iDECIDE: A Mobile Application for Insulin Dosing Using an Evidence Based Equation to Account for Patient Preferences

Buffy Lloyd, B.S1,3, Danielle Groat, B.S.1,3, Jelena Mirkovic, Ph.D. 2, Curtiss B. Cook, MD3, Adela Grando, Ph.D.1,3

1Arizona State University Department of Biomedical Informatics, Arizona;2Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital HF, Oslo, Norway;

3Mayo Clinic Arizona, Division of Endocrinology, Scottsdale, AZ

M O T I VAT I O N Diabetes requires the patient to dose insulin and conduct

frequent self-monitoring of blood glucose. Evidence has shown that patients are more compliant with their diabetes

management when they incorporate personal lifestyle choices[1] .

M E T H O D S

A literature review was conducted to gather the latest evidence on insulin dosing for diabetes patients and to understand the impact that exercise and alcohol consumption have on blood glucose levels.

Ten prototypical diabetes patient case scenarios were created to guide the tool development. The scenarios were based on the American Diabetes Association Guidelines and the opinion of domain experts.

A new evidence-based equation to recommend insulin dosing was proposed (patent pending) using as starting point an equation currently used by patients to manually calculate insulin[2]. The new equation computes Insulin dosing adjusting for Alcohol and Exercise, and taking into account meal’s Carbohydrates, Active Insulin, patient’s Current Blood Glucose (BG), Target BG, Insulin to Glucose ratio and Correction Factor.

An ontology was proposed to capture the domain knowledge of iDECIDE, mapping concepts to the Current Procedural Terminology (CPT), the SNOMED Clinical Terms, the National Cancer Institute thesaurus (NCI) and RXNORM.

R E S U LT S

1. Enter current glucose and carbs before exercising

2. Enter plans for exercise

3. Review entereddata

4. Receive iDECIDE advice on insulin dosing and carbs intake before exercise

F U T U R E W O R K Retrospectively calibrate the equation used by iDECIDE to recommend insulin. We are recruiting 20 diabetes patients who use insulin pumps, who are requested to keep diaries on exercise and alcohol intake. Improve the user interfaces, using user-centered participatory design approaches. Deploy a SMART (Specific, Measureable, Attainable, Realistic and Timely) goal management system to help patients set up, achieve, and track the achievement of goals for diabetes, well-being and nutrition (e.g., walk everyday 20 minutes after work), even in the presence of obstacles (if it rains why don’t you clean your house instead, to get some exercise done?).

For more information:dlgroat@asu.edu, cook.curtiss@mayo.edu, adelagrando@asu.edu

Special thanks to: Anita Murcko, MD, FACP; David Kaufman, PhD.; Marilyn Bailey, RN

References1. Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with conditions and their clinicians: The case of diabetes. Health Expectations. 2006; 9(1): p. 25-36.2. Colin I, Paris I. Glucose meters with built-in automated bolus calculator: Gadget or real value for insulin treated diabetic patients? 2013;(4): p. 1-11.

We propose a multi-platform mobile application, iDECIDE, to further

personalize insulin dosing based on patient’s lifestyle preferences. The tool is based on a new evidence based equation that incorporates variables known to influence post-prandial glucose levels: alcohol and exercise.

iDECIDE uses an evidence-based equation, different from the one used by insulin pumps, for advising on insulin dosage when carbs are consumed. iDECIDE provides advice on everyday life scenarios not supported by insulin pumps: Sets up an alarm to check glucose to reduce risk of hypoglycemia when

more than 2 alcoholic drinks are consumed. Recommends insulin dosing or carbs consumption before exercising, taking

into account exercise duration and intensity (e.g., an exercise of medium intensity and 30 minutes duration should reduce insulin intake by 0.25 units)