Use of automated insulin algorithms

Use of automated insulin algorithms — In order to achieve glycemic goals, the dose of insulin must be titrated often. Most patients with type 2 diabetes adjust their insulin dose with clinician advice (rather than independently), but the adjustments are made less frequently than necessary, in part due to clinician time constraints. At least one handheld device is under development that contains a glucose meter and uses an insulin algorithm to determine each insulin dose, based on the glucose readings. The software analyzes glucose patterns and adjusts the insulin dose to meet patient needs. In a randomized trial in 181 insulin-requiring patients with type 2 diabetes (mean A1C 8.6 percent), the use of one such device along with clinician support reduced A1C compared with clinician support alone (from baseline to six months, -1 versus -0.3 percentage points) [49]. The frequency of chemical hypoglycemia (glucose <54 mg/dL [3 mmol/L]) was similar in the two groups, whereas weight gain was slightly more in the intervention group (2.3 versus 0.7 percent above baseline). This type of device shows promise for improving glycemic control in patients with type 2 diabetes.