Reducing of Glycemic Variability in Patients with Type 1 Diabetes by Automated Calculation of Bolus Insulin Doses using Mobile Devices

Backgrounds and aim: The calculation of insulin dosage, adjusted to the carbohydrates and insulin sensitivity, with mobile applications have a potential to reduce glucemic variability (GV) in patients with type 1 diabetes (T1D). The study aimed to develop the technology to reduce glycemic variability in patients with T1D on the basis of automated calculation of bolus insulin doses using mobile devices. Materials and methods: The single-center controlled trial composed of 46 individuals with T1D, which were assigned into the intervention and control groups ( N=21 and N=25, respectively). Patients in the intervention group were educated to count the dosage of prandial insulin by the app Diabetes: M (Sirma Medical Systems JSC, Bulgaria). The patients in the control group accounted for carbohydrates using a table of bread units. The parameters of GV Lability Index (LI), Low Blood Glucose Index (LGBI), High Blood Glucose Index (HGBI) and Mean Amplitude of Glucose Excursions (MAGE) were evaluated. Results: Both groups did not differ in baseline GV parameters. The fasting glucose levels decreased throughout the trial in both groups ( for both). However 2h-postprandial glucose reduced in the bolus calculator group only ( p=0.001). Moreover, patients from the bolus calculator group demonstrated decrease in LI ( p=0.02) and HGBI ( p=0.007). Conclusions: The study shows that the use of mobile apps Diabetes:M to calculate bolus insulin dosage facilitates the correction of postprandial glucose excursions and improve the parameters of glycemic variability.