Use of the KADIS-CSII program for adjusting insulin pump therapy in type 1 diabetes

Abstract

Continuous subcutaneous insulin infusion (CSII) has become a standard for treatment optimization of type 1 diabetes (T1D). However, the transition from Multiple Dose Injection (MDI) to CSII therapy can be challenging. The objective of the present study was to use KADIS, the Karlsburg Diabetes Management System, for individual basal and bolus insulin adjustments in patients with type 1 diabetes while switching from MDI to pump therapy. We describe the extended KADIS-CSII program and its practical application for adjustment of insulin pump therapy. We conducted a pilot study including 12 patients with T1D who had received MDI therapy consisting of short- and long-acting insulin injections. Baseline HbA1c was 8.2±0.8 %, age 31.3±11.1 years, and diabetes duration 15.7±6.7 years (mean±SD). Data derived from continuous glucose monitoring (CGM) during MDI therapy were processed by the KADIS algorithm in order to characterise the patient’s specific metabolic parameters. Those were used to estimate individual basal infusion rate patterns as well as insulin boluses based on carbohydrate consumption for the transition to CSII. Three months after transitioning from MDI to CSII based on KADIS guided therapy, the mean HbA1c value was reduced to 7.6±0.5 % (–0.6 % vs. baseline, p<0.05) and remained at this level until the end of the 6-month study. Likewise, time <3.9 mmol/L (p=0.008), glycemic variability indexes, such as SD around mean glucose (p=0.010), MAGE (p=0.001), and CONGA (p=0.007), were all significantly lower at study end. Consistent with these data, quality of glycemia measured by the GRADE index and a recently developed Q-score was also improved. The proposed KADIS-CSII program could become a practicable and efficient tool to support adjusting insulin pump therapy.