Decision Support Systems for Insulin Treatment Adjustment in People with Type 1 Diabetes

摘要

For people with type 1 diabetes, achieving optimal glycemic control requires use of intensive insulin therapy. To achieve this goal individuals are required to become proficient in accurately determining the appropriate amount of insulin needed to address a variety of situations throughout the day while considering numerous influencing factors. They also need to perform multiple tasks a day such as counting carbohydrates to accurately determine the required premeal bolus. There is also a need to periodically adjust insulin dosing as insulin sensitivity varies considerably over time. Sophisticated advanced technologies are being used by growing numbers of individuals to manage diabetes. However, despite innovations in glucose monitoring technologies and new insulin formulations, many of these individuals are not achieving their glycemic goals. The new technologies provide ample amount of valuable diabetes related data that may complicate even further the insulin dosing decision making for people with diabetes as well as for the health care providers. Mobile health, digital tools and decision support systems can help to increase accurate, timely insulin dosing and insulin titration and holds the potential to improve glycemic control to a wide range of individuals with diabetes. The emerging mobile toolbox for insulin dosing adjustments that will be reviewed in this paper includes insulin management Apps; diverse range of Apps to guide insulin adjustments such as in times of physical activity and eating; data management systems which enable visualization and analysis of insulin and glucose data of various devices; real-time alarms and glucose prediction Apps that help to prevent hypoglycemia and hyperglycemia events; various bolus calculators for meal time dosing; sophisticated decision support algorithms for people using insulin pump, multiple insulin injections and closed loop systems for real-time and retrospective insulin dosing adjustments.