Real-life application and validation of flexible intensive insulin-therapy algorithms in type 1 diabetes patients.

AIMS Flexible intensive insulin therapy FIT has become the reference standard in type 1 diabetes Besides carbohydrate counting CHO it requires the use of algorithms to adjust prandial insulin doses to the number of CHO portions As recourse to standard algorithms is usual when initiating FIT the use of personalized algorithms would also allow more precise adjustments to be made The aim of the present study was to validate personalized prandial algorithms for FIT as proposed by Howorka et al in 1990 METHODS We conducted a 4 month observational study of 35 patients with type 1 diabetes treated with FIT for at least 6 months who were already using Howorka s prandial algorithms meal related and correctional insulin doses for blood glucose increases induced by CHO These patients were asked to use a personal digital assistant PDA phone with an electronic diary instead of a paper one to take advantage of the computerized data collection system to assess the quality of postprandial metabolic control RESULTS Whatever the number of CHO portions mean postprandial blood glucose values remained close to the target of 7 8mmol L and the compensatory algorithm allowed precise correction of preprandial hyperglycaemia In fact the algorithms for meal related and correctional insulin doses at the end of the study did not differ significantly from those initially calculated but they generally differed from one patient to another CONCLUSION In type 1 diabetic patients treated with FIT the use of individualized parameters permits fast and accurate adjustment of mealtime insulin doses leading to good control of the postprandial state