Insulin dosage adjustment using manual methods and computer algorithms: A comparative study
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Abstract
The paper presents a three-way comparative study of the responses of computer-simulated diabetic patients to intervention for insulin dosage adjustment either by a diabetologist according to conventional methods or by the patient himself according to either recommended manual methods or a newly developed computerimplementable algorithm. In all cases, insulin dosage adjustment improved glycaemic control. However, the new computer algorithm described in this report was superior both in respect to the speed of improving diabetes control and the avoidance of undesirable hypoglycaemia. We conclude, on the basis of our simulations, that a computer may advantageously be used to accept daily blood glucose estimates and recommend changes in insulin therapy, that these dosage changes should improve glycaemic control (as assessed by reductions in both the mean premeal glycaemia and its variability), and finally that the development of a portable insulin dosage microcomputer device can provide both the patient having diabetes mellitus and his physician with a new and unique method for significantly improving conventional insulin therapy.
Keywords
Artificial intelligence Automated therapy Diabetes Glucose homeostasis Medical computers MetabolismPreview
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References
- Albisser, A. M. Perlman, K. andSchulz, M. (1985) Titrating the insulin dose by computer: the effects of measurement errors in capillary blood glucose estimation. Abstract presented at the XII Cong. of the IDF, Madrid, Spain, 23rd–28th Sept. 1985.Google Scholar
- Albisser, A. M. andSchulz, M. (1986) Simulating human intermediary metabolism: OMNIet al.. Proc. Clin. Biochem. Nearer the Patient II Conf., University of Surrey, Guildford, Surrey, Transmedia Europe Ltd., (in press).Google Scholar
- Cahill, F. G., Etzwiler, D. D. andFreinkel, N. (1976) Blood glucose control in diabetes.Diabetes, 1976,25, 237–238, andN. Engl. Med., 1976,294, 1004–1005.Google Scholar
- Diabetes Care (1980) Symposium on home glucose monitoring.Diabetes Care,3, 57–139.Google Scholar
- Engermann, R., Bloodworth, J. M. B. andNelson, S. (1977) Relationship of microvascular disease in diabetes to metabolic control.Diabetes,26, 760–769.Google Scholar
- Job, D., Eschwege, E., Guyot, C., Aubry, J. P. andTchobroutsky, G. (1976) Effect of multiple daily insulin injections on the course of diabetic retinopathy.,25, 463–469.Google Scholar
- Mauer, S. M., Steffes, M. W., Connett, J., Najarian, J. S., Sutherland, E. R. andBarbosa, J. J. (1983) The development of lesions in the glomerular basement membrane and mesangium after transplantation of normal kidneys to diabetic patients.,32, 948–952.Google Scholar
- Salans, L. B. (1983) Proposed protocol for the clinical trial to assess the relationship between metabolic control and the early vascular complications of Type 1 (insulin-dependent) diabetes.Diabetologia,24, 216.CrossRefGoogle Scholar
- Schiffrin, A. andBelmonte, M. M. (1981) Combined continuous subcutaneous insulin infusion and multiple subcutaneous injections in type I diabetic patients.Diabetes Care,4, 595–600.Google Scholar
- Schiffrin, A., Mihic, M., Leibel, B. S., Albisser, A. M. (1985) Computer assisted insulin dosage adjustment.,8, 545–552.Google Scholar
- Siperstein, M. D., Foster, D. W., Knowles, H. C., Levine, R., Madison, L. L. andRoth, J. (1977) Control of blood glucose and diabetic vascular disease.N. Engl. J. Med.,296, 1060–1063.CrossRefGoogle Scholar
- Skyler, J. S., Skyler, D. L., Seigler, D. E. andO'Sullivan, M. J. (1981) Algorithms for adjustment of insulin dosage by patients who monitor blood glucose.Diabetes Care,4, 311–318.Google Scholar