STOCHASTIC MODEL OF SELF-REGULATION DECISION MAKING EXEMPLIFIED BY DECISIONS CONCERNING HYPOGLYCEMIA

The following sequence-internal condition --> symptom perception --> appraisal --> decision-models various symptom-based self-regulation processes. A formal mathematical model describes the first three steps by continuous variables and the decisions at the fourth step by binary variables. The stochastic transitions between the sequential steps are quantified by transition probabilities. The model is illustrated by blood glucose level estimation and detection and treatment of hypoglycemia in 78 patients with insulin-dependent diabetes mellitus. These patients made 50 to 70 data collection trials over 3 to 4 weeks recording perceived symptoms, cognitive-motor performance, subjective estimates of blood glucose, decisions about treatment of hypoglycemia, and driving. A statistical estimation of the model's parameters demonstrates the utility of this approach for understanding the awareness, detection, and treatment of hypoglycemia as a process of symptom-based decision making.

[1]  James W. Pennebaker,et al.  The psychology of physical symptoms , 1982 .

[2]  D. Cox,et al.  Perceived Symptoms in the Recognition of Hypoglycemia , 1993, Diabetes Care.

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

[4]  N. Driesen,et al.  Individual Differences in Neurobehavioral Disruption During Mild and Moderate Hypoglycemia in Adults With IDDM , 1994, Diabetes.

[5]  Illness representations and matching labels with symptoms. , 1989 .

[6]  D. Cox,et al.  Long-Term Follow-Up Evaluation of Blood Glucose Awareness Training , 1994, Diabetes Care.

[7]  P. Cryer,et al.  Plasma glucose concentrations at the onset of hypoglycemic symptoms in patients with poorly controlled diabetes and in nondiabetics. , 1988, The New England journal of medicine.

[8]  N. Driesen,et al.  Reliability of Driving Performance During Moderate Hypoglycemia in Adults With IDDM , 1994, Diabetes Care.

[9]  D. Simonson,et al.  Glycemic control and neuropsychologic function during hypoglycemia in patients with insulin-dependent diabetes mellitus. , 1990, Annals of internal medicine.

[10]  F. E. Richards,et al.  Intensive versus standard blood glucose awareness training (BGAT) with insulin‐dependent diabetes: mechanisms and ancillary effects. , 1991, Psychosomatic medicine.

[11]  M. Diefenbach,et al.  The Active Side of Illness Cognition , 1991 .

[12]  George E. P. Box,et al.  Time Series Analysis: Forecasting and Control , 1977 .

[13]  D. Cox,et al.  A Biopsychobehavioral Model of Risk of Severe Hypoglycemia , 1997, Diabetes Care.

[14]  D. Cox,et al.  Behavioral Responses to Perceived Hypoglycemic symptoms , 1986, The Diabetes educator.

[15]  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.

[16]  Gwilym M. Jenkins,et al.  Time series analysis, forecasting and control , 1972 .

[17]  W. Tamborlane,et al.  Effect of Intensive Insulin Therapy on Glycemic Thresholds for Counterregulatory Hormone Release , 1988, Diabetes.