI) and continuous subcutaneous insulin therapy (CSII). It is important to differentiate fixed dose MDI with more flexible use, based on carbohydrate counting and structured education programmes, often termed functional insulin therapy (FIT), shown to deliver better outcomes. A significant proportion of patients can achieve optimal glucose control with either therapy, and for those who are unable to achieve desired glucose control with MDI, there is a large body of observational data showing CSII enables them to reduce HbA1c and hypoglycemia, with associated improvements in diabetes-related quality of life. However, in many healthcare systems, guidelines restrict the use of CSII on the basis of cost, with only 20-35 % of patients with type 1 diabetes across Europe using CSII. Although data support improved glucose control and quality of life with CSII, we must recognize that insulin pump therapy is not for everyone and has some downsides such as being attached to a device or issues with cannulas. When we sit down with our patients, we have a responsibility to support those patients with the therapeutic strategy that is best suited to them. In this paper, we review some of the literature that informs this decision-making, highlighting areas where CSII offers clear benefits and also some areas where it may not be appropriate.
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Affiliation(s)
- Mamta Joshi
- Specialist Registrar in Diabetes and Endocrinology, King's College Hospital, Denmark Hill, SE5 9RS, London, UK,
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Pérez-García L, Goñi-Iriarte M, García-Mouriz M. Comparación del tratamiento con infusión subcutánea continua de insulina frente a la terapia con múltiples dosis de insulina con calculador de bolus en pacientes con diabetes tipo 1. ACTA ACUST UNITED AC 2015; 62:331-7. [DOI: 10.1016/j.endonu.2015.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
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Liebl A, Khunti K, Orozco-Beltran D, Yale JF. Health economic evaluation of type 2 diabetes mellitus: a clinical practice focused review. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2015; 8:13-9. [PMID: 25861233 PMCID: PMC4374638 DOI: 10.4137/cmed.s20906] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 01/04/2023]
Abstract
Type 2 diabetes mellitus (T2D) is a growing healthcare burden primarily due to long-term complications. Strict glycemic control helps in preventing complications, and early introduction of insulin may be more cost-effective than maintaining patients on multiple oral agents. This is an expert opinion review based on English peer-reviewed articles (2000–2012) to discuss the health economic consequences of T2D treatment intensification. T2D costs are driven by inpatient care for treatment of diabetes complications (40%–60% of total cost), with drug therapy for glycemic control representing 18% of the total cost. Insulin therapy provides the most improved glycemic control and reduction of complications, although hypoglycemia and weight gain may occur. Early treatment intensification with insulin analogs in patients with poor glycemic control appears to be cost-effective and improves clinical outcomes.
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Affiliation(s)
- Andreas Liebl
- Department for Internal Medicine, Center for Diabetes and Metabolism, m&i-Fachklinik Bad Heilbrunn, Woernerweg 30, D-83670 Bad Heilbrunn, Germany
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Domingo Orozco-Beltran
- Cathedra of Family Medicine, Clinical Medicine Department, University Miguel Hernandez, San Juan de Alicante, Spain
| | - Jean-Francois Yale
- McGill Nutrition Centre, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
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Lawton J, Kirkham J, Rankin D, Barnard K, Cooper CL, Taylor C, Heller S, Elliott J. Perceptions and experiences of using automated bolus advisors amongst people with type 1 diabetes: a longitudinal qualitative investigation. Diabetes Res Clin Pract 2014; 106:443-50. [PMID: 25451897 PMCID: PMC4270460 DOI: 10.1016/j.diabres.2014.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 09/02/2014] [Accepted: 09/15/2014] [Indexed: 11/21/2022]
Abstract
AIMS We explored people's reasons for, and experiences of, using bolus advisors to determine insulin doses; and, their likes/dislikes of this technology. SUBJECTS AND METHODS 42 people with type 1 diabetes who had received instruction in use of bolus advisors during a structured education course were interviewed post-course and 6 months later. Data were analysed thematically. RESULTS Participants who considered themselves to have poor mathematical skills highlighted a gratitude for, and heavy reliance on, advisors. Others liked and chose to use advisors because they saved time and effort calculating doses and/or had a data storage facility. Follow-up interviews highlighted that, by virtue of no longer calculating their doses, participants could become deskilled and increasingly dependent on advisors. Some forgot what their mealtime ratios were; others reported a misperception that, because they were pre-programmed during courses, these parameters never needed changing. Use of data storage facilities could hinder effective review of blood glucose data and some participants reported an adverse impact on glycaemic control. DISCUSSION While participants liked and perceived benefits to using advisors, there may be unintended consequences to giving people access to this technology. To promote effective use, on-going input and education from trained health professionals may be necessary.
