Insulin titration and technology-based solutions

U.S-FDA approved inpatient and outpatient technology-based solutions for effective insulin dose management for people with diabetes

This review focuses on U.S. Food and Drug Administration (FDA) approved products designed to aid insulin dosing (inpatient/outpatient settings).

Key Takeaway

Diabetes care is well suited for virtual/remote care:

• Insulin dosing technology integrated with electronic medical record (EMR) supports clinicians in glucose management in the hospital setting, and app-based systems assist insulin dose adjustments at home.
• Inpatient and outpatient digital solutions can serve as educational tools in the academic settings, particularly for insulin initiation and titration.
• Appropriate usage of inpatient/outpatient insulin management technologies aids effective self-management of diabetes by the patients, reduces the economic burden, and assists health care providers (HCPs) in communicating with the patients efficiently.
• New technologies with computer algorithms improve health outcomes by overcoming barriers associated with insulin initiation/titration/adherence.
• With the availability of mobile apps for insulin management and other digital solutions that remotely transmit glucose monitoring results, diabetes care is well adapted for the novel coronavirus pandemic situation.

Why This Matters

• Diabetes and associated complications increase the economic burden on the U.S. health care system, emphasizing the need for effective diabetes management.
• Despite significant advances in drug development, people with diabetes and their HCPs find it difficult to achieve guidelinerecommended A1C goals, making improvisation/digitalization of insulin-management essential.

Key Results

Inpatient electronic glucose management systems to manage insulin doses: These programs support clinical reasoning but do not substitute for it

• Glucommander (Glytec): Uses evidence-based multivariate algorithms: (1) offers surveillance/report capabilities (2) is adaptable for EMR systems (3) approved for intravenous (IV) insulin infusion, IV–subcutaneous (SQ) transition, SQ insulin, hospital-to-home transitions, and outpatient SQ insulin management (4) increased nurses’ satisfaction (5) cost saving
• EndoTool system (Monarch Medical Technologies): Provides clinical decision support for IV insulin, IV-to-SQ transition, and SQ insulin for pediatric and adult patients; is suitable for EMR systems; supports parenteral carbohydrate calculation; its usage decreases hospital-acquired conditions
• GlucoStabilizer (Medical Decision Network): Network-based software solution that enables automatic IV insulin drip rate calculation; it is also approved for IV–SQ transitions
• Core Diabetes App (Transformative Med): Helps the HCPs to calculate insulin dose, but the app does not make automatic changes to the dose; it can be integrated into EMR systems; it provides help with IV insulin rates, IV-to-SQ transitions, and SQ insulin initial doses

Technologies to assist in outpatient insulin dosing: These systems are not intended to be used as a substitute for professional medical advice

• Basal insulin titration systems:
  • Insulia (Voluntis): Shares reports with HCPs; patients receive educational coaching messages and safety rules for hypoglycemia management (type 2 diabetes [T2D]/long-acting insulin dosing/manual entry/mobile app + web-based portal)
  • iSage Rx (Amalgam): HCPs can choose which algorithm to use for titration and can access reports (T2D/long-acting insulin dosing/manual entry/mobile app + web-based portal)
  • Mobile Insulin Dosing System (MIDS, Glooko): Patient can self-adjust basal insulin after the HCPs install the treatment plan using MIDS (T2D/long-acting insulin dosing/automatic/mobile app + web-based platform)
  • My Dose Coach (Sanofi, Approved by authorities and available in KSA & KWT) The HCPs can create an individualized dose plan on a Web-based portal. Patients need to manually input their fasting blood glucose levels and insulin dosing once daily, along with any incidences of hypoglycemia in the mobile app. Based on these inputs, the app tells users whether and by how much to adjust their dose (shares reports with HCPs/T2D/long-acting insulin dosing/manual entry/mobile app + web-based portal)
• Mealtime insulin calculators:
  • InPen (Companion Medical): Shares reports with HCPs, sends reminders, and monitors insulin temperature (insulin on board [IOB]) (type 1 diabetes [T1D] and T2D/rapid-acting insulin dosing/manual entry/pen connected with app by Bluetooth)
  • Accu-Chek Bolus Advisor (Roche): Shares reports with HCPs and calculates IOB (T1D and T2D/rapid-acting insulin dosing/manual entry/mobile app + web-based portal)

MAT-BH-2300641/v1/October 2023