Inter- and intra-physician variability in insulin injection adjustments compared with Bayesian algorithm recommendations in type 1 diabetes
Authors' conclusion
The direction of insulin adjustments was comparable between physicians and the McGill algorithm. The large intra-physician variability further emphasises the subjective nature of insulin management.
Study context
- Population
- Canadian endocrinologists making mock insulin adjustments for MDI in T1D on retrospective participants' data
- Participants
- 13 endocrinologists
- Exposure
- McGill decision support system (DSS) Bayesian algorithm vs endocrinologists
- Outcome
- Agreement rate on the direction of weekly insulin adjustments (prandial bolus and basal insulin)
- Follow-up
- Weekly (part A)
Methodological detailsmock insulin adjustments on retrospective participants' data, three parts (A: weekly data; B: intra-physician repeat of part A; C: biweekly data), non-inferiority comparison
- Mock insulin adjustments on retrospective participants' data
- Three parts (A: weekly data; B: intra-physician repeat of part A; C: biweekly data)
- Non-inferiority comparison
Main finding
As reported in the abstract
Agreement rate on direction of weekly adjustments, prandial bolus · part A
P = 0.006
Observational data: associations, not effects.
Further findings
Mean
| Outcome | Algorithm–physician | Physician–physician | P value |
|---|---|---|---|
| Agreement rate on direction of weekly adjustments, basal insulin · part ANon-inferior · non-inferiority | 48% (SD 6) | 51% (SD 11) | P = 0.037 |
| Full disagreement rate on weekly adjustments, prandial bolus · part A | 3.9% (SD 2.3) | 4.1% (SD 2.3) | P = 0.006 |
| Full disagreement rate on weekly adjustments, basal insulin · part A | 10.6% (SD 4.6) | 9.2% (SD 7.1) | P = 0.23 |
Biweekly insulin adjustments · part C
- Similar rates were observed for biweekly insulin adjustments in part C
Intra-physician full agreement (part A vs part B)
- Prandial bolus adjustments, mean
- 66% (SD 7)
- Basal insulin adjustments, mean
- 67% (SD 7)
Original publication
Inter- and intra-physician variability in insulin injection adjustments compared with Bayesian algorithm recommendations in type 1 diabetes. Diabetologia. Published 15 December 2025. doi:10.
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