The Importance of the Bolus Calculator Use for Improving Glycemic Control in Patients on the Insulin Pump Therapy

Abstract

Introduction: Bolus calculator is an advanced function of insulin pump (IP). The use of bolus calculator increases the accuracy of calculation of the proper meal or corrective dose of insulin in patients with type 1 diabetes (T1D). Aim of the Study: Compare the difference in the parameters of glycemic control (HbA1c, postprandial increase of blood glucose and number of hypoglycemic episodes per week) between the group of patients who use bolus calculator for <50% of the total daily boluses, and the group of patients who use bolus calculator for ≥50% of total daily boluses. Patients and Methods: This study included 36 patients aged over 18 years with T1D on IP therapy in the Republika of Srpska. All patients used IP for at least one year prior to participation in the study. Before the IP therapy was initiated, all the patients were trained for carbohydrate counting in course of flexible insulin therapy training (FIT). Professional software, CareLink Pro® Software (Medtronic Inc., Northridge, CA, USA) was used to download data from insulin pumps to a personal computer. The default frequency of bolus calculator use was ≥50% of total daily boluses. Results: No statistically significant difference was found in HbA1c (6.61 ± 1.10 vs. 0.84 ± 6:56, p = 0.896) or the number of hypoglycemic episodes (2.00 (1.00, 4.00) (1.0 - 6.0) vs 3.00 (2.00, 4:00) (1.0 - 5.0), p = 0.298) between the group of patients who used bolus calculator for <50% of the total daily boluses, and the group of patients who used bolus calculator for ≥50% of total daily boluses. Patients who used bolus calculator had significantly lower postprandial increase in blood glucose after breakfast. Conclusion: In order to maximize all the advantages of IP therapy, a regular reeducation of both patients and diabetologists about advanced IP functions is needed for improving the glycoregulation in T1DM.