Optimal control of medical treatment: adaptive control of blood glucose level in diabetic coma

Computer assisted diabetes care: a 6-year retrospective

Over the past 6 years we have designed a number of computer-based prototypes for the provision of therapeutic advice and the generation of glycaemic predictions in insulin-dependent (type 1) diabetic patients. In this paper we provide an overview of some of this work, and describe our experiences in trying to develop such methods for clinical use. We review, as an example, a model of the glucoregulatory system which has been developed for patient and medical staff education about type 1 diabetes mellitus, as well as possibly for therapeutic use. Using individualised parameter values the predictions of the model can be applied to generate 24-h simulations of patient blood glucose profiles. Previous preliminary retrospective validation work performed with this model has revealed a mean predictive accuracy for blood glucose simulations of approximately 2 mmol/l. Conceptual limitations of such modelling approaches are considered. We comment that such "mechanistic' models may lack the necessary sophistication and flexibility to represent the complexity of the human glucoregulatory system and the challenges it has to face. Although such methodologies may therefore not be suitable for safe and effective application in routine clinical practice, we conclude that the evolution of such a system for demonstration/educational purposes could have widespread clinical utility as an interactive teaching tool.

Application of computers in diabetes care--a review. I. Computers for data collection and interpretation

The paper reviews the contribution of information technology (IT) to diabetes care. An appraisal of this topic with respect to insulin-dependent (type 1) diabetic patients is carried out in view of the landmark findings of the Diabetes Control and Complications Trial (DCCT) which has demonstrated that maintaining tight blood glucose control can delay the onset and slow the progression of the later life complications of diabetes. The review starts with the clinical background and the main features of the control schema in which diabetic patients receive insulin therapy. An overview is then provided of recent IT initiatives in diabetes care, and the application of IT techniques to assist in the diagnosis and characterization of patients with diabetes mellitus is considered. The role of IT approaches for short-term glycaemic control is discussed and the utilization of computers for collecting, viewing and interpreting home monitoring blood glucose data is reviewed; both quantitative and qualitative techniques being considered. In the second paper the role of decision support tools for planning insulin therapy using clinical algorithms, hand-held devices, knowledge-based approaches, telemedicine techniques and interactive simulations is reviewed, and the validation and clinical evaluation of these tools is discussed. The likely impact of the routine clinical application of implantable/non-invasive blood glucose monitoring devices is also considered. Finally, the application of computers as teaching tools is reviewed and the ways in which such educational approaches might be applied for disseminating the benefits of the DCCT trial more widely are discussed.