Walsh John, Roberts Ruth, Bailey Timothy S, Heinemann Lutz
1 Advanced Metabolic Care and Research, Escondido, CA, USA.
2 Diabetes Services, Inc, San Diego, CA, USA.
J Diabetes Sci Technol. 2018 Jan;12(1):190-198. doi: 10.1177/1932296817718213. Epub 2017 Jul 25.
Bolus advisors that are designed to improve the accuracy of individual bolus doses relative to a meal's carb content and the current glucose have not substantially changed since they were introduced 15 years ago despite an obvious need for enhancement and innovation. Although some glycemic benefits have been demonstrated, bolus advisors largely ignore the large amounts of clinical data they gather that could have a significant impact on glucose outcomes. Concerns have also been raised regarding the aggressive nature of largely unpublished or poorly explained bolus advisor algorithms. Hypoglycemia and hyperglycemia remain significant risks due to inaccurate bolus advisor settings and the absence of tracking or an inappropriate handling of bolus on board. This review covers common sources for bolus advisor error such as the selection of physiologically inappropriate bolus advisor settings, the use of short duration of insulin action times, poor algorithm logic that tends to cover all carb intake fully, and an excessive reliance on simplistic dosing algorithms. As well as discussing these areas, we provide 21 ways to improve current bolus calculators.
自15年前推出以来，旨在根据餐食碳水化合物含量和当前血糖水平提高单次大剂量胰岛素准确性的大剂量胰岛素输注建议器，尽管明显需要改进和创新，但基本没有变化。虽然已证明有一些血糖益处，但大剂量胰岛素输注建议器很大程度上忽略了它们收集的大量临床数据，而这些数据可能对血糖结果产生重大影响。对于很大程度上未发表或解释不清的大剂量胰岛素输注建议器算法的激进性质，也有人提出了担忧。由于大剂量胰岛素输注建议器设置不准确、缺乏追踪或对体内大剂量胰岛素处理不当，低血糖和高血糖仍然是重大风险。本综述涵盖了大剂量胰岛素输注建议器错误的常见来源，例如选择生理上不合适的大剂量胰岛素输注建议器设置、使用短效胰岛素作用时间、倾向于完全覆盖所有碳水化合物摄入量的算法逻辑不佳以及过度依赖简单的给药算法。除了讨论这些领域外，我们还提供了21种改进当前大剂量胰岛素输注计算器的方法。
