Experience with Automated Insulin Dose Adjustment based upon Computerized Formula in a Tertiary Care Diabetes Center

Prevalence of Diabetes is increasing in world especially in developing countries. Changing lifestyle in developing countries, urbanization and increased life expectancy are proposed causes of that increasing burden [1-5]. Based on the most recent International Diabetes Federation (IDF) report, the number of people with diabetes will increase from 425 million in 2017 to 629 million by 2045 [6]. Best management strategies to manage diabetes include healthy lifestyle and good dietary habits and proper pharmacological interventions [7-10]. Insulin therapy requires skillful adjustment of dosage in DM management [11]. Integrated model of diabetes care has shown promising results in terms of metabolic parameters [12]. With increasing burden of disease, existing system with limited trained medical personals especially in a developing country with poor health system will not be able to cope patient load. So an automated insulin dose adjustment based upon computerized algorithms might be a need of the hour. Software must be very accurate to suggest insulin dosage on entered blood glucose levels so that better outcomes with improved HbA1c and fewer hypo and hyperglycemic episodes can be achieved in out-patient management [13]. Similar software systems are also introduced for insulin dose calculation of in-patients [14-15]. A real-time cellular-enabled blood glucose (BG) meter and Glytec's Glucommander™ clinical decision support software (CDSS) use in diabetic patients effectively lowered HbA1c, treated patients safely, and maintain those improvements over 12 months period [16]. In another study done on in-patients by Newsom R et al, Glycemic management improved with use of eGMS based on computerized insulin algorithm [16]. Diabetes management center (DMC) of Services Hospital Lahore, Pakistan (SHL) has a physician aiding software, which has weight based formula for prescription and dose adjustment of insulin dosage. That formula is patient’s weight based and adjust doses of insulin on values of Self-monitoring of blood glucose (SMBG) entered in software. We hypothesized that the use of automated insulin dose adjustment models based upon computerized algorithms will improve glycaemic control and work flow at heavily burdened diabetic clinics.