Driscoll Kimberly A, Johnson Suzanne Bennett, Hogan John, Gill Elizabeth, Wright Nancy, Deeb Larry C
Florida State University, College of Medicine, Department of Medical Humanities and Social Sciences, 1115 W. Call St., Tallahassee, FL 32306, USA.
J Diabetes Sci Technol. 2013 May 1;7(3):646-52. doi: 10.1177/193229681300700309.
Insulin bolusing calculators alleviate the burden of having to calculate insulin bolus doses for patients with type 1 diabetes mellitus (T1DM). Three important pieces of information are needed: a blood glucose monitoring (BGM) result, carbohydrates to be consumed, and the amount of insulin bolus delivered. The purpose of this study was to describe insulin pump adherence behaviors associated with the use of bolus calculators in youth who use Medtronic insulin pumps.
Data were downloaded from the MiniMed Paradigm insulin pumps (Medtronic) of 31 youth with T1DM. Areas of adherence that were evaluated included fundamental insulin pump adherence behaviors (e.g., BGM, carbohydrate entry, and insulin bolusing), decisions about Wizard® recommendations, and three Wizard steps: BGM result-carbohydrate input-insulin bolus.
On average, patients conducted BGM ≥4 times/day on 69% of days, inputted carbohydrates ≥3 times/day on 63% of days, and insulin bolused ≥3 times/day on 85% of days. Participants generally followed Wizard recommendations. Finally, participants completed all three Wizard steps (BGM, carbohydrate input, insulin bolus) within 30 min for an average of 29% of boluses. Almost 3% of boluses that were preceded by Wizard use were delivered without conducting BGM or inputting carbohydrates.
There was substantial variability in insulin pump adherence behaviors (e.g., days when no BGM occurred, reliance on basal insulin). Interventions targeting insulin pump adherence behaviors have the potential to optimize diabetes health outcomes and glycemic control. Improving insulin pump software reports is one promising avenue for improving adherence.
胰岛素大剂量计算器减轻了1型糖尿病（T1DM）患者计算胰岛素大剂量的负担。需要三个重要信息：血糖监测（BGM）结果、要摄入的碳水化合物量以及输注的胰岛素大剂量。本研究的目的是描述使用美敦力胰岛素泵的青少年中与使用大剂量计算器相关的胰岛素泵依从行为。
从31名T1DM青少年的美敦力MiniMed Paradigm胰岛素泵下载数据。评估的依从性领域包括基本的胰岛素泵依从行为（如BGM、碳水化合物输入和胰岛素大剂量输注）、关于Wizard®建议的决策以及Wizard的三个步骤：BGM结果 - 碳水化合物输入 - 胰岛素大剂量输注。
平均而言，患者在69%的日子里每天进行BGM≥4次，在63%的日子里每天输入碳水化合物≥3次，在85%的日子里每天胰岛素大剂量输注≥3次。参与者通常遵循Wizard的建议。最后，参与者在30分钟内完成所有三个Wizard步骤（BGM、碳水化合物输入、胰岛素大剂量输注）的大剂量平均为29%。在使用Wizard之后，近3%的大剂量输注在未进行BGM或输入碳水化合物的情况下进行。
胰岛素泵依从行为存在很大差异（例如，没有进行BGM的日子、对基础胰岛素的依赖）。针对胰岛素泵依从行为的干预措施有可能优化糖尿病健康结局和血糖控制。改进胰岛素泵软件报告是提高依从性的一个有前景的途径。
