Objective: Artificial intelligence-based decision support systems (DSS) need to provide decisions that are not inferior to those given by experts in the field. Recommended insulin dose adjustments on the same individual data set were compared among multinational physicians, and with recommendations made by automated Endo.Digital DSS (ED-DSS). Research Design and Methods: This was a noninterventional study surveying 20 physicians from multinational academic centers. The survey included 17 data cases of individuals with type 1 diabetes who are treated with multiple daily insulin injections. Participating physicians were asked to recommend insulin dose adjustments based on glucose and insulin data. Insulin dose adjustments recommendations were compared among physicians and with the automated ED-DSS. The primary endpoints were the percentage of comparison points for which there was agreement on the trend of insulin dose adjustments. Results: The proportion of agreement and disagreement in the direction of insulin dose adjustment among physicians was statistically noninferior to the proportion of agreement and disagreement observed between ED-DSS and physicians for basal rate, carbohydrate-to insulin ratio, and correction factor (P < 0.001 and P ≤ 0.004 for all three parameters for agreement and disagreement, respectively). The ED-DSS magnitude of insulin dose change was consistently lower than that proposed by the physicians. Conclusions: Recommendations for insulin dose adjustments made by automatization did not differ significantly from recommendations given by expert physicians regarding the direction of change. These results highlight the potential utilization of ED-DSS as a useful clinical tool to manage insulin titration and dose adjustments.

1st Pediatric Department Aristotle University of Thessaloniki Hippokratio General Hospital Thessaloniki Greece

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

Department of Biomedical Sciences Humanitas University Milan Italy

Department of Clinical Medicine and Surgery University of Naples Federico 2 Naples 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 Endocrinology Diabetes and Metabolic Diseases UMC University Children's Hospital Ljubljana and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Department of Medicine and Diabetes Unit Soroka Medical Center Faculty of Health Sciences Beer Sheva Israel

Department of Pediatric Endocrinology Arnold Palmer Hospital for Children Orlando Florida USA

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

Dia Care Diabetes Care and Hormone Clinic Ahmedabad Gujarat India

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

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

Diabetes Center for Children and Adolescents Children's Hospital AUF DER BULT Hannover Germany

Division of Endocrinology ASST Fatebenefratelli Sacco Milan Italy

Division of Endocrinology Diabetes and Metabolism Dalia and David Arabov Endocrinology and Diabetes Research Center Sheba Medical Center Tel Hashomer Israel

Division of Maternal Fetal Medicine Helen Schneider Women's Hospital Rabin Medical Center Endocrinology Clinic Petah Tikva Israel

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

DreaMed Diabetes Ltd Petah Tikva Israel

Pediatric Endocrine Division Sheikh Shakhbout Medical City and Khalifa University Abu Dhabi United Arab Emirates

Rabin Medical Center Institute of Endocrinology Beilinson Hospital Petach Tikva Israel

Sackler Faculty of Medicine Tel Aviv University Tel Hashomer 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

Unit of Pediatrics IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

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