Bournemouth, United Kingdom
Bournemouth, United Kingdom

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Browne S.,Beaumont Hospital | Burson-Thomas J.,North Lincolnshire and Goole Hospital Trust | Carling A.,Wiltshire and North Somerset Diabetes Service | Chapman L.,Queen Elizabeth II Hospital | And 9 more authors.
Journal of Diabetes Nursing | Year: 2012

Multiple daily injection (MDI) insulin regiments offer people with diabetes the potential of tight blood glucose control in combinatioin with dietary and lifestyle flexibility. The calculation required for adjusting insulin bolus doses appropriately can be complicated for peole with diabetes to perform and few of those receiving MDI regiment are adjusting their doses on a daily basis. From our clinical perspective as nurses, a substantial barrier appears to be the fact that only a minority of people on these regiments regularly carbohydrate count. Lack of bolus dose adjustment has adverse imolications for overall glycaemic control, the likelihood of hyper and hypogiycaemia and lifestyle flexibility. Automatic bolus calculator (ABC) technology has been introduced in recent years to assist people with diabetes in making bolus dose calculation. In this article we explore what role ABC technology has in people with diabetes using MDI regimens with a specific focus on what benefits ABC devices may provide to people who do not carbohydrate count.


Cavan D.A.,Bournemouth Diabetes and Endocrine Center | Ziegler R.,Diabetes Clinic for Children and Adolescents | Cranston I.,Queen Alexandra Hospital | Barnard K.,University of Southampton | And 8 more authors.
Diabetes Technology and Therapeutics | Year: 2014

Background: We assessed the impact of using an automated bolus advisor integrated into a blood glucose meter on the timing and frequency of adjusting insulin therapy parameter settings and whether the availability of this technology would increase blood glucose test strip utilization in diabetes patients treated with multiple daily insulin injection (MDI) therapy. Subjects and Methods: The Automated Bolus Advisor Control and Usability Study (ABACUS) trial, a 26-week, prospective, randomized, controlled, multinational study that enrolled 218 type 1 and type 2 diabetes patients, demonstrated that use of an automated insulin bolus advisor helps improve glycemic control in suboptimally controlled, MDI-treated patients. Patient data were assessed to determine when and how often changes in insulin parameter settings occurred during the study. Patient meters were downloaded to determine blood glucose monitoring frequency. Results: One hundred ninety-three patients completed the study: 93 control arm (CNL) and 100 intervention (experimental) arm (EXP). Significantly more EXP (47.5%) than CNL (30.7%) patients received one or more changes in their insulin sensitivity factor (ISF) settings during the study (P=0.0191). Changes in ISF settings occurred earlier and more frequently in EXP than CNL patients throughout the study. A similar trend was seen in changes in insulin-to-carbohydrate ratios. There were no differences in daily self-monitoring of blood glucose frequency [mean (SD)] between CNL and EXP patients: 4.7 (1.5) versus 4.6 (1.3) (P=0.4085). Conclusions: Use of an automated bolus advisor was associated with earlier, more frequent changes in key insulin parameters, which may have contributed to subsequent improvements in glycemic control but without increased glucose test strip utilization. © Mary Ann Liebert, Inc.


Everett J.,Bournemouth Diabetes and Endocrine Center | Kerr D.,Bournemouth University
Practical Diabetes International | Year: 2010

New National Institute for Health and Clinical Excellence guidance is likely to increase the use of insulin pump therapy, and the challenge for diabetes teams is to maintain the initial improvement in HbA1c without extra resources. A telehealth system has been developed where both health professionals and patients can view downloaded pump and blood glucose data. A pilot study in patients with HbA1c >8%, using pump therapy for more than a year, demonstrated a mean reduction from 9.3% to 8.2% at 12 months after using the telehealth system. Patient satisfaction with the system reported more understanding, insight and control by viewing the data, as well as easy access to the health professional. This pilot study has demonstrated that, for some people, using a telehealth approach has resulted in improved diabetes control. Copyright © 2010 John Wiley & Sons.


Todres L.,Bournemouth University | Todres L.,Bournemouth Diabetes and Endocrine Center | Keen S.,Bournemouth University | Keen S.,Bournemouth Diabetes and Endocrine Center | And 2 more authors.
Diabetic Medicine | Year: 2010

Aims The aims of this study were to provide in-depth insight into the changes that may be experienced by patients embarking on continuous subcutaneous insulin infusion and to answer the research question, what is it like to live with an insulin pump? Methods An in-depth, qualitative, multiple interview study of individuals with Type 1 diabetes using continuous subcutaneous insulin infusion in a secondary care setting in the south of England. Four patients (two male, two female) across the age range and with varied experience of pump use, were recruited from a specialist diabetes centre. Results Switching from multiple injection therapy to insulin pump therapy presents challenges in the short term. Over a longer period, use of this technology is associated with a significant improvement in quality of life for the users and also a change in the relationship between the patient and their specialist healthcare provider. Conclusions Insulin pump therapy has additional qualitative benefits beyond improvements in glycaemic control and reducing the risk of hypoglycaemia for people with Type 1 diabetes. © 2010 Diabetes UK.


PubMed | Bournemouth Diabetes and Endocrine Center
Type: Journal Article | Journal: Journal of diabetes science and technology | Year: 2012

Self-monitoring of blood glucose (SMBG) values is an accepted requirement for patients with diabetes using multiple daily injections of insulin. Nevertheless, for many patients, the full value of SMBG has yet to be realized due to a number of factors that contribute to patients not taking appropriate action based on the achieved result. The reasons for this are complex but are related to the burden imposed by performing the tests, the need for complex numerical calculations, and the demand for undertaking this activity multiple times each day. In the near future, SMBG devices are likely to include technological innovations that are aimed at overcoming these barriers, offering actionable SMBG for patients using insulin. These innovations should include technologies that will allow customization and individualization based upon specific therapy regimens.

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