Albisser A Michael, Alejandro Rodolfo, Sperlich Marianne, Ricordi Camillo
Diabetes Control and Complications Treatment Initiative, Hollywood Beach, FL 33019, USA.
J Diabetes Sci Technol. 2009 May 1;3(3):524-32. doi: 10.1177/193229680900300317.
Satisfactory glycemic control, meeting American Diabetes Association recommendations, is often accompanied by unsatisfactory hypoglycemia. The converse is also true. We hypothesize that this diabetes treatment dilemma may be resolved by repeated, objective, prescription checks. To do this, a new, two-part device has been developed. It includes a personal diabetes database for the patient and a built-in diabetes prescription checker for the provider. Its goals are to enhance diabetes education and improve patient care.
The device includes a database and supporting software, all contained in a standard USB flash drive. Using the medical prescription, body weight, and recent self-monitored blood glucose (SMBG) data, prescription checks can be done at any time. To demonstrate the device's capabilities, an observational study was performed using data from 11 patients with type 1 diabetes mellitus, on intensified therapy, with a mean glycated hemoglobin A1c <7%, and who all suffered intractable hypoglycemia. Patients had performed SMBG contours on successive days at monthly intervals. Each contour included pre- and postmeal as well as bedtime measurements. The replicated contours were used to predict the patient's glycemic profile each month. Applying a built-in simulator to each profile, changes in the prescription were explored that were consistent with reducing the recalcitrant hypoglycemia.
A total of 110 glycemic profiles containing 822 profile points were explored. Of these profile points, 351 (43%) showed risks of hypoglycemia, whereas 385 (47%) fell outside desired ranges. With the simulated changes in the prescription, the predicted risks of hypoglycemia were reduced 2.5-fold with insignificant increases predicted in hemoglobin A1c levels of +0.6 +/- 0.9%.
A novel support tool for diabetes promises to resolve the diabetes treatment dilemma. Supporting the patient, it improves self-management. Supporting the provider, it reviews the medical prescription in light of objective outcomes and formalizes interventions for maximum safety and efficacy.
达到美国糖尿病协会推荐标准的令人满意的血糖控制，常常伴随着不尽人意的低血糖情况。反之亦然。我们推测，这种糖尿病治疗困境或许可以通过反复、客观的处方检查来解决。为此，已开发出一种新型的、由两部分组成的设备。它包括一个供患者使用的个人糖尿病数据库和一个供医护人员使用的内置糖尿病处方检查器。其目标是加强糖尿病教育并改善患者护理。
该设备包括一个数据库及配套软件，全部包含在一个标准的USB闪存盘中。利用医疗处方、体重以及近期自我监测的血糖（SMBG）数据，可随时进行处方检查。为展示该设备的功能，进行了一项观察性研究，使用了11例1型糖尿病患者的数据，这些患者接受强化治疗，糖化血红蛋白A1c平均<7%，且均患有顽固性低血糖。患者每月连续数日进行SMBG轮廓测量。每个轮廓包括餐前、餐后以及睡前测量值。利用复制的轮廓来预测患者每月的血糖情况。将一个内置模拟器应用于每个血糖情况，探索与减少顽固性低血糖相一致的处方变化。
共探索了110个血糖情况，包含822个情况点。在这些情况点中，351个（43%）显示有低血糖风险，而385个（47%）超出了理想范围。随着处方的模拟变化，预测的低血糖风险降低了2.5倍，而预测糖化血红蛋白A1c水平仅显著增加了+0.6 +/- 0.9%。
一种新型的糖尿病支持工具有望解决糖尿病治疗困境。它支持患者，改善自我管理。支持医护人员，根据客观结果审查医疗处方，并将干预措施规范化以实现最大安全性和疗效。
