Janusz Krzymien

Area of the Diabetic Ulcers Estimated Applying a Foot Scanner–Based Home Telecare System and Three Reference Methods

BACKGROUND Diabetic foot ulcer area is a basic parameter used for monitoring the wound healing and effectiveness of the treatment applied. TeleDiaFoS (developed earlier in collaboration with the Department and Clinic of Gastroenterology and Metabolic Diseases, Medical University of Warsaw, Warsaw, Poland) is one of just a few systems available that make possible monitoring of the wound size remotely based on the foot scans transmitted to the physician from a patients home. The aim of this study was to compare the diabetic foot ulcer areas measured using TeleDiaFoS with the results obtained using three reference methods. METHODS The reference measurements were conducted using the elliptical method with a ruler, the wound tracing method and planimetrics with the Visitrak (Smith & Nephew, London, UK) system, and the pattern-coded structured light method with the Silhouette (ARANZ Medical, Christchurch, New Zealand) system. Regression and Bland-Altman analyses were performed. The study group consisted of 23 diabetes patients with plantar foot ulcers. RESULTS Thirty-three wounds were successfully examined. The measurement method influenced the measured area significantly (P=0.00005). The correlation coefficients between TeleDiaFoS and the ruler, Visitrak, and Silhouette methods were 0.949, 0.985, and 0.987, and the limits of agreement equaled -1.3±5.5 cm(2), -0.4±2.2 cm(2), and -0.6±2.1 cm(2), respectively. The strong linear relationships obtained can be used to convert the wound area measured with TeleDiaFoS to the corresponding value of each of the reference methods. CONCLUSIONS The results indicate that the wound area of plantar ulcers in diabetes might be monitored effectively using the TeleDiaFoS system based on the foot scans that the patient can produce at home with no assistance of other persons.

Application of the Home Telecare System in the Treatment of Diabetic Foot Syndrome

Diabetes is a group of metabolic diseases affecting more than 200 mln people worldwide, which is characterized by elevated blood glucose level. Diabetes causes a number of late complications among which diabetic foot syndrome (DFS) is one of the most dramatic as a major cause of the lower limb amputations. In IBBE PAS the TeleDiaFoS system aimed at monitoring of DFS treatment was developed. In the system, the Central Clinical Server is accessed by the Patient’s Module using a wireless internet connection to send the wound pictures, the blood glucose (BG) readings and the blood pressure (BP) values. Clinical verification of the TeleDiaFoS system has been organized as a randomized 90-days trial with the study and the control groups consisting of 10 type 2 diabetic patients, each. Currently, the evaluation of the first patient treated with multi-injection insulin delivery and antibiotic — dalacin therapies has been terminated. Home telecare therapy led to 12-fold reduction of the wound surface (from 356 mm2 to 29 mm2). During the whole 90-days period BP was controlled efficiently, however, acceptable BG level has not been maintained. In conclusion, application of the system leads to more effective realization of the DFS therapy and has a positive impact on the patient’s comfort.

System for Calculating of Compensating Insulin Dose from Voice Description of Meal

An effective application of insulin treatment in diabetic patients requires ability of the patient to select proper insulin doses, which compensate ingested meals. This is difficult, time consuming and in some cases outreach patient’s abilities.

Accuracy of Automatic Carbohydrate, Protein, Fat and Calorie Counting Based on Voice Descriptions of Meals in People with Type 1 Diabetes

The aim of this work was to assess the accuracy of automatic macronutrient and calorie counting based on voice descriptions of meals provided by people with unstable type 1 diabetes using the developed expert system (VoiceDiab) in comparison with reference counting made by a dietitian, and to evaluate the impact of insulin doses recommended by a physician on glycemic control in the study’s participants. We also compared insulin doses calculated using the algorithm implemented in the VoiceDiab system. Meal descriptions were provided by 30 hospitalized patients (mean hemoglobin A1c of 8.4%, i.e., 68 mmol/mol). In 16 subjects, the physician determined insulin boluses based on the data provided by the system, and in 14 subjects, by data provided by the dietitian. On one hand, differences introduced by patients who subjectively described their meals compared to those introduced by the system that used the average characteristics of food products, although statistically significant, were low enough not to have a significant impact on insulin doses automatically calculated by the system. On the other hand, the glycemic control of patients was comparable regardless of whether the physician was using the system-estimated or the reference content of meals to determine insulin doses.

