Endocrine Abstracts

Automated Bolus Calculators (ABC) were introduced into two inner city hospitals with a high deprivation index in August 2010.

Objective: To observe the change in HbA1c for 3–6 months after the introduction of ABC and carbohydrate counting. Also to explore the effects of age, gender, psycho-social circumstances on HbA1c as well as the uptake of insulin pump therapy after implementation.

Method: ABC were offered to all families who were carbohydrate counting or required a method of calculating a correction bolus. Two ABC were used: Accuchek Expert, Roche and Insulinx, Abbott. They were trained to use devices to give insulin bolus advice for meals and corrections as required. HbA1c was recorded at time of obtaining the meter and on average 167 days after implementation. Data was collected retrospectively. Patients using the meter within the year of diagnosis were excluded. Results were statistically analyzed using a paired t-test.

Results: Sample size 105. Mean HbA1c decreased by a small but statistically significant amount (0.41%) (2.54 mmol/l) P<0.001. 80% of the sample size carbohydrate counted all their meals whereas 15% counted only evening meals. Those reported to have no known psycho-social problems had an improved mean difference in the HbA1c compared to those who did.

Conclusion: ABC, whether used for a corrective dose, or with carbohydrate counting shows a statistically significant change in HbA1c over time. There were reductions in HbA1c when stratified by age, gender, difficulties, or carbohydrate counting. These were not statistically significant however the sample size was underpowered to detect significance in the different subgroups. This evidence supports the belief that regular usage of this meter alongside carbohydrate counting has a positive effect on HbA1c. Accurate advice is best obtained when using ABC alongside carbohydrate counting.