Clinical Assessment of a Computer System for Insulin Dosage Adjustment

Abstract

A computer system has been developed to provide advice on the day-to-day adjustment of carbohydrate intake and insulin regime in the diabetic patient. The prototype is intended to be used as a decision support system by clinical personnel in the context of day-to-day management of insulin-treated diabetic patients. It is designed for use during consultations, as a simulator of patient response following changed insulin and dietary regime and as a system to provide education on planning insulin therapy. Advice is generated by a qualitative knowledge based system which suggests what the next step in improving glycaemic control might be for a given patient, e.g. ‘