Interactive educational simulators in diabetes care.

Since the Diabetes Control and Complications Trial demonstrated the substantial benefits of tight glycaemic control there has been renewed interest in the application of information technology (IT) based techniques for improving the day-to-day care of patients with diabetes mellitus. Computer-based educational approaches have a great deal of potential for patients use, and may offer a means of training more health-care professionals to deliver such improved care. In this article the potential role of IT in diabetes education is reviewed, focusing in particular on the application of compartmental models in both computer-based interactive simulators and educational video games. Close attention is devoted to practical applications-available today-for use by patients, their relatives, students and health-care professionals. The novel features and potential benefits of such methodologies are highlighted and some of the limitations of currently available software are discussed. The need for improved graphical user interfaces, and for further efforts to evaluate such programs and demonstrate an educational benefit from their use are identified as hurdles to their more widespread application. The review concludes with a look to the future and the type of modelling features which should be provided in the next generation of interactive diabetes simulators and educational video games.

[1]  R. Bergman,et al.  Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose. , 1981, The Journal of clinical investigation.

[2]  K. Meadows,et al.  Effect of Computer-Based Learning on Diabetes Knowledge and Control , 1986, Diabetes Care.

[3]  P C Davidson,et al.  Computer-Assisted Instruction in Intense Insulin Therapy Using a Mathematical Model for Clinical Simulation With a Clinical Algorithm and Flow Sheet , 1989, The Diabetes educator.

[4]  E. Biermann.  DIACATOR: simulation of metabolic abnormalities of type II diabetes mellitus by use of a personal computer. , 1994, Computer methods and programs in biomedicine.

[5]  L J Donaldson,et al.  From black bag to black box: will computers improve the NHS? , 1996, BMJ.

[6]  C. Sammut,et al.  Assessment of Experts' Approach to Insulin Therapy and Development of a Simulator for Diabetes Insulin Adjustment , 1992, Diabetes Care.

[7]  E D Lehmann,et al.  AIDA2: a Mk. II automated insulin dosage advisor. , 1993, Journal of biomedical engineering.

[8]  Eldon D. Lehmann,et al.  Combining rule-based reasoning and mathematical modelling in diabetes care , 1994, Artif. Intell. Medicine.

[9]  T. Deutsch,et al.  Application of computers in diabetes care--a review. I. Computers for data collection and interpretation. , 1995, Medical informatics = Medecine et informatique.

[10]  Use of computer simulator training in the education of diabetic teenagers , 1995 .

[11]  F. del Pozo,et al.  A simulator of therapies for education in diabetes , 1989, Images of the Twenty-First Century. Proceedings of the Annual International Engineering in Medicine and Biology Society,.

[12]  R N Bergman,et al.  Impact of Computer Simulation on Diabetes Research and Practice , 1989, Diabetes Care.

[13]  K. Smyth-Staruch,et al.  Energy metabolism in diabetes: computer-assisted instruction for persons with diabetes. , 1987, The Diabetes educator.

[14]  T. Deutsch,et al.  A Physiological Model Of Glucose-insulin Interaction , 1991, Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society Volume 13: 1991.

[15]  E. Lehmann.  The diabetes control and complications trial (DCCT): a role for computers in patient education? , 1994 .

[16]  E D Lehmann,et al.  A physiological model of glucose-insulin interaction in type 1 diabetes mellitus. , 1992, Journal of biomedical engineering.

[17]  J. Ludvigsson,et al.  Särimner: a computer model of diabetes physiology for education of physicians and patients. , 1991, Diabetes research and clinical practice.

[18]  D. Rodbard.  Potential role of computers in clinical investigation and management of diabetes mellitus. , 1988, Diabetes care.

[19]  Computer-based diagnostic systems. , 1994 .

[20]  T. Deutsch,et al.  Application of computers in diabetes care--a review. II. Computers for decision support and education. , 1995, Medical informatics = Medecine et informatique.

[21]  A. Schiffrin,et al.  Computer-assisted Insulin Dosage Adjustment , 1985, Diabetes Care.

[22]  P P Horan,et al.  Computer-Assisted Self-Control of Diabetes by Adolescents , 1990, The Diabetes educator.

[23]  A. Albisser,et al.  Diabetes intervention in the information age. , 1996, Medical informatics = Medecine et informatique.

[24]  Y. Z. Ider,et al.  Quantitative estimation of insulin sensitivity. , 1979, The American journal of physiology.

[25]  D Rodbard,et al.  Computer Simulation of Plasma Insulin and Glucose Dynamics After Subcutaneous Insulin Injection , 1989, Diabetes Care.

[26]  P. Cryer,et al.  Glucose counterregulation, hypoglycemia, and intensive insulin therapy in diabetes mellitus. , 1985, The New England journal of medicine.

[27]  P H Wise,et al.  Computer Based Learning and Assessment for Diabetic Patients , 1984, Diabetic medicine : a journal of the British Diabetic Association.

[28]  E. Lehmann,et al.  Diabetes moves onto the Internet , 1996, The Lancet.

[29]  J. Assal,et al.  Designing computer assisted instruction programs for diabetic patients: how can we make them really useful? , 1992, Proceedings. Symposium on Computer Applications in Medical Care.

