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
- Ralph Ziegler, MD1,
- David A. Cavan, MD2,
- Iain Cranston, MD3,
- Katharine Barnard, CPSYCHOL, AFBPSS4,
- Jacqueline Ryder, RGN5,
- Claudia Vogel, DDB6,
- Christopher G. Parkin, MS7⇑,
- Walter Koehler, MS8,
- Iris Vesper, MS9,
- Bettina Petersen, PHD9,
- Matthias A Schweitzer, MD, MBA9 and
- Robin S. Wagner, DVM, PHD10
- 1Diabetes Clinic for Children and Adolescents, Muenster, Germany
- 2Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, U.K.
- 3Academic Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Portsmouth, U.K.
- 4University of Southampton, Southampton General Hospital, Southampton, U.K.
- 5Royal Bournemouth Hospital, Castle Lane East, Bournemouth, U.K.
- 6Internistisches Fachaerztezentrum, Langen, Germany
- 7CGParkin Communications, Boulder City, Nevada
- 8Baseline Statistics GmbH, Frankfurt, Germany
- 9Roche Diagnostics GmbH, Mannheim, Germany
- 10Roche Diagnostics, Indianapolis, Indiana
- Corresponding author: Christopher G. Parkin, .
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/m2 (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.
- Received January 31, 2013.
- Accepted May 31, 2013.
- © 2013 by the American Diabetes Association.
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