Albisser A M, Sozzi S, Strack T R
Loyal True Blue and Orange Research Institute, Ontario, Canada.
Diabetes Care. 1990 Apr;13(4):393-400. doi: 10.2337/diacare.13.4.393.
Adjustment algorithms for conventional insulin therapy must be tested for safety and efficacy before clinical implementation. We did this by computer simulation. Accordingly, a computer simulator of human intermediary metabolism created 10 randomly chosen diabetic subjects for study. All were well defined with respect to compliance (i.e., medication and diet) and life-style (i.e., physical and emotional stress). Insulin-adjustment algorithms that were tested calculated daily insulin dosages for these computer-simulated patients based on either blood or urine glucose concentrations self-measured 4 times/day before breakfast, lunch, dinner, and bedtime snack. The twofold purpose of the simulation study was to determine the ability of the adjustment algorithms to improve initially poor metabolic control and to compare the outcomes when either blood or urine glucose measurements were the basis on which glycemic control was implemented. A significant improvement in metabolic control could be achieved with either blood or urine glucose measurements as input to the algorithms. Detailed comparisons between blood and urine glucose-based treatments showed no significant advantage of blood glucose-based algorithms at breakfast (122 +/- 21 vs. 131 +/- 16 mg/dl) and dinner (117 +/- 27 vs. 130 +/- 23 mg/dl), whereas mean glycemia at lunch (122 +/- 24 vs. 164 +/- 21 mg/dl) and bedtime (117 +/- 25 vs. 150 +/- 21 mg/dl) after 120 days of simulation did differ significantly (P less than 0.01). Hypoglycemia was not provoked by either treatment. Total daily insulin doses evolved by blood glucose-based algorithms were significantly (P less than 0.05) higher than the doses used by urine glucose-based algorithms (53 vs. 47 U).(ABSTRACT TRUNCATED AT 250 WORDS)
传统胰岛素治疗的调整算法在临床应用前必须进行安全性和有效性测试。我们通过计算机模拟来完成此项工作。相应地，一个人体中间代谢的计算机模拟器创建了10名随机选取的糖尿病受试者用于研究。所有受试者在依从性（即用药和饮食）和生活方式（即身体和情绪压力）方面都有明确界定。所测试的胰岛素调整算法根据受试者每天早餐前、午餐前、晚餐前和睡前小吃前自行测量4次的血糖或尿糖浓度，为这些计算机模拟患者计算每日胰岛素剂量。模拟研究的双重目的是确定调整算法改善初始不良代谢控制的能力，并比较以血糖或尿糖测量值为血糖控制基础时的结果。以血糖或尿糖测量值作为算法输入，均可显著改善代谢控制。基于血糖和尿糖治疗的详细比较显示，早餐时（122±21 vs. 131±16 mg/dl）和晚餐时（117±27 vs. 130±23 mg/dl），基于血糖的算法没有显著优势，而在模拟120天后，午餐时（122±24 vs. 164±21 mg/dl）和睡前（117±25 vs. 150±21 mg/dl）的平均血糖水平确实存在显著差异（P<0.01）。两种治疗方法均未引发低血糖。基于血糖的算法得出的每日胰岛素总剂量显著高于基于尿糖的算法（53 vs. 47 U）（P<0.05）。（摘要截选至250词）
