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Using an automated calculator built into a blood glucose meter improved blood sugars….
According to Ralph Ziegler, MD, of the Diabetes Clinic for Children and Adolescents in Muenster, Germany, and colleagues, in the first results of a randomized trial, more than half of the volunteers using the automated bolus adviser saw improvement in their A1C’s.
In contrast, only about a third of those using a standard glucose meter and carrying out the calculations by hand had improved A1C levels at the end of the study.
The researchers noted that, for patients taking multiple daily injections of insulin, "manual calculation of insulin boluses is complex and time-consuming, often leading to dosing errors."
Automatic calculation of the insulin bolus needed to cover meals has been shown to be effective in diabetes patients using insulin pumps, Ziegler and colleagues reported, and in some small studies with glucose meters.
But, they noted, there have been no large randomized trials to evaluate the issue. To help fill the gap, they conducted the industry-sponsored ABACUS trial, which enrolled 218 volunteers with poorly controlled type 1 and type 2 diabetes.
On average, participants had a baseline A1C of 8.9% and a body mass index of 26.5. They were, on average, just over 42 years old and had had diabetes for 17.7 years. They took 3.5 boluses of insulin daily on average and checked their blood glucose more than four times a day. The primary end point of the 26-week trial was change in A1C and specifically the number of patients who achieved an A1C reduction of at least 0.5%.
On average, participants using the glucose meter with the automated bolus adviser had a drop in A1C from baseline of 0.7%. That compared with a reduction of 0.5% for those doing the calculation by hand. The 0.2 percentage point difference was significant at P<0.05, the researchers reported.
However, they found, 56% of those using the automated system reached the study goal of more than a 0.5% reduction in A1C, compared with 34.4% of those calculating by hand. That difference was significant at P<0.01.
Among those in both arms who achieved the study goal, the average A1C change was a 1.2% decrease, Ziegler and colleagues reported. Participants using the automated system also reported a significantly greater satisfaction with treatment, Ziegler and colleagues reported.
On the Diabetes Treatment Satisfaction Questionnaire, participants reported an average score of 11.4, compared with 9 for those doing manual calculations, a difference that was significant at P<0.01.
- Use of an automated bolus tool resulted in improved glycemic control and treatment satisfaction without increasing severe hypoglycemia.
- This is a prospective, randomized study that enrolled patients with poorly controlled diabetes, predominantly type 1, who were receiving multiple daily insulin injection therapy, and evaluated the use of an automated bolus adviser to calculate insulin dosages compared with manual bolus calculation.