The Effective Use by Primary Care Clinicians of a Comprehensive Computerized Insulin Dose Adjustment Algorithm.

Abstract

Primary care clinicians (PCCs) manage 90% of patients with diabetes, 30% of whom require insulin with a substantial number poorly controlled because of the challenges that PCCs face (time constraints and lack of experience). The author has developed Federal Drug Administration cleared and Conformite Europeenne mark registered comprehensive computerized insulin dose adjustment algorithms (CIDAAs) to enable PCCs to significantly lower HbA1c levels in insulin-requiring patients. Reports sent to PCCs contain scatter plots of glucose readings, their organization into pre- and postprandial and before bedtime values, their analyses, and recommendations for insulin dose adjustments (if indicated) that the PCC can accept or modify. The glucose readings are provided to the CIDAAs for analysis at either in-person visits or remotely. The new doses accepted by PCCs serve as the basis for the subsequent report. Published studies evaluating this comprehensive CIDAA involved 104 poorly controlled patients taking insulin for greater than or equal to six months who were independently managed by PCCs. Over four to six months, initial HbA1c levels of 9.7% fell by 1.7%. Combining these results with 138 other better controlled patients in real-world situations, initial measured and estimated HbA1c levels of 8.3% fell by 0.7% in 6.4 months enabling PCCs to significantly improve glycemic control. Other advantages of PCCs utilizing these comprehensive CIDAAs are saving time for PCCs so that they can address non-diabetes issues and/or see other patients and ongoing PCC education in adjusting insulin doses by matching glucose patterns and dose-change recommendations with subsequent glycemic responses.