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

Abstract

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 ≥53 mmol/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 ± 15 mmol/mol (9.2 ± 1.4%) at baseline to 62 ± 13 mmol/mol (7.8 ± 1.2%) at the three- to five-month clinic visit and to 59 ± 13 mmol/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 ≤3.6 mmol/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.