[30]  E Biermann,et al.  DIABLOG: a simulation program of insulin-glucose dynamics for education of diabetics. , 1990, Computer methods and programs in biomedicine.

[31]  D. Lieberman,et al.  The Computer's Potential Role in Health Education , 1992 .

[32]  S. Page,et al.  Blood Glucose Monitoring: Does Technology Help? , 1993, Diabetic medicine : a journal of the British Diabetic Association.

[33]  E. Berner,et al.  COMPUTER-BASED DIAGNOSTIC SYSTEMS. AUTHORS REPLY , 1994 .

[34]  E. Carson,et al.  Situation analysis: needs in diabetes care and existing IT solutions , 1993 .

[35]  L. V. Miller,et al.  More efficient care of diabetic patients in a county-hospital setting. , 1972, The New England journal of medicine.

[36]  F. Pozo,et al.  Telemedicine for diabetes care: the DIABTel approach towards diabetes telecare. , 1996, Medical informatics = Medecine et informatique.

[37]  L. Jovanovic,et al.  The Evaluation of a Pocket Computer as an Aid to Insulin Dose Determination by Patients , 1985, Diabetes Care.

[38]  D. Lieberman,et al.  Educational video game for juvenile diabetes: results of a controlled trial. , 1997, Medical informatics = Medecine et informatique.

[39]  J. Day,et al.  'Learning Diabetes'--a multi-media learning package for patients, carers and professionals to improve chronic disease management. , 1997, Medical informatics = Medecine et informatique.

[40]  I P Coleman,et al.  A computer simulation for learning about the physiological response to exercise. , 1994, The American journal of physiology.

[41]  C. Hessett,et al.  An Evaluation of Diabetes Knowledge Amongst General Practitioners and Senior Medical Students , 1989, Diabetic medicine : a journal of the British Diabetic Association.

[42]  J. Muir-Nash,et al.  Perceived and Actual Level of Knowledge of Diabetes Mellitus Among Nurses , 1989, Diabetes Care.

[43]  E. Salzsieder,et al.  KADIS: model-aided education in type I diabetes. Karlsburg Diabetes Management System. , 1994, Computer methods and programs in biomedicine.

[44]  R. Rubin,et al.  Implications of the DCCT: Looking beyond tight control , 1994, Diabetes Care.

[45]  F. Harvey,et al.  A Role for Computers in Diabetes Care? , 1988, Diabetic medicine : a journal of the British Diabetic Association.

[46]  G. Bolli,et al.  The "dawn phenomenon"--a common occurrence in both non-insulin-dependent and insulin-dependent diabetes mellitus. , 1984, The New England journal of medicine.

[47]  R. DeFronzo,et al.  Synergistic interaction between exercise and insulin on peripheral glucose uptake. , 1981, The Journal of clinical investigation.

[48]  Diabetes and the Number Revolution , 1991, Diabetic medicine : a journal of the British Diabetic Association.

[49]  N C Broering,et al.  Computers as teachers: learning from animations. , 1994, The American journal of physiology.

[50]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[51]  D. Chisholm,et al.  Will computers replace or complement the diabetes educator? , 1992, The Medical journal of Australia.

[52]  E. Carson,et al.  AIDA: an interactive diabetes advisor. , 1994, Computer methods and programs in biomedicine.

[53]  Self‐adjustment of insulin: An educational failure? , 1991 .

[54]  John G. Webster,et al.  Portable Accelerometer Device for Measuring Human Energy Expenditure , 1981, IEEE Transactions on Biomedical Engineering.

[55]  E D Lehmann,et al.  Computer assisted diabetes care: a 6-year retrospective. , 1996, Computer methods and programs in biomedicine.

[56]  J. Benn,et al.  Glucose Turnover in Type I Diabetic Subjects During Exercise: Effect of selective and nonselective β-blockade and insulin withdrawal , 1992, Diabetes Care.

[57]  Albisser Am.  Intelligent instrumentation in diabetic management , 1989 .

[58]  J. Engvall.  Use of Computer-Assisted Instruction in Diabetes Education , 1994, The Diabetes educator.

[59]  D. Singer,et al.  The clinical information value of the glycosylated hemoglobin assay. , 1984, The New England journal of medicine.

[60]  D. Howey,et al.  [Lys(B28), Pro(B29)]-Human Insulin: A Rapidly Absorbed Analogue of Human Insulin , 1994, Diabetes.

[61]  K Piwernetz,et al.  What are computers and models good for? Pros and cons. , 1990, Computer methods and programs in biomedicine.

[62]  A M Albisser,et al.  Compliance in microcomputer-assisted conventional insulin therapy: computer simulation study results. , 1988, The American journal of physiology.

[63]  Knowledge, Attitudes, Technical Competence, and Blood Glucose Control of Type 1 Diabetic Patients During and After an Education Programme , 1990, Diabetic medicine : a journal of the British Diabetic Association.

[64]  M. Levy,et al.  SESAM-DIABETE, an expert system for insulin-requiring diabetic patient education. , 1989, Computers and biomedical research, an international journal.

[65]  R. Holman,et al.  Randomized controlled pilot trial of a hand-held patient-oriented, insulin regimen optimizer. , 1996, Medical informatics = Medecine et informatique.