Computer Technology in Insulin Based Therapy of Diabetes

Computer Technology in Insulin Based Therapy of Diabetes Mr. sc. Maja Baretić MD Division of endocrinology Department of Internal medicine University Hospital Zagreb

2000 DIABETES IN THE WORLD patients < 5, 000– 74, 000 75, 000– 349, 000 350, 000– 1, 499, 000 1, 500, 000– 4, 999, 000 Adapted from WHO Diabetes Programme Facts and Figures: > 5, 000 www. who. int/diabetes/facts/world_figures/en. Accessed 1 August, 2006.

2030 PREDICTION patients < 5, 000– 74, 000 75, 000– 349, 000 350, 000– 1, 499, 000 1, 500, 000– 4, 999, 000 Adapted from WHO Diabetes Programme Facts and Figures: > 5, 000 www. who. int/diabetes/facts/world_figures/en. Accessed 1 August, 2006.

Diabetes Mellitus : a group of diseases characterised by high levels of blood glucose resulting from defects in insulin production, insulin action, or both ¨ Consists 2 main types: 1) Type 1 diabetes 2) Type 2 diabetes

Diabetes Mellitus : a group of diseases characterised by high levels of blood glucose resulting from defects in insulin production, insulin action, or both ¨ Consists 2 main types: 1) Type 1 insulin secreting cells destroyed 2) Type 2 diabetes

Diabetes Mellitus : a group of diseases characterised by high levels of blood glucose resulting from defects in insulin production, insulin action, or both ¨ Consists 2 main types: 1) Type 1 insulin secreting cells destroyed 2) Type 2 insufficient insulin action

$Why to treat diabetes mellitus? stroke blindness myocardial infraction kidney failure haemodialysis • In$

Why to treat diabetes mellitus? stroke blindness myocardial infraction kidney failure haemodialysis • In type I acute complication and death gangrene amputation nerve damage

How to treat diabetes? ¨ Insulin is applied subcutaneously ¨ Before application glucose level is measured ¨ Glucose regulation is one of the most sophisticated ones in the body ¨ Impossible to imitate

INFORMATION ¨ What is happening with me today? ¨ How high is the glucose level now? ¨ Am I going to eat a lot? ¨ Is my food going to contain many carbohydrates? ¨ Am I going to perform an exercise and for how long? ¨ How much insulin should I apply? ¨ Which type of insulin should be applied and when? ¨ When is the proper time to measure blood glucose again?

Applications of information technology in clinical diabetes care Lehmann E. D. Application of information technology in clinical diabetes care Part 2. Models and education. Medical Informatics, 1997; 22, (1), 1 -120

Algorithmic-based decision support systems www. nidm. org/Huma. Link/Diabetes/ ¨ provide set of schemes by which patient can adjust a therapeutic insulin routine and achieve the desired glycemic control – fully automated mode, within pre-defined limits – manual’ recording mode

Applications of information technology in clinical diabetes care Lehmann E. D. Application of information technology in clinical diabetes care Part 2. Models and education. Medical Informatics, 1997; 22, (1), 1 -120

Educational tutorials ¨ web sites designed for educational and teaching purposes ¨ AIDA: a freeware diabetes software simulator / modelling program of blood glucose-insulin action + insulin dose & diet adjustment ¨ for education, self-learning & teaching diabetes programmes www. 2 aida. net/welcome

Applications of information technology in clinical diabetes care Lehmann E. D. Application of information technology in clinical diabetes care Part 2. Models and education. Medical Informatics, 1997; 22, (1), 1 -120

Databases ¨ information about diabetic patient accessible locally, regionally and nationally ¨ used for statistics, research and clinical practice ¨ Cro. Diab. NET founded 1997 ¨ firs public health registry where users can input data through www

Databases ¨ information about diabetic patient accessible locally, regionally and nationally ¨ used for statistics, research and clinical practice ¨ Cro. Diab. NET founded 1997 ¨ firs public health registry where users can input data through www ¨ http: //crodiab. continuu m. hr http: //crodiab. continuum. hr

Applications of information technology in clinical diabetes care Lehmann E. D. Application of information technology in clinical diabetes care Part 2. Models and education. Medical Informatics, 1997; 22, (1), 1 -120

Glucose monitoring ¨ Continuous glucose monitoring ¨ tiny sensor inserted under the skin ¨ pricking a fingertip ¨ using a glucose meter that measures the blood sample’s glucose level checks glucose levels ¨ sensor stays in for several days ¨ transmitter sends information about glucose levels via radio waves to wireless monitor

Glucose monitoring ¨ Software systems download data to a computer to see patterns and trends in their glucose levels ¨ Send to a physician by email ¨ Analyse, store

Insulin pump the pump itself: ¨controls ¨processing module disposable infusion set: • short tube with a needle • tubing system ¨batteries reservoir for insulin ¨delivers insulin continuously into the body

Artificial pancreas ¨ Science fiction?

Artificial pancreas ¨ Science fiction? Borg?

Artificial pancreas = insulin pump + continuous glucose monitoring ¨ closed loop system ¨ data from continuous glucose monitoring blood glucose reading every few minutes ¨ sensor is connected via wire to the insulin pump ¨ blood glucose variation is signalling to the pump Friedrich M J. Artificial Pancreas May Soon how much insulin to Be a Reality JAMA. 2009; 301: 1525 -1527 deliver

Telemedicine ¨ medicine at distance ¨ facilitates communication among two or more medical professionals or among medical professional and patient care ¨ Telemedicine on Croatian islands ¨ Croatian Telemedicine Society of the Croatian Medical Association

Telemedicine Croatia-Japan ¨Live TV report ( National Japanese TV) about successful telemedicine activities in cardiology between National Institute of Health, Osaka, Japan and Makarska, Croatia www. mef. hr/telmed-MA 2002

In 1922 a 14 -year-old boy Leonard Thompson, patient with diabetes type 1, was dying from ketoacidosis. He was the first patient who got insulin in therapy. Without insulin he would dye in a few days, but the fact that he lived 13 years more was considered a miracle

“We have data on hand today that suggests that you could get much better diabetes outcomes with the computer taking the lead instead of the person with diabetes doing it all themselves. ” Aaron Kowalski research director of the Juvenile Diabetes Research Foundation's Artificial Pancreas Project