Bolus guide: a novel insulin bolus dosing decision support tool based on selection of carbohydrate ranges.
BACKGROUND
Optimal continuous subcutaneous insulin infusion (CSII) therapy emphasizes the relationship between insulin dose and carbohydrate consumption. One widely used tool (bolus calculator) requires the user to enter discrete carbohydrate values; however, many patients might not estimate carbohydrates accurately. This study assessed carbohydrate estimation accuracy in type 1 diabetes CSII users and compared simulated blood glucose (BG) outcomes using the bolus calculator and the "bolus guide," an alternative system based on ranges of carbohydrate load.


METHODS
Patients (n = 60) estimated the carbohydrate load of a representative sample of meals of known carbohydrate value. The estimated error distribution [coefficient of variation (CV)] was the basis for a computer simulation (n = 1.6 million observations) of insulin recommendations for the bolus guide and bolus calculator, translated into outcome blood glucose (OBG) ranges (< or =60, 61-200, >201 mg/dl). Patients (n = 30) completed questionnaires assessing satisfaction with the bolus guide.


RESULTS
The CV of typical meals ranged from 27.9% to 44.5%. The percentage of simulated OBG for the calculator and the bolus guide in the <60 mg/dl range were 20.8% and 17.2%, respectively, and 13.8% and 15.8%, respectively, in the >200 mg/dl range. The mean and median scores of all bolus guide satisfaction items and ease of learning and use were 4.17 and 4.2, respectively (of 5.0).


CONCLUSIONS
The bolus guide recommendation based on carbohydrate range selection is substantially similar to the calculator based on carbohydrate point estimation and appears to be highly accepted by type 1 diabetes insulin pump users.
Shapira
Gali
G
Medingo, Haifa, Israel. gali@medingo.com
Yodfat
Ofer
O
HaCohen
Arava
A
Feigin
Paul
P
Rubin
Richard
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002241:Carbohydrates / Q000097:blood*; D003198:Computer Simulation; D020000:Decision Support Systems, Clinical; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003927:Diet, Diabetic; D005260:Female; D005504:Food Analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose; D002241:Carbohydrates; D007004:Hypoglycemic Agents; D007328:Insulin