Originally published March 14, 2019 by
The latest from Tandem Diabetes Care®, Basal-IQ™ Technology is a predictive low-glucose suspend feature on the t:slim X2™ Insulin Pump that integrates with the Dexcom G6® Continuous Glucose Monitoring (CGM) System. The Basal-IQ feature helps reduce the frequency and duration of low-glucose events by predicting glucose levels 30 minutes ahead and suspending insulin if they are expected to drop below 80 mg/dL or anytime they drop below 70mg/dL. The feature suspends insulin delivery for as few as five minutes and up to 120 minutes. The graph shows how the feature predicts, suspends, and resumes insulin based on CGM data. Insulin resumes in as few as five minutes, as soon as glucose values rise by 1 mg/dL. A pivotal trial, Predictive Low-Glucose Suspend for Reduction of Low Glucose (PROLOG), found that Basal-IQ Technology not only prevented the frequency and duration hypoglycemia, but also reduced rebound hyperglycemia.1
Hypoglycemia is at the top of the list of frustrations for people with diabetes. Whether mild or severe, all forms of hypoglycemia take time and quality away from everyday life. For example, among people with non-severe hypoglycemic events (NSHE) (able to self-treat), 18.3 percent experienced decrease in work productivity.2 Additionally, many patients suffer from hypoglycemia unawareness, which is the inability to feel the signs and symptoms of low blood glucose in a timely fashion. Hypoglycemia unawareness is dangerous and can be scary because without the help of technology, the patient may not be able to treat hypoglycemia before it becomes an emergency.
Basal-IQ Technology is not a cure-all for hypoglycemia, but it can help patients avoid severe lows and allow them to spend less time worrying about micromanaging hypoglycemia throughout the day and night. The burden of managing a chronic disease has known impacts on mental health. Depression is twice as likely to occur in persons with diabetes.3 For some, simply the fear itself of having a low-glucose event may be enough to prevent them from taking part in activities they enjoy.2
Because automated insulin delivery (AID) systems are new, it helps to have a simple acronym to understand how they work. The CARE model is a systematic approach to evaluate AID systems using four elements: calculate, adjust, revert, and educate. The following is an analysis of the t:slim X2 Pump with Basal-IQ Technology using the CARE model.4
When managing a patient using Basal-IQ Technology, looking at the suspension data on the Therapy Timeline is important. Look for suspensions that occur over long stretches of time (over 45 minutes) during which insulin is suspended on some regular basis. This is when Basal-IQ Technology suspensions can help identify patterns that could dictate lifestyle or therapy adjustments. For example, if you see someone has experienced an extended suspension of insulin right after dinner three times in the last two weeks, you may need to ask some important questions such as: “Do you remember what kind of meal you ate last Tuesday and Wednesday? Should the bolus for that meal change due to high fat or high protein items?”
A wider pattern of suspensions after meals might suggest that other settings, like the insulin-to-carb ratio, may be more aggressive than necessary. You have to determine the cause of these events, but looking at patterns of longer suspensions on the therapy timeline is a great place to start.
When someone first starts using Basal-IQ Technology, you can provide that person with some simple tips to help ensure the experience is optimal. For example, you may want to discuss the importance of connectivity between the t:slim X2 Pump and the Dexcom G6 CGM System with patients, because the Basal-IQ Technology will not be able to predict glucose levels and suspend insulin delivery if the patient’s CGM is not working properly or is unable to communicate with the pump. For this communication to be clear, the patient needs to know two things. First, the signal between the two devices travels directly through the glass screen of the pump. Since wireless signals do not travel well through the body, the screen should be facing out and on the same side of the body as the sensor. Second, when a patient begins using Basal-IQ Technology, he or she should set an out-of-range alert for the sensor, which lets the patient know when the pump and CGM are not communicating. A lapse in data of 10 minutes will prevent the Basal-IQ feature from suspending insulin based on predicted values until connection is re-established and enough data are collected to start predicting future glucose values again. Setting the alert for 20 to 30 minutes is helpful to warn the patient to troubleshoot any connectivity issues. In addition to the CGM signal, remind patients that Basal-IQ Technology is not a substitute for active diabetes management and does not prevent hypoglycemia in all scenarios. Patients should pay attention to their symptoms and blood glucose levels and treat according to your recommendations.
Finally, you need to remember how easy Basal-IQ Technology is to use when recommending it to patients. In the PROLOG trial, 91 percent of patients stated that they felt the device was intuitive and easy to use.1 Additionally, 95 percent of patients didn’t feel like they needed help from a technical person to use the system.1 Ease of use for medical technology is so important. After all, adherence to therapy is directly tied to the patient’s experience using the device.5 When you consider that 70 percent of medical device accidents are attributable to user error,6 then ease of use becomes paramount. For more information about Basal-IQ Technology, please visit the Tandem Diabetes Care provider website at tandemdiabetes.com/providers.
Access additional resources and practical information to enhance the care and treatment of your diabetes patients.
Molly McElwee-Malloy, RN, CDE, Clinical Services Manager Tandem, Diabetes Care
Source URL: https://www.diabetesselfmanagement.com/practical-diabetology/technology-innovation/using-tandems-basal-iq-technology-with-your-patients/
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