title: A Methodology to Compare Insulin Dosing Recommendations in Real-Life Settings.
abstract: BACKGROUND
  We propose a methodology to analyze complex real-life glucose data in insulin pump users.
  
  
  METHODS
  Patients with type 1 diabetes (T1D) on insulin pumps were recruited from an academic endocrinology practice. Glucose data, insulin bolus (IB) amounts, and self-reported alcohol consumption and exercise events were collected for 30 days. Rules were developed to retrospectively compare IB recommendations from the insulin pump bolus calculator (IPBC) against recommendations from a proposed decision aid (PDA) and for assessing the PDA's recommendation for exercise and alcohol.
  
  
  RESULTS
  Data from 15 participants were analyzed. When considering instances where glucose was below target, the PDA recommended a smaller dose in 14%, but a larger dose in 13% and an equivalent IB in 73%. For glucose levels at target, the PDA suggested an equivalent IB in 58% compared to the subject's IPBC, but higher doses in 20% and lower in 22%. In events where postprandial glucose was higher than target, the PDA suggested higher doses in 25%, lower doses in 13%, and equivalent doses in 62%. In 64% of all alcohol events the PDA would have provided appropriate advice. In 75% of exercise events, the PDA appropriately advised an IB, a carbohydrate snack, or neither.
  
  
  CONCLUSIONS
  This study provides a methodology to systematically analyze real-life data generated by insulin pumps and allowed a preliminary analysis of the performance of the PDA for insulin dosing. Further testing of the methodological approach in a broader diabetes population and prospective testing of the PDA are needed.
authors.affiliation: 1 Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Groat
authors.affiliation: 1 Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA.|2 Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Grando
authors.affiliation: 2 Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA.
authors.forename: Bithika
authors.initials: B
authors.lastname: Thompson
authors.affiliation: 1 Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Neto
authors.affiliation: 1 Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA.
authors.forename: Hiral
authors.initials: H
authors.lastname: Soni
authors.affiliation: 2 Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Boyle
authors.affiliation: 2 Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Bailey
authors.affiliation: 1 Arizona State University Department of Biomedical Informatics, Scottsdale, AZ, USA.|2 Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ, USA.
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003661:Decision Support Techniques; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D054796:Drug Dosage Calculations; D015444:Exercise; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: alcohol; bolus calculator; exercise; insulin pump; postprandial blood glucose; retrospective analysis