Case-Based Decision Support for Patients with Type 1 Diabetes on Insulin Pump Therapy

This paper presents a case-based approach to decision support for diabetes management in patients with Type 1 diabetes on insulin pump therapy. To avoid serious disease complications, including heart attack, blindness and stroke, these patients must continuously monitor their blood glucose levels and keep them as close to normal as possible. Achieving and maintaining good blood glucose control is a difficult task for these patients and their health care providers. A prototypical case-based decision support system was built to assist with this task. A clinical research study, involving 20 patients, yielded 50 cases of actual problems in blood glucose control, with their associated therapeutic adjustments and clinical outcomes, for the prototype's case base. The prototype operates by: (1) detecting problems in blood glucose control in large quantities of patient blood glucose and life event data; (2) finding similar past problems in the case base; and (3) offering the associated therapeutic adjustments stored in the case base to the physician as decision support. Results from structured evaluation sessions and a patient feedback survey encourage continued research and work towards a practical tool for diabetes management.

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