Controlled multicenter study on the effect of computer assistance in intensive insulin therapy of type 1 diabetics

This paper describes the results of a controlled multicenter study on the effect of the computer assistance in the intensive insulin therapy. The patient collective consisted of 50 diabetics, randomly divided in two groups with 25 patients per group. The Multiple Subcutaneous Injection (MSI) group was treated with the usually intensive regimen. The treatment in the Computer Assisted Meal Related Insulin Therapy (CAMIT) group was performed with the aid of a specialized pocket computer. Only in the CAMIT group during the study we observed a significant decrease: in the mean blood glucose (BG) with 1.6+/-0.4 mmol/l (P<0.05), in the BG amplitudes by 1.0+/-0.3 mmol/l (P<0.05), and in the hypoglycemia frequency-from 2.0+/-0.4 to 1.2+/-0.3 (P<0.01) hypoglycemic episodes weekly. The HbA(1) values fell in the MSI group by 3.7+/-3.7% and in the CAMIT group significantly by 15.6+/-2.2% (P<0.05). Consequently, the computer-assisted intensive insulin therapy resulted in an improved metabolic control.

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

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

[3]  R. Renner,et al.  Telemedical care reduces hypoglycemias and improves glycemic control in children and adolescents with type 1 diabetes. , 2000, Diabetes technology & therapeutics.

[4]  A. M. Albisser,et al.  Insulin dosage adjustment using manual methods and computer algorithms: A comparative study , 2006, Medical and Biological Engineering and Computing.

[5]  G Perriello,et al.  Impact of activated glucose counterregulation on insulin requirements in insulin-dependent diabetes mellitus. , 1990, Hormone and metabolic research. Supplement series.

[6]  G. Bolli,et al.  Insulin analogues and their potential in the management of diabetes mellitus , 1999, Diabetologia.

[7]  P. Cryer,et al.  Glucose counterregulation and waning of insulin in the Somogyi phenomenon (posthypoglycemic hyperglycemia). , 1984, The New England journal of medicine.

[8]  Norman Fleischer,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. , 1993 .

[9]  C. Christiansen,et al.  Practical clinical value of the C-peptide response to glucagon stimulation in the choice of treatment in diabetes mellitus. , 2009, Acta medica Scandinavica.

[10]  J. Skyler,et al.  Optimizing Pumped Insulin Delivery , 1982, Diabetes Care.

[11]  J A Waterhouse,et al.  Letter: Incidence of childhood leukaemia. , 1973, Lancet.

[12]  I. Mincu,et al.  Evaluation of an intensified insulin treatment and teaching programme as routine management of Type 1 (insulin-dependent) diabetes , 1987, Diabetologia.

[13]  J. Beyer,et al.  The influence of different generations of computer algorithms on diabetes control. , 1990, Computer methods and programs in biomedicine.

[14]  W. Duckworth,et al.  Genetically engineered insulin analogs: diabetes in the new millenium. , 2000, Pharmacological reviews.

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

[16]  D. Rodbard,et al.  Personal Computer Programs to Assist with Self-Monitoring of Blood Glucose and Self-Adjustment of Insulin Dosage , 1986, Diabetes Care.

[17]  Torsten Deckert,et al.  EFFECT OF TWO YEARS OF STRICT METABOLIC CONTROL ON PROGRESSION OF INCIPIENT NEPHROPATHY IN INSULIN-DEPENDENT DIABETES , 1986, The Lancet.

[18]  G. Tchobroutsky,et al.  Relation of diabetic control to development of microvascular complications , 1978, Diabetologia.

[19]  E. Ritz,et al.  Blood pressure and metabolic control as risk factors for nephropathy in Type 1 (insulin-dependent) diabetes , 2004, Diabetologia.

[20]  L. Rand,et al.  Multiple factors in the prediction of risk of proliferative diabetic retinopathy. , 1985, The New England journal of medicine.

[21]  O. Faber,et al.  C-peptide Response to Glucagon: A Test for the Residual β-cell Function in Diabetes Mellitus , 1977, Diabetes.

[22]  S Andreassen,et al.  DIAS--the diabetes advisory system: an outline of the system and the evaluation results obtained so far. , 1997, Computer methods and programs in biomedicine.

[23]  S. Nelson,et al.  Relationship of Microvascular Disease in Diabetes to Metabolic Control , 1977, Diabetes.

[24]  K. Dahl-Jørgensen,et al.  Diabetic control and microvascular complications: The near-normoglycaemic experience , 1986, Diabetologia.

[25]  J Beyer,et al.  Computer assisted insulin dosage adjustment--perspectives for diabetes control. , 1990, Hormone and metabolic research. Supplement series.

[26]  S Andreassen,et al.  Using a double blind controlled clinical trial to evaluate the function of a Diabetes Advisory System: a feasible approach? , 1998, Computer methods and programs in biomedicine.

[27]  T Brismar,et al.  Reversible diabetic nerve dysfunction: Structural correlates to electrophysiological abnormalities , 1985, Annals of neurology.

[28]  W. F. Taylor,et al.  Mean Amplitude of Glycemic Excursions, a Measure of Diabetic Instability , 1970, Diabetes.

[29]  Kroccollaborativestudygroup.  Blood glucose control and the evolution of diabetic retinopathy and albuminuria. A preliminary multicenter trial. , 1984, The New England journal of medicine.

[30]  J. R. Daube,et al.  Near normoglycaemia improved nerve conduction and vibration sensation in diabetic neuropathy , 1985, Diabetologia.

[31]  S. A. Kumar,et al.  REVERSAL OF DIABETIC NEPHROPATHY IN HUMAN CADAVERIC KIDNEYS AFTER TRANSPLANTATION INTO NON-DIABETIC RECIPIENTS , 1983, The Lancet.

[32]  E. Gale,et al.  A randomized, controlled trial comparing insulin lispro with human soluble insulin in patients with Type 1 diabetes on intensified insulin therapy. The UK Trial Group. , 2000, Diabetic medicine : a journal of the British Diabetic Association.

[33]  E R Carson,et al.  Preliminary experience of the DIAS computer model in providing insulin dose advice to patients with insulin dependent diabetes. , 1998, Computer methods and programs in biomedicine.

[34]  P. Raskin,et al.  Effect of glycemic control on microvascular complications in patients with type I diabetes mellitus. , 1986, The American journal of medicine.

[35]  Steen Andreassen,et al.  Insulin dose adjustment of type I diabetics by the DIAS decision support system , 2000 .

[36]  J. Skyler,et al.  Algorithms for Adjustment of Insulin Dosage by Patients Who Monitor Blood Glucose , 1981, Diabetes Care.

[37]  P. Cryer,et al.  Pathogenesis of the dawn phenomenon in patients with insulin-dependent diabetes mellitus. Accelerated glucose production and impaired glucose utilization due to nocturnal surges in growth hormone secretion. , 1985, The New England journal of medicine.

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

[39]  H. Keen,et al.  Glycaemia, arterial pressure and micro-albuminuria in Type 1 (insulin-dependent) diabetes mellitus , 1984, Diabetologia.

[40]  J Beyer,et al.  Controlled study on the use of hand-held insulin dosage computers enabling conversion to and optimizing of meal-related insulin therapy regimens. , 1985, Life support systems : the journal of the European Society for Artificial Organs.

[41]  K Irjala,et al.  C-peptide determination in the choice of treatment in diabetes mellitus. , 1985, Scandinavian journal of clinical and laboratory investigation.

[42]  J. Beyer,et al.  Use of Computer Systems in Treatment of Insulin-Dependent Diabetics , 1990 .