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Affiliation(s)
- J Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
| | - J Kirkham
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - D Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - K Barnard
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C L Cooper
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - C Taylor
- The Sheffield Diabetes and Endocrine Centre, Northern General Hospital, Sheffield, UK
| | - S Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
| | - J Elliott
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
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Cavan DA, Ziegler R, Cranston I, Barnard K, Ryder J, Vogel C, Parkin CG, Koehler W, Vesper I, Petersen B, Schweitzer MA, Wagner RS. Use of an insulin bolus advisor facilitates earlier and more frequent changes in insulin therapy parameters in suboptimally controlled patients with diabetes treated with multiple daily insulin injection therapy: results of the ABACUS trial. Diabetes Technol Ther 2014; 16:310-6. [PMID: 24716820 DOI: 10.1089/dia.2013.0280] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND We assessed the impact of using an automated bolus advisor integrated into a blood glucose meter on the timing and frequency of adjusting insulin therapy parameter settings and whether the availability of this technology would increase blood glucose test strip utilization in diabetes patients treated with multiple daily insulin injection (MDI) therapy. SUBJECTS AND METHODS The Automated Bolus Advisor Control and Usability Study (ABACUS) trial, a 26-week, prospective, randomized, controlled, multinational study that enrolled 218 type 1 and type 2 diabetes patients, demonstrated that use of an automated insulin bolus advisor helps improve glycemic control in suboptimally controlled, MDI-treated patients. Patient data were assessed to determine when and how often changes in insulin parameter settings occurred during the study. Patient meters were downloaded to determine blood glucose monitoring frequency. RESULTS One hundred ninety-three patients completed the study: 93 control arm (CNL) and 100 intervention (experimental) arm (EXP). Significantly more EXP (47.5%) than CNL (30.7%) patients received one or more changes in their insulin sensitivity factor (ISF) settings during the study (P=0.0191). Changes in ISF settings occurred earlier and more frequently in EXP than CNL patients throughout the study. A similar trend was seen in changes in insulin-to-carbohydrate ratios. There were no differences in daily self-monitoring of blood glucose frequency [mean (SD)] between CNL and EXP patients: 4.7 (1.5) versus 4.6 (1.3) (P=0.4085). CONCLUSIONS Use of an automated bolus advisor was associated with earlier, more frequent changes in key insulin parameters, which may have contributed to subsequent improvements in glycemic control but without increased glucose test strip utilization.
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Affiliation(s)
- David A Cavan
- 1 Bournemouth Diabetes and Endocrine Centre , Bournemouth, United Kingdom
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Ziegler R, Cavan DA, Cranston I, Barnard K, Ryder J, Vogel C, Parkin CG, Koehler W, Vesper I, Petersen B, Schweitzer MA, Wagner RS. 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. Diabetes Care 2013; 36:3613-9. [PMID: 23900590 PMCID: PMC3816874 DOI: 10.2337/dc13-0251] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Use of automated bolus advisors is associated with improved glycemic control in patients treated with insulin pump therapy. We conducted a study to assess the impact of using an insulin bolus advisor embedded in a blood glucose (BG) meter on glycemic control and treatment satisfaction in patients treated with multiple daily insulin injection (MDI) therapy. The study goal was to achieve >0.5% A1C reduction in most patients. RESEARCH DESIGN AND METHODS This was a 26-week, prospective, randomized, controlled, multinational study that enrolled 218 MDI-treated patients with poorly controlled diabetes (202 with type 1 diabetes, 16 with type 2 diabetes) who were 18 years of age or older. Participants had mean baseline A1C of 8.9% (SD, 1.2 [74 mmol/mol]), mean age of 42.4 years (SD, 14.0), mean BMI of 26.5 kg/m(2) (SD, 4.2), and mean diabetes duration of 17.7 years (SD, 11.1). Control group (CNL) patients used a standard BG meter and manual bolus calculation; intervention group (EXP) patients used the Accu-Chek Aviva Expert meter with an integrated bolus advisor to calculate insulin dosages. Glucose data were downloaded and used for therapy parameter adjustments in both groups. RESULTS A total of 193 patients (CNL, n = 93; EXP, n = 100) completed the study. Significantly more EXP than CNL patients achieved >0.5% A1C reduction (56.0% vs. 34.4%; P < 0.01). Improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire scale) was significantly greater in EXP patients (11.4 [SD, 6.0] vs. 9.0 [SD, 6.3]; P < 0.01). Percentage of BG values <50 mg/dL was <2% in both groups during the study. CONCLUSIONS Use of an automated bolus advisor resulted in improved glycemic control and treatment satisfaction without increasing severe hypoglycemia.
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