Andriani Vazeou

SMARTDIAB: A Communication and Information Technology Approach for the Intelligent Monitoring, Management and Follow-up of Type 1 Diabetes Patients

SMARTDIAB is a platform designed to support the monitoring, management, and treatment of patients with type 1 diabetes mellitus (T1DM), by combining state-of-the-art approaches in the fields of database (DB) technologies, communications, simulation algorithms, and data mining. SMARTDIAB consists mainly of two units: 1) the patient unit (PU); and 2) the patient management unit (PMU), which communicate with each other for data exchange. The PMU can be accessed by the PU through the internet using devices, such as PCs/laptops with direct internet access or mobile phones via a Wi-Fi/General Packet Radio Service access network. The PU consists of an insulin pump for subcutaneous insulin infusion to the patient and a continuous glucose measurement system. The aforementioned devices running a user-friendly application gather patients related information and transmit it to the PMU. The PMU consists of a diabetes data management system (DDMS), a decision support system (DSS) that provides risk assessment for long-term diabetes complications, and an insulin infusion advisory system (IIAS), which reside on a Web server. The DDMS can be accessed from both medical personnel and patients, with appropriate security access rights and front-end interfaces. The DDMS, apart from being used for data storage/retrieval, provides also advanced tools for the intelligent processing of the patients data, supporting the physician in decision making, regarding the patients treatment. The IIAS is used to close the loop between the insulin pump and the continuous glucose monitoring system, by providing the pump with the appropriate insulin infusion rate in order to keep the patients glucose levels within predefined limits. The pilot version of the SMARTDIAB has already been implemented, while the platforms evaluation in clinical environment is being in progress.

Home blood pressure monitoring in children and adolescents: a systematic review.

Objective As in the adults, in children and adolescents with elevated blood pressure (BP), the conventional office BP measurements might lead to incorrect diagnosis. Therefore, out-of-office BP measurements are often needed. Several studies have demonstrated the value of ambulatory BP (ABP) monitoring in pediatric hypertension, whereas home BP (HBP) monitoring has only recently been evaluated. Methods A systematic review of the evidence on HBP monitoring in children and adolescents has been performed (Medline/PubMed, Embase and Cochrane Library). Results A total of 27 studies (19 original study reports, two surveys, three guidelines documents, two reviews and one letter) were identified. These data suggest that by using electronic arm devices, reliable HBP readings are obtained. Unfortunately, very few electronic devices have been successfully validated in children. The reproducibility of HBP in children appears to be superior to office and similar to ABP measurements. Three-day-HBP monitoring with duplicate morning and evening measurements is the minimum schedule required, yet 6–7-day monitoring is recommended. HBP in children and adolescents is lower than daytime ABP, whereas no such difference exists in the adults. A school-based study in 778 children and adolescents provided the first HBP normalcy data. HBP has similar diagnostic value in children as in the adults and appears to be a reliable alternative to ABP monitoring in the detection of white-coat hypertension. Conclusion HBP monitoring appears to have considerable potential in pediatric hypertension. More research is needed on the clinical application of this method in children and adolescents.

Neural Network based Glucose - Insulin Metabolism Models for Children with Type 1 Diabetes

In this paper two models for the simulation of glucose-insulin metabolism of children with Type 1 diabetes are presented. The models are based on the combined use of Compartmental Models (CMs) and artificial Neural Networks (NNs). Data from children with Type 1 diabetes, stored in a database, have been used as input to the models. The data are taken from four children with Type 1 diabetes and contain information about glucose levels taken from continuous glucose monitoring system, insulin intake and food intake, along with corresponding time. The influences of taken insulin on plasma insulin concentration, as well as the effect of food intake on glucose input into the blood from the gut, are estimated from the CMs. The outputs of CMs, along with previous glucose measurements, are fed to a NN, which provides short-term prediction of glucose values. For comparative reasons two different NN architectures have been tested: a Feed-Forward NN (FFNN) trained with the back-propagation algorithm with adaptive learning rate and momentum, and a Recurrent NN (RNN), trained with the Real Time Recurrent Learning (RTRL) algorithm. The results indicate that the best prediction performance can be achieved by the use of RNN

An Insulin Infusion Advisory System Based on Autotuning Nonlinear Model-Predictive Control

This paper aims at the development and evaluation of a personalized insulin infusion advisory system (IIAS), able to provide real-time estimations of the appropriate insulin infusion rate for type 1 diabetes mellitus (T1DM) patients using continuous glucose monitors and insulin pumps. The system is based on a nonlinear model-predictive controller (NMPC) that uses a personalized glucose-insulin metabolism model, consisting of two compartmental models and a recurrent neural network. The model takes as input patients information regarding meal intake, glucose measurements, and insulin infusion rates, and provides glucose predictions. The predictions are fed to the NMPC, in order for the latter to estimate the optimum insulin infusion rates. An algorithm based on fuzzy logic has been developed for the on-line adaptation of the NMPC control parameters. The IIAS has been in silico evaluated using an appropriate simulation environment (UVa T1DM simulator). The IIAS was able to handle various meal profiles, fasting conditions, interpatient variability, intraday variation in physiological parameters, and errors in meal amount estimations.

Mobile phone technologies and advanced data analysis towards the enhancement of diabetes self-management

Advances in the area of mobile and wireless communication for healthcare (m-Health) along with the improvements in information science allow the design and development of new patient-centric models for the provision of personalised healthcare services, increase of patient independence and improvement of patients self-control and self-management capabilities. This paper comprises a brief overview of the m-Health applications towards the self-management of individuals with diabetes mellitus and the enhancement of their quality of life. Furthermore, the design and development of a mobile phone application for Type 1 Diabetes Mellitus (T1DM) self-management is presented. The technical evaluation of the application, which permits the management of blood glucose measurements, blood pressure measurements, insulin dosage, food/drink intake and physical activity, has shown that the use of the mobile phone technologies along with data analysis methods might improve the self-management of T1DM.

Relationship of home blood pressure with target-organ damage in children and adolescents

The objective of this study was to compare home blood pressure (HBP) vs. ambulatory (ABP) and clinic (CBP) measurements in terms of their association with target-organ damage in children and adolescents. A total of 81 children and adolescents (mean age 13±3 years, 53 boys) referred for elevated CBP had measurements of CBP (1 visit), HBP (6 days) and ABP (24-h). Seventy-six participants were also assessed with carotid-femoral pulse wave velocity (PWV) and 54 with echocardiography. Average CBP was 122.1±15.1/71±12.9 mm Hg (systolic/diastolic), HBP 121.3±11.5/69.4±6.6 mm Hg and 24-h ABP 118.9±12/66.6±6.1 mm Hg. Left ventricular mass (LVM) was correlated with systolic blood pressure (BP) (coefficient r=0.55/0.54/0.45 for 24-h/daytime/nighttime ABP, 0.53 for HBP and 0.41 for CBP; all P<0.01). No significant correlations were found for diastolic BP. PWV was also significantly correlated with systolic BP (r=0.52/0.50/0.48 for 24-h/daytime/nighttime ABP, 0.50 for HBP and 0.47 for CBP; all P<0.01). Only diastolic ABP and HBP were significantly correlated with PWV (r=0.30 and 0.28, respectively, P<0.05). In multivariate stepwise regression analysis (with age, gender, body mass index [BMI], clinic, home and 24-h ambulatory systolic/diastolic BP and pulse pressure, clinic, home and 24-h heart rate as independent variables), PWV was best predicted by systolic HBP (R2=0.22, beta±s.e. =0.06±0.01), whereas LVM was determined (R2=0.67) by 24-h pulse pressure (beta=1.21±0.41), age (beta=2.93±1.32), 24-h heart rate (beta=−1.27±0.41) and BMI (beta=1.78±0.70). These data suggest that, in children and adolescents, ABP as well as HBP measurements appear to be superior to the conventional CBP measurements in predicting the presence of subclinical end-organ damage.

Mobile technology to empower people with Diabetes Mellitus: Design and development of a mobile application

Recent advances in information and communication technologies permitted the design and development of new patient-centric models for the provision of better health care services and enhancement of patients self-management. This paper presents a prototype mobile phone application which is being designed to improve the self-management of individuals with Type 1 Diabetes Mellitus (T1DM). The developed application using the Microsoft .Net framework runs on 3G mobile phones. The application consists of five major interfaces for the management of: blood glucose measurements, blood pressure measurements, insulin dosage, food/drink intake and physical activity. Furthermore, the user has the following capabilities i) to keep notes, and ii) in case of an emergency to press a button, in order to transmit immediately his/her position to both an emergency call center, and the attendant physician. It has to be noted, that the above mentioned data are stored locally to the mobile phone, and regularly transmitted via the mobile network to a dedicated hospital web-server. Technical evaluation of the prototype indicates that the use of the mobile network makes feasible the self-management of T1DM.

Continuous blood glucose monitoring in diabetes treatment

Continuous glucose monitoring system (CGMS) is a developing technology in the field of diabetes treatment since it enables patients to effectively control and adjust their insulin therapy. Clinical trials have shown its efficacy in lowering HbAlc significantly especially in adults with type 1 diabetes and those with HbAlc >8%. Improvement is sustained for at least one year. Conflicting data exist for children. Most recent studies agree that the nearly daily use of CGMS is accompanied by significant lowering of HbA1c independent of age. However, the randomized clinical trials have shown that the use of CGMS does not reduce significantly the number of severe hypoglycemic episodes as it is expected, but recent data indicate that it reduces the time spent in hypoglycemia. Accuracy remains a key issue for CGMS, particularly in children and adolescents who may have increased variability of blood glucose. CGMS cost is another barrier to the everyday use since reimbursement of CGM is limited to a few countries only. This review will focus on the present status of the use of CGMS in type 1 diabetes (T1D) patients.

Office, ambulatory and home blood pressure measurement in children and adolescents

There is an increasing interest in pediatric hypertension, the prevalence of which is rising in parallel with the obesity epidemic. Traditionally the assessment of hypertension in children has relied on office blood pressure (BP) measurements by the physician. However, as in adults, office BP might be misleading in children mainly due to the white coat and masked hypertension phenomena. Thus, out-of-office BP assessment, using ambulatory or home monitoring, has gained ground for the accurate diagnosis of hypertension and decision-making. Ambulatory monitoring is regarded as indispensable for the evaluation of pediatric hypertension. Preliminary data support the usefulness of home monitoring, yet more evidence is needed. Office, ambulatory and home BP normalcy tables providing thresholds for diagnosis have been published and should be used for the assessment of elevated BP in children.

Heterogeneity in the systems of pediatric diabetes care across the European Union

It is known that the systems of pediatric diabetes care differ across the member states of the European Union (EU). The aim of this project was to characterize some of the main differences among the national systems.