Diabetes Insulin Guidance System: a real-world evaluation of new technology (d-Nav) to achieve glycaemic control in insulin-treated type 2 diabetes

The aim was to conduct a service evaluation of the effectiveness of using d-Nav (a handheld device that automates the process of insulin dosage titration using the Diabetes Insulin Guidance System [DIGS] software) in achieving glycaemic control in patients with type 2 diabetes. The study comprised an exploratory single-centre pilot evaluation of the use of d-Nav in patients with type 2 diabetes aged >= 21 years with an HbA1c level >= 53mmol/mol (>= 7.0%) who were receiving insulin therapy for at least one year. Patients were asked to use d-Nav to monitor their blood glucose level before every insulin injection and, when they suspected the occurrence of hypoglycaemia, to allow d-Nav to adjust their insulin dosage. At scheduled three-monthly clinic visits, HbA1c was measured and information on episodes of hypoglycaemia collected from d-Nav and by patient reporting. Patients were followed for a minimum of six months. A total of 94 patients completed the evaluation as active users. The mean (+/- standard deviation) HbA1c for active users decreased from 77 +/- 15mmol/mol (9.2 +/- 1.4%) at baseline to 62 +/- 13mmol/mol (7.8 +/- 1.2%) at the three- to five-month clinic visit and to 59 +/- 13mmol/mol (7.5 +/- 1.2%) at the six-to 12-month clinic visit. In patients for whom paired data were available, the decreases were statistically significant at both post-baseline visits (both p<0.001). The frequency of minor hypoglycaemia (blood glucose <= 3.6mmol/L) was low and well within the tolerated range. In conclusion, d-Nav is shown to be a safe and effective solution for blood glucose management in insulin users with type 2 diabetes. Copyright (C) 2015 John Wiley & Sons.