Time for Using Machine Learning for Dose Guidance in Titration of People With Type 2 Diabetes? A Systematic Review of Basal Insulin Dose Guidance.

IF 4.1 Q2 ENDOCRINOLOGY & METABOLISM
Camilla Heisel Nyholm Thomsen, Stine Hangaard, Thomas Kronborg, Peter Vestergaard, Ole Hejlesen, Morten Hasselstrøm Jensen
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Abstract

Background: Real-world studies of people with type 2 diabetes (T2D) have shown insufficient dose adjustment during basal insulin titration in clinical practice leading to suboptimal treatment. Thus, 60% of people with T2D treated with insulin do not reach glycemic targets. This emphasizes a need for methods supporting efficient and individualized basal insulin titration of people with T2D. However, no systematic review of basal insulin dose guidance for people with T2D has been found.

Objective: To provide an overview of basal insulin dose guidance methods that support titration of people with T2D and categorize these methods by characteristics, effect, and user experience.

Methods: The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies about basal insulin dose guidance, including adults with T2D on basal insulin analogs published before September 7, 2022, were included. Joanna Briggs Institute critical appraisal checklists were applied to assess risk of bias.

Results: In total, 35 studies were included, and three categories of dose guidance were identified: paper-based titration algorithms, telehealth solutions, and mathematical models. Heterogeneous reporting of glycemic outcomes challenged comparison of effect between the three categories. Few studies assessed user experience.

Conclusions: Studies mainly used titration algorithms to titrate basal insulin as telehealth or in paper format, except for studies using mathematical models. A numerically larger proportion of participants seemed to reach target using telehealth solutions compared to paper-based titration algorithms. Exploring capabilities of machine learning may provide insights that could pioneer future research while focusing on holistic development.

在 2 型糖尿病患者剂量滴定中使用机器学习指导的时机已到?基础胰岛素剂量指导的系统回顾。
背景:对 2 型糖尿病(T2D)患者的实际研究表明,在临床实践中,基础胰岛素滴定过程中的剂量调整不足会导致治疗效果不理想。因此,60%接受胰岛素治疗的 2 型糖尿病患者达不到血糖目标。这就强调了对支持 T2D 患者进行高效和个体化基础胰岛素滴定的方法的需求。然而,目前尚未发现针对 T2D 患者基础胰岛素剂量指导的系统性综述:概述支持 T2D 患者滴定的基础胰岛素剂量指导方法,并根据特点、效果和用户体验对这些方法进行分类:方法:根据系统综述和荟萃分析首选报告项目(PRISMA)指南进行综述。纳入了2022年9月7日之前发表的有关基础胰岛素剂量指导的研究,包括使用基础胰岛素类似物的T2D成人患者。采用乔安娜-布里格斯研究所(Joanna Briggs Institute)的关键评估清单来评估偏倚风险:共纳入了 35 项研究,并确定了三类剂量指导:基于纸张的滴定算法、远程医疗解决方案和数学模型。由于对血糖结果的报告不尽相同,因此难以比较三类方法的效果。很少有研究对用户体验进行评估:除使用数学模型的研究外,其他研究主要采用远程医疗或纸质形式的滴定算法来滴定基础胰岛素。与纸质滴定算法相比,使用远程医疗解决方案达到目标的参与者比例更大。探索机器学习的能力可能会为未来的研究提供启示,同时关注整体发展。
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来源期刊
Journal of Diabetes Science and Technology
Journal of Diabetes Science and Technology Medicine-Internal Medicine
CiteScore
7.50
自引率
12.00%
发文量
148
期刊介绍: The Journal of Diabetes Science and Technology (JDST) is a bi-monthly, peer-reviewed scientific journal published by the Diabetes Technology Society. JDST covers scientific and clinical aspects of diabetes technology including glucose monitoring, insulin and metabolic peptide delivery, the artificial pancreas, digital health, precision medicine, social media, cybersecurity, software for modeling, physiologic monitoring, technology for managing obesity, and diagnostic tests of glycation. The journal also covers the development and use of mobile applications and wireless communication, as well as bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors. Articles in JDST cover both basic research and clinical applications of technologies being developed to help people with diabetes.
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