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Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Artikel i vetenskaplig tidskrift
Författare Peter Adolfsson
N. V. Hartvig
A. Kaas
J. B. Moller
J. Hellman
Publicerad i Diabetes Technology & Therapeutics
ISSN 1520-9156
Publiceringsår 2020
Publicerad vid Institutionen för kliniska vetenskaper
Språk en
Länkar dx.doi.org/10.1089/dia.2019.0411
Ämnesord Connected insulin pen, Time in range, Adherence, Hypoglycemia, Glycemic, control, glycemic variability, decision-making, glucose, type-1, adherence, adults, barriers, therapy, communication, Endocrinology & Metabolism
Ämneskategorier Endokrinologi och diabetes

Sammanfattning

Background: This observational study investigated whether the connected NovoPen(R) 6 could influence insulin regimen management and glycemic control in people with type 1 diabetes (T1D) using a basal-bolus insulin regimen and continuous glucose monitoring in a real-world setting. Methods: Participants from 12 Swedish diabetes clinics downloaded pen data at each visit (final cohort: n = 94). Outcomes included time in range (TIR; sensor glucose 3.9-10.0 mmol/L), time in hyperglycemia (>10 mmol/L), and hypoglycemia (L1: 3.0- <3.9 mmol/L; L2: <3.0 mmol/L). Missed bolus dose (MBD) injections were meals without bolus injection within -15 and +60 min from the start of a meal. Outcomes were compared between the baseline and follow-up periods (>= 5 health care professional visits). Data were analyzed from the first 14 days following each visit. For the TIR and total insulin dose analyses (n = 94), a linear mixed model was used, and for the MBD analysis (n = 81), a mixed Poisson model was used. Results: TIR significantly increased (+1.9 [0.8; 3.0](95% CI) h/day; P < 0.001) from baseline to follow-up period, with a corresponding reduction in time in hyperglycemia (-1.8 [-3.0; -0.6](95% CI) h/day; P = 0.003) and L2 hypoglycemia (-0.3 [-0.6; -0.1](95% CI) h/day; P = 0.005), and no change in time in L1 hypoglycemia. MBD injections decreased by 43% over the study (P = 0.002). Change in MBD injections corresponded to a decrease from 25% to 14% based on the assumption that participants had three main meals per day. Conclusions: Our study highlights the potential benefit on glycemic control and dosing behavior when reliable insulin dose data from a connected pen contribute to insulin management in people with T1D.

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