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Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes.

ABSTRACT: To compare a modified fixed meal dosing strategy to flexible meal dosing in hospitalized patients with type 2 diabetes.Patients (N = 126) with refractory hyperglycemia or requiring at least 20 units of insulin per day were randomly assigned to fixed meal dosing (including withholding the dose if less than half of the meal tray was consumed) or flexible meal dosing based upon carbohydrate intake. The inpatient diabetes management team made all treatment adjustments. Outcomes included day 3 mean glucose, 72-h glucose trend analysis, hypoglycemia (<3.9 mmol/L), and inpatient diabetes treatment satisfaction.The mean glucose on day 3 was 9.5 and 8.8 mmol/L in the fixed and flexible meal groups, respectively (P = 0.26). The frequency of hypoglycemia was 23 and 39% overall in the fixed and flexible meal groups (P = 0.08), with half of events occurring in the morning. There was a wide range of carbohydrate intake (median 51 g/meal, 10-90% range 26-72 g on day 3). The fixed dose group required significantly more prandial insulin overall and more correction insulin over time. There was no difference in composite treatment satisfaction or dosing miscalculations between groups.A fixed meal dosing strategy provided similar glucose control as flexible meal dosing, when managed by an inpatient diabetes treatment team. However, a larger sample size would be needed to definitively evaluate a treatment effect of flexible meal dosing in the hospital. Further study is needed to improve the delivery of bolus insulin in hospitalized patients.

SUBMITTER: Dungan KM

PROVIDER: S-EPMC3816892 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes.

Dungan Kathleen M KM Sagrilla Colleen C Abdel-Rasoul Mahmoud M Osei Kwame K

Diabetes care 20130923 11

<h4>Objective</h4>To compare a modified fixed meal dosing strategy to flexible meal dosing in hospitalized patients with type 2 diabetes.<h4>Research design and methods</h4>Patients (N = 126) with refractory hyperglycemia or requiring at least 20 units of insulin per day were randomly assigned to fixed meal dosing (including withholding the dose if less than half of the meal tray was consumed) or flexible meal dosing based upon carbohydrate intake. The inpatient diabetes management team made all ...[more]

PMID: 24062326

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Project description:BackgroundCarbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates.ObjectiveOur objective was to test the app's usability and potential impact on carbohydrate counting accuracy.MethodsIterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed.ResultsUse of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study.ConclusionsOur results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management.Trial registrationClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142.

Dataset Information

Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes.

Publications

Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes.

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