AIMS: To compare insulin dose adjustments made by physicians to those made by an artificial intelligence-based decision support system, the Advisor Pro, in people with type 1 diabetes (T1D) using an insulin pump and self-monitoring blood glucose (SMBG). METHODS: This was a multinational, non-interventional study surveying 17 physicians from 11 countries. Each physician was asked to provide insulin dose adjustments for the settings of the pump including basal rate, carbohydrate-to-insulin ratios (CRs), and correction factors (CFs) for 15 data sets of pumps and SMBG of people with T1D (mean age 18.4 ± 4.8 years; eight females; mean glycated hemoglobin 8.2% ± 1.4% [66 ± 11mmol/mol]). The recommendations were compared among the physicians and between the physicians and the Advisor Pro. The study endpoint was the percentage of comparison points for which there was an agreement on the direction of insulin dose adjustments. RESULTS: The percentage (mean ± SD) of agreement among the physicians on the direction of insulin pump dose adjustments was 51.8% ± 9.2%, 54.2% ± 6.4%, and 49.8% ± 11.6% for the basal, CR, and CF, respectively. The automated recommendations of the Advisor Pro on the direction of insulin dose adjustments were comparable )49.5% ± 6.4%, 55.3% ± 8.7%, and 47.6% ± 14.4% for the basal rate, CR, and CF, respectively( and noninferior to those provided by physicians. The mean absolute difference in magnitude of change between physicians was 17.1% ± 13.1%, 14.6% ± 8.4%, and 23.9% ± 18.6% for the basal, CR, and CF, respectively, and comparable to the Advisor Pro 11.7% ± 9.7%, 10.1% ± 4.5%, and 25.5% ± 19.5%, respectively, significant for basal and CR. CONCLUSIONS: Considerable differences in the recommendations for changes in insulin dosing were observed among physicians. Since automated recommendations by the Advisor Pro were similar to those given by physicians, it could be considered a useful tool to manage T1D.

A' Department of Pediatrics Diabetes Center P and A Kyriakou Athens Greece

Children's Hospital of the King's Daughters Eastern Virginia Medical School Norfolk VA USA

Clinic for Endocrinology Diabetes and Metabolic Diseases Clinical Center of Serbia Faculty of Medicine University of Belgrade Serbia

Department of Biomedical Sciences Humanitas Clinical and Research Center IRCCS and Humanitas University Milan Italy

Department of Clinical Medicine and Surgery University of Naples Federico 2 Italy

Department of Diabetology Hospital Mazzoni Ascoli Piceno Italy

Department of Endocrinology and Diabetes UHC Zagreb School of Medicine University of Zagreb Zagreb Croatia

Department of Internal Medicine Diabetes and Endocrinology Unit University Hospital Pilsen Faculty of Medicine in Pilsen Charles University Czech Republic

Department of Internal Medicine Division of Endocrinology University of Pretoria South Africa

Department of Pediatrics Children's Endocrinology Unit University Hospital of Salamanca Spain

Department of Pediatrics Division of Pediatric Endocrinology and Diabetology Antwerp University Hospital and University of Antwerp Belgium

Department of Pediatrics University Hospital of Bologna Sant'Orsola Malpighi Polyclinic Italy

Department of Pediatrics University Hospital of Tampere Finland

Diabetes Research Institute IRCCS San Raffaele Hospital Milan Italy

DreaMed Diabetes Ltd Petah Tiqva Israel

Pediatric Department Aristotle University of Thessaloniki Hippokratio General Hospital Thessaloniki Greece

Pediatric Endocrinology and Diabetes Unit Dana Dwek Children's Hospital Tel Aviv Sourasky Medical Center Israel

Sackler School of Medicine Tel Aviv University Israel

The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes National Center for Childhood Diabetes Schneider Children's Medical Center of Israel Petah Tikva Israel

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