Abstract
Insulin replacement therapy is mostly used by patients with type 2 diabetes who become insulin deficient and have failed other therapeutic options. They comprise about a quarter of those with diabetes, endures the majority of the complications and consumes the majority of the resources. Adequate insulin replacement therapy can prevent complications and reduce expenses, as long as therapy goals are achieved and maintained. Sadly, these therapy goals are seldom achieved and outcomes have not improved for decades despite advances in pharmacotherapy and technology.There is a growing recognition that the low success rate of insulin therapy results from intra-individual and inter-individual variations in insulin requirements. Total insulin requirements per day vary considerably between patients and constantly change without achieving a steady state. Thus, the key element in effective insulin therapy is unremitting and frequent dosage adjustments that can overcome those dynamics. In practice, insulin adjustments are done sporadically during outpatient clinic. Due to time constraints, providers are not able to deliver appropriate insulin dosage optimization.The d-Nav® Insulin Guidance Service has been developed to provide appropriate insulinization in insulin users without increasing the burden on healthcare systems. It relies on dedicated clinicians and a spectrum of technological solutions. Patients are provided with a handheld device called d-Nav® which advises them what dose of insulin to administer during each injection and automatically adjust insulin dosage when needed. The d-Nav care specialists periodically follow-up with users through telephone calls and in-person consultations to bestow user confidence, correct usage errors, triage, and identify uncharacteristic clinical courses.The following review provide details about the service and its clinical outcomes.
Highlights
Index cases Ms R. is a 69-year-old woman with type 2 diabetes who has been treated with insulin since 2011
She is currently treated with basal-bolus insulin therapy that consists of once daily long-acting insulin analog and 3 rapid-acting insulin analog boluses with meals
To achieve good glycemic control on insulin therapy, her insulin dosage has been adjusted 48 times over the past 28 weeks. Her total daily insulin was increased by about 15% for a period of 5 months before it decreased to the original daily insulin dosage
Summary
Index cases Ms R. is a 69-year-old woman with type 2 diabetes who has been treated with insulin since 2011. They have required considerable clinical effort in insulin titrations to improve and maintain appropriate diabetes control. Many patients can do well with simple regimens such as long-acting insulin only, yet over a period of a few years most require some level of fast acting insulin coverage to maintain appropriate glycemia [6].
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