Real time support to insulin dose
adjustment improves glycemic control
Magalhães VA1, Queiroz MS1, Nery M1, Alves C2, Silva RPS2, Fagundes FDC2, Melo KFS1,2
Evaluate the acceptance by patients with diabetes (DM) of using a mobile phone based software (GlicOnLine – Figure 1) that automates carbohydrate counting and performs the insulin doses adjustment according to glycemic targets, carbohydrate/insulin ratio and insulin sensitivity factor (ISF) prescribed electronically by the physician, compared with the traditional basal/bolus method. Another goal is to evaluate the impact of using the system in patients’ glycemic control and quality of life.
Materials and methods
20 patients with type 1 DM with mean age of 27.2±6.6 yr that previously had been educated to perform carbohydrate counting and correct blood glucose using the ISF were enrolled. They used a mobile phone with the software for 3 months and calculated the insulin doses adjustment without the system for another 3 months. The patients went through these 2 phases of study in a randomized and cross-over way and the 2 periods were compared. The WHOQOL-brief questionnaire was applied at all stages to evaluate the impact of the system utilization in patients’ quality of life, and a comparative questionnaire (DCCT QOL) between treatments
was applied at the end of the study. Laboratory evaluation (HbA1c and lipid profile) and anthropometric measurements were realized before and after each 3 months period.
A significant reduction (p=0,01) in the HbA1c levels (8.14±0.76 to 7.82±0.92%) was observed after the 3 months of GlicOnLine use (Figure 2). No differences were identified between initial and final lipid profile and anthropometric measurements of both treatment periods, and between initial (8.03±0,88%) and final (8.08±0,95%) HbA1c levels of the period without the system support (Tables 1 and 2). Although the WHOQOL-brief questionnaire analysis did not show any change in the two phases of study, the DCCT QOL analysis revealed that 69,6% of the patients reported improvement in the treatment satisfaction during the system usage (Tables 3 and 4). The mean grade given to the system by the patients, in a 0 to 10 scale, was 9.7.
Apart from the benefits in glycemic control, GlicOnLine has proven to have a good acceptance by the patients improving the treatment satisfaction by turning the carbohydrates counting using mobile phones easier and more practical. The factors mentioned above indicate that this real time system can be an important tool on DM treatment.
This work was supported by FAPESP 04/09111-0 and 2007/53989.
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