Fan ZhiYuan, Cui LiYuan, Ye Ying, Li ShouCheng, Deng Ning
College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China.
Binjiang Institute of Zhejiang University, Hangzhou, China.
JMIR Med Inform. 2022 Dec 19;10(12):e42664. doi: 10.2196/42664.
Diabetes needs to be under control through management and intervention. Management of diabetes through mobile health is a practical approach; however, most diabetes mobile health management systems do not meet expectations, which may be because of the lack of standardized management processes in the systems and the lack of intervention implementation recommendations in the management knowledge base.
In this study, we aimed to construct a diabetes management care pathway suitable for the actual situation in China to express the diabetes management care pathway using ontology and develop a diabetes closed-loop system based on the construction results of the diabetes management pathway and apply it practically.
This study proposes a diabetes management care pathway model in which the management process of diabetes is divided into 9 management tasks, and the Diabetes Care Pathway Ontology (DCPO) is constructed to represent the knowledge contained in this pathway model. A telehealth system, which can support the comprehensive management of patients with diabetes while providing active intervention by physicians, was designed and developed based on the DCPO. A retrospective study was performed based on the data records extracted from the system to analyze the usability and treatment effects of the DCPO.
The diabetes management pathway ontology constructed in this study contains 119 newly added classes, 28 object properties, 58 data properties, 81 individuals, 426 axioms, and 192 Semantic Web Rule Language rules. The developed mobile medical system was applied to 272 patients with diabetes. Within 3 months, the average fasting blood glucose of the patients decreased by 1.34 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.63 mmol/L (P=.003); the average systolic and diastolic blood pressures decreased by 11.84 mmHg (P=.02) and 8.8 mmHg (P=.02), respectively. In patients who received physician interventions owing to abnormal attention or low-compliance warnings, the average fasting blood glucose decreased by 2.45 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.89 mmol/L (P=.003) in all patients with diabetes; the average systolic and diastolic blood pressure decreased by 20.06 mmHg (P=.02) and 17.37 mmHg (P=.02), respectively, in patients with both hypertension and diabetes during the 3-month management period.
This study helps guide the timing and content of interactive interventions between physicians and patients and regulates physicians' medical service behavior. Different management plans are formulated for physicians and patients according to different characteristics to comprehensively manage various cardiovascular risk factors. The application of the DCPO in the diabetes management system can provide effective and adequate management support for patients with diabetes and those with both diabetes and hypertension.
糖尿病需要通过管理和干预来控制。通过移动健康进行糖尿病管理是一种切实可行的方法；然而，大多数糖尿病移动健康管理系统未达预期，这可能是因为系统中缺乏标准化的管理流程以及管理知识库中缺乏干预实施建议。
在本研究中，我们旨在构建适合中国实际情况的糖尿病管理护理路径，使用本体来表达糖尿病管理护理路径，并基于糖尿病管理路径的构建结果开发糖尿病闭环系统并实际应用。
本研究提出一种糖尿病管理护理路径模型，其中糖尿病管理过程分为9项管理任务，并构建糖尿病护理路径本体（DCPO）以表示该路径模型中包含的知识。基于DCPO设计并开发了一个远程医疗系统，该系统可以支持糖尿病患者的综合管理，同时由医生提供主动干预。基于从系统中提取的数据记录进行回顾性研究，以分析DCPO的可用性和治疗效果。
本研究构建的糖尿病管理路径本体包含119个新添加的类、28个对象属性、58个数据属性、81个个体、426条公理和192条语义网规则语言规则。开发的移动医疗系统应用于272例糖尿病患者。在3个月内，患者的平均空腹血糖下降了1.34 mmol/L（P = 0.003），平均餐后2小时血糖下降了2.63 mmol/L（P = 0.003）；平均收缩压和舒张压分别下降了11.84 mmHg（P = 0.02）和8.8 mmHg（P = 0.02）。在因异常关注或低依从性警告而接受医生干预的患者中，所有糖尿病患者的平均空腹血糖下降了2.45 mmol/L（P = 0.003），平均餐后2小时血糖下降了2.89 mmol/L（P = 0.003）；在3个月的管理期内，同时患有高血压和糖尿病的患者的平均收缩压和舒张压分别下降了20.06 mmHg（P = 0.02）和17.37 mmHg（P = 0.02）。
本研究有助于指导医生与患者之间互动干预的时机和内容，并规范医生的医疗服务行为。根据不同特征为医生和患者制定不同的管理计划，以全面管理各种心血管危险因素。DCPO在糖尿病管理系统中的应用可以为糖尿病患者以及糖尿病合并高血压患者提供有效且充分的管理支持。
