AIDA2: a Mk. II automated insulin dosage advisor.

A prototype computer system has been developed to provide advice on the day-to-day adjustment of insulin dosage in the insulin-dependent (type 1) diabetic patient. The system also allows the patient's daily steady-state blood glucose profile to be generated based on these adjustments using a clinical model of glucose-insulin interaction. The prototype is intended to be used as a decision support system by clinical personnel. It is designed for use during consultations, as a simulator of patient response following changes in the insulin and/or dietary regimen, and as a system to provide education on planning insulin therapy. Advice is generated by a qualitative therapeutic advisor which suggests what the next step in improving glycaemic control might be for a given patient. The clinical model attempts to reflect the underlying (patho)physiology of insulin action and carbohydrate absorption in quantitative terms. It consists of a one-compartment glucose model linked to a model with plasma and 'active' insulin compartments. An overview of the integrated prototype is provided along with a detailed description of the new time-point-orientated logical reasoning methodology adopted by the therapeutic advisor. The operation of the system is illustrated by a clinical case study from a 70 kg, male, insulin-dependent diabetic patient.