Clinical Usefulness Of A Bolus Calculator In Postprandial Glycaemic Control In Patient With Type 2 Diabetes Treated With Continuous Subcutaneous Insulin Infusion

Objective:To assess the clinical efficacy in postprandial glycaemic control of a bolus calculator(Bolus Wizard)in corporate into the insulin pump in Type 2 diabetic patients using continuous subcutaneous insulin infusion(CSⅡ)treatment during hospitalization.Methods:In a prospective observational study,One hundred type 2 diabetic patients participated in the study.The basic glycosylated hemoglobin A_1c(HbA_1c) was above 7%and fasting blood glucose(FBG)was above 8.0 mmol/L.They were treated with CSⅡusing insulin aspart for seven days at least during hospitalization.They were enrolled into this two-group study.In group A patients were randomized to treat postprandial hyperglycaemia using the Bolus Wizard to determine the correction boluses.In group B patients used conventional method to determine correction boluses.The glucose control target is between 4.4 and 6.1 mmol/L of FBG and below 8.0mmol/L of 2h postprandial glucose(2hPG).It is between 5.6 and 7.8mmol/L of blood glucose before sleeping.The duration and side reaction were recorded.Seven capillary blood glucose values were recorded in their diaries.Before the treatment of CSⅡ,all patients had to test the following indexes such as FBG,2hPBG,GSP,HbA_1c,C peptide and 2h C peptide.In group A,the procedure of Bolus Wizard were recorded which estimate correction boluses administered on the basis of the following parameters:current blood glucose value,grams of carbohydrate in the meal,insulin sensitivity factors(ISF), blood glucose target and quantity of active insulin.In group B,the calculation was made by doctors using empirical methods.Results:Fifty patients(mean age 55.40±14.62 years;with 1 to 26 years of diabetes)participated in group A.Of them,there were 23 patients who had already used MDI and 27 patients who had oral antidiabetic drugs.Fifty patients (57.72±12.83 years;with 1 to 25 years of diabetes)participated in group B.Of them,there were 21 patients who had already used MDI and 29 patients had oral antidiabetic drugs.After CSⅡtreatment,average FBG in group A decreased from 13.12±3.18mmol/L to 6.10±0.69mmol/L P＜0.01,and average FBG in group B decreased from 11.87±3.32mmol/L to 5.83±0.99mmol/L P＜0.01.The mean duration of FBG from higher level to target level range were 1.68±0.71 days in group A,1.54±0.81 days in group B P＞0.01.There were less postprandial hyperglycemia in group A than that in group B P＜0.01.There was a significant reduction in the number of correction boluses in group A with respect to group B of the study.In group A,the frequency in patients using the calculator to correct hyperglycaemia 2h post-breakfast and post-dinner were 186 times and 146 times, respectively.After considering the active insulin,the frequency in patients added the corrective insulin at the time of 2h post-breakfast and post-dinner were 9 times(with 0.3 to 2.9U of insulin)and 14 times(with 0.1 to 2.3U of insulin), respectively.In group B,the frequency in patients to correct hyperglycaemia 2h post-breakfast and post-dinner were 186 times and 157 times,respectively.The mean doses added to correct the hyperglycaemia at the time of 2h post-breakfast and post-dinner were 1.163±0.92U and 1.184±0.95U,respectively.The frequency of hypoglycaemic events between two groups did not reach statistical significance. There were 15 times in group A and 24 times in group B.Conclusions The Bolus Wizard tracked the active insulin during CSⅡ.The correction bolus insulin which was calculated by Bolus Wizard was more effective in improving postprandial glycaemic control with fewer correction boluses.