Computer Technology in Insulin Based Therapy

of DiabetesMr. sc. Maja Baretić MDDivision of endocrinologyDepartment of Internal medicine University Hospital Zagreb

Adapted from WHO Diabetes Programme Facts and Figures: www.who.int/diabetes/facts/world_figures/en. Accessed 1 August, 2006.

2000 DIABETES IN THE WORLD

patients< 5,0005,000–74,00075,000–349,000350,000–1,499,0001,500,000–4,999,000> 5,000,000

2030 PREDICTION

patients< 5,0005,000–74,00075,000–349,000350,000–1,499,0001,500,000–4,999,000> 5,000,000

Adapted from WHO Diabetes Programme Facts and Figures: 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?

blindness

kidney failurehaemodialysis

stroke

myocardial

gangreneamputation

nerve damage• In type I acute complication and death

infraction

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

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/HumaLink/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

Algorithmic-based decision support systems

www.nidm.org/HumaLink/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

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.2aida.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

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

CroDiabNET 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

CroDiabNET founded 1997

firs public health registry where users can input data through www

http://crodiab.continuum.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

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

checks glucose levels sensor stays in for several days transmitter sends information

about glucose levels via radio waves to wireless monitor

pricking a fingertip using a glucose meter that measures the blood sample’s glucose level

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

delivers insulin continuously into the body

the pump itself: controlsprocessing module

batteries reservoir for

insulin

disposable infusion set:

•short tube with a needle

•tubing system

Artificial pancreas

Science fiction?

Artificial pancreas

Science fiction? Borg?

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 how much insulin to deliver

Friedrich M J. Artificial Pancreas May Soon Be a Reality JAMA. 2009;301:1525-1527

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-MA2002

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