Alexander Dipl.-Ing. Rutscher

Computer-aided systems in the management of type I diabetes: the application of a model-based strategy

One approach of improving metabolic control in type I diabetic patients is the application of computer-aided procedures aimed at supporting the decision on optimal therapeutic regimens. To accomplish this, a complex strategy was developed which in an individual patient permits (1) the evaluation of metabolic data by means of statistical and graphical methods, and (2) the prediction of the outcome in feedback and in non-feedback-controlled insulin therapy. The latter is realized by means of simulation, employing a structured model of the glucose-insulin control system where the model parameters can either be identified individually or be taken at random. The practical applicability was validated in C-peptide-negative type I diabetic patients who were on intensified insulin injection therapy. The comparison between theoretical predictions and daily glycaemic profiles measured by the patients under ambulatory conditions showed close correspondence which justifies the application of this method as a clinical decision support.

Identification of the parameters of a glucose/insulin control model based on individually monitored self-control data in diabetes care

Intensified diabetes treatment including education and training in self-management of blood glucose control has become a permanent task for all people involved in diabetes care, To support this process the interactive computer program KADIS(R) (Karlsburger Diabetes Management System) has been developed and realised. The entire program comprises tools for handling of the self-control data, for automatic adjustment of the program to the individual self-control data of a given patient, and for model-based prediction of the apparent effects of self selected therapeutic measures on the 24 h-blood glucose profiles. To enable easy handling of the program without any special experience in medical informatics, KADIS(R) comprises also a problem-oriented knowledge base to visualise dose- and time-dependent-action profiles of therapeutically administered insulin formulations, of dose-dependent resorption profiles of various foodstuffs, and of dose- and time-dependent profiles of insulin action equivalents of exercise. The feasibility and acceptance of the prototype version of the program which is written in DELPHI/sup R/ was successfully tested in 43 young diabetic children of either sex during a summer camp.

KADIS: A computer-aided decision support, system to improve the quality of metabolic care in diabetes

One potential tool of further improving the results in diabetes treatment consists in the application of computer-aided procedures to estimate individually optimal therapeutic regimes. To meet this goal the decision support system KADIS was developed and verified in management of type I diabetes. The system is based on a validated model of the glucoregulatory system, which parameters can be identified individually. To run the system on a micro-computer a software package was programmed which alloved both the retrospective analysis of data resulting form home blood glucose monitoring, and the prospective simulation of the outcome of alterations in the therapeutic regime in terms of daily profiles in glycaemia and insulinaemia.