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
1
Arizona State University Department of Biomedical Informatics, Arizona;
2
Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital HF, Oslo, Norway;
3
Mayo 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] .

R E S U LT S
We propose a multi-platform mobile application, iDECIDE, to further
personalize insulin dosing based on patients 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.

METHODS
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.

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.

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.

1. Enter current
glucose and carbs
before exercising

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 meals
Carbohydrates, Active Insulin, patients Current Blood Glucose
(BG), Target BG, Insulin to Glucose ratio and Correction Factor.

2. Enter plans for

exercise

3. Review entered
data

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

FUTURE WORK

For more information:

References

dlgroat@asu.edu, cook.curtiss@mayo.edu, adelagrando@asu.edu

1. 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.

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

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)

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 dont you clean your house
instead, to get some exercise done?).