KADIS: model-aided education in type I diabetes. Karlsburg Diabetes Management System.

Education and training in self-management of blood glucose control has become a permanent task for all people involved in the care of diabetic patients. Since this may be facilitated by applying state-of-the-art information technology, we have developed the decision support system KADIS (Karlsburg Diabetes Management System). It comprises computer-aided tools for (1) the evaluation (selection, aggregation, storage, statistics, graphics) of therapeutic data, e.g. from patients' logbooks, and (2) the simulation of daily profiles of glycaemia and insulinaemia on the basis of a mathematical model of the glucose-insulin regulatory system, parameters of which can be adapted to the characteristics of individual patients. The latter tool allows the patient to predict his response to any modification in the therapeutic regime and to learn how variations in timing, formulation and doses of insulin, in carbohydrate equivalents and absorption characteristics of meals, and in exercise may influence the daily pattern in glycaemia. This procedure has been well accepted as an educational tool by those patients who were 'self-managing' their metabolic control.

Computer-aided systems in the management of type I diabetes: the application of a model-based strategy.

One approach of improving metabolic control in type I diabetic patients is the application of computer-aided procedures aimed at supporting the decision on optimal therapeutic regimens. To accomplish this, a complex strategy was developed which in an individual patient permits (1) the evaluation of metabolic data by means of statistical and graphical methods, and (2) the prediction of the outcome in feedback and in non-feedback-controlled insulin therapy. The latter is realized by means of simulation, employing a structured model of the glucose-insulin control system where the model parameters can either be identified individually or be taken at random. The practical applicability was validated in C-peptide-negative type I diabetic patients who were on intensified insulin injection therapy. The comparison between theoretical predictions and daily glycaemic profiles measured by the patients under ambulatory conditions showed close correspondence which justifies the application of this method as a clinical decision support.

KADIS--a computer-aided decision support system for improving the management of type-I diabetes.

Despite the introduction of new therapeutic aids such as insulin pumps and injectors, blood glucose test tapes, particular insulin formulations, and the physiological basis-bolus principle of insulin dosage regimes, the metabolic care of most insulin-dependent patients is still insufficient. One potential tool of further improving the results in diabetes treatment consists in the application of computer-aided procedures to estimate individually optimal regimes. Employing a validated mathematical model of the glucose/insulin metabolic control system and individual sets of data from patients' self-monitoring, a software package was developed on a micro-computer which allowed both the retrospective analysis of data resulting from the therapeutic process, and the prospective simulation of the outcome of alterations in the regime in terms of glycaemia and insulinaemia. The two parts of the programme provide either for the patient or for the physician an interactive mode of working with the computer. The system is now being validated by means of a long-term follow-up study in type-I diabetic patients. It may be used mainly in diabetic outpatient centers and as a tool of educating, training, and motivating patients.

A model-based system for the individual prediction of metabolic responses to improve therapy in type I diabetes.

Despite recent achievements such as home glucose monitoring and intensified injection regimens or insulin pumps, the metabolic care in diabetic patients is still mostly insufficient. One approach of further improving the management is the application of computer-aided procedures to estimate individually the optimal regimes. To accomplish this, a model-based strategy was developed which permits the prospective assessment of the metabolic outcome. This strategy comprises the following components: (1) a validated model of the physiological glucose-insulin regulatory system; (2) a procedure for identifying the metabolic situation of a given patient in terms of the model parameters; (3) methods of estimating the pharmacokinetics of insulin and its effect on glycemia, the absorption profiles of ingested glucose equivalents, and the effect of exercise as expressed in equivalents of insulin action; (4) computer procedures of prospective simulation of glycemic profiles around the day under the influence of selected or proposed therapeutic regimes. The entire method has been validated in C-peptide negative type I diabetic patients by comparing experimental results with theoretical predictions from model-based simulations over up to one year. This model-based simulation may be applied by ambulatory patients together with their physicians as a decision-support system in selecting appropriate individually suited regimes.