Averting iatrogenic hypoglycemia through glucose prediction in clinical practice: Progress towards a new procedure in diabetes

• Published in: Diabetes research and clinical practice Vol. 76; no. 2; pp. 207 - 214
• Main Authors: Albisser, A.M, Wright, C.E, Sakkal, S
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.05.2007
• Subjects: Adolescent; Adult; Aged; Algorithms; Blood Glucose - analysis; Blood glucose control; Diabetes control; Diabetes Mellitus - blood; Diabetes Mellitus - prevention & control; Disease management; Endocrinology & Metabolism; Female; Follow-Up Studies; Glucose monitoring; Humans; Hypoglycemia - blood; Hypoglycemia - prevention & control; Hypoglycemia unawareness; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin - adverse effects; Insulin - therapeutic use; Insulin resistance; Intervention; IVR; Male; Middle Aged; Outcome measure; Predictive Value of Tests; Prognosis; Telemedicine; Time Factors; Intervention; Glucose monitoring; Hypoglycemia unawareness; Algorithms; Telemedicine; IVR; Outcome measure; Insulin resistance; Blood glucose control; Models; Diabetes control; Disease management
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2006.09.007

Abstract Background Hypoglycemia is a risk factor common to all insulin therapy. The hypothesis is that efforts to reduce or prevent this adverse side effect may fail because providers generally lack the resources to predict not only future blood glucose levels but also future risks of hypoglycemia. This lack has been remedied. A controlled study was undertaken to test the hypothesis. Methods Twenty-two insulin dependent subjects suffering more than one (1) episode/week of hypoglycemia with similar insulin regimens, similar diabetes education and similar self-management training participated in this study. For all subjects, a remote monitoring resource (registry and database) was used to capture daily SMBG and afford a return path for provider interventions and decision support. Identical telemedical methods were used which differed only for the provider either by the presence (prediction group) or by the absence (control group) of an on-screen, visual display of predicted glycemia and predicted risks of hypoglycemia. The study lasted 2 months. Results Over an average of 41 days from baseline to follow up and while using the glycemic prediction resource, providers intervened more effectively in the prediction group reducing rates of hypoglycemia nine-fold ( P < 0.0001) and insulin therapy by just −9 U/day ( P < 0.01). Mean pre-meal glycemia was not compromised. Over 61 days from baseline to final follow up but without glycemic predictions in the control group, providers’ interventions were less effective and resulted in no net changes in rates of hypoglycemia, daily insulin therapy, or mean pre-meal glycemia. Conclusions Given knowledge of future glycemia and future risks of hypoglycemia, providers in clinical practice can now avert iatrogenic hypoglycemia in less than 2 months. A shared diabetes data center furnishing remote data capture and decision support is fundamental to the implementation of this as a new clinical procedure in diabetes.