Microdialysis monitoring of glucose, lactate, glycerol, and pyruvate in patients with diabetic ketoacidosis.

Purpose The objective was to assess glucose, lactate, glycerol, and pyruvate concentrations in the interstitial fluid of the adipose tissue as well as the glucose relative recovery coefficient in reference to capillary blood (RC) during the first two days of the standard treatment of diabetic ketoacidosis (DKA) in patients with type 1 and type 2 diabetes. Materials and Methods The study group consisted of 19 patients (12 with type 1 diabetes and 7 with type 2 diabetes). The metabolic state of the patients was monitored using the microdialysis technique. The analysis of variance was used to investigate whether the type of diabetes and the duration of treatment influenced the assessed parameters. Results Concentrations of all the monitored components were stable after the initial 12 h of treatment. Glucose concentration was higher and concentrations of all the other components were lower (p<0.0001) in patients with type 1 diabetes than in patients with type 2 diabetes. Significantly higher RC was observed in patients with type 1 diabetes during the initial 12 h. Conclusions The results suggest that the standard treatment of DKA is effective in stabilizing a concentration of the studied metabolic components in the interstitial fluid in patients with type 1 and type 2 diabetes despite differences in the glucose concentration at the beginning of the treatment.

Insulin Bolus Calculator with Automatic Speech Recognition

There is a recommendation regarding diabetes treatment with insulin pens or pumps that elevated blood glucose concentration after meal should be compensated by insulin bolus. This requires effective estimation of food carbohydrates and performing arithmetic calculations, what may be challenging tasks for many persons with diabetes. Consequently, their glycemic control is poor with glycated hemoglobin level higher than recommended. When this state lasts too long, it directly leads to microvascular and macrovascular diabetes complications. Microvascular complications include retinopathy leading to blindness, nephropathy leading to renal failure and neuropathy leading to diabetic foot disorders leading to amputation. Macrovascular complications include cardiovascular diseases, strokes and serious reduction in blood flow rate to legs. Good metabolic control in diabetes delays the onset and progression of diabetes complications. Some help may assure insulin bolus calculators. They must be safe, effective and easy to use. The developed VoiceDiab system helps users in estimation of insulin dose based on voice description of a meal. It consists of smartphone application and MS Windows servers working with developed linguistic database and nutrient database. The system calculates the insulin dosage for insulin pen or pump users. The system automatically suggests a dual-wave bolus, if there is significant amount of proteins and fats in a meal. The outpatient clinic study revealed that patients supported by the system or those unsupported had comparable means and variabilities of blood glucose concentration. The inpatient clinic trial showed that the VoiceDiab system was able to properly estimate insulin boluses compensating meals based on the voice description of these meals.

Estimation of the Hemoglobin Glycation Rate Constant Based on the Mean Glycemia in Patients with Diabetes

Glycated hemoglobin A1c (HbA1c) has been the gold standard index of the metabolic control in the diabetes treatment for 30 years. The goal of this study was to estimate the overall glycation rate constant (k) in a simple mathematical model of HbA1c formation for patients with type 1 and type 2 diabetes based on the mean glycemia calculated using the continuous glucose monitoring data. The study group consisted of 10 participants including 5 patients with type 1 diabetes (1 women and 4 men aged 50 ± 19 years) and 5 patients with type 2 diabetes (3 women and 2 men aged 57 ± 10 years) with stable glycemic control. The mean k in the whole study group was equal to 1.37 ± 0.25 x 10− 9 L/(mmol s). The mean k values calculated separately for patients with type 1 and type 2 diabetes were equal to 1.40 ± 0.30 x 10− 9 L/(mmol s) and 1.34 ± 0.21 x 10− 9 L/(mmol s), respectively (p = 0.60). The obtained results show that the hemoglobin glycation rate constant in patients with type 1 and type 2 diabetes with stable metabolic control is close to the value of this parameter in non-diabetic volunteers. However, a higher inter-subject variability of k estimated in patients with diabetes suggests that some additional factors might influence a pace of HbA1c formation that are not present in the simplistic model that was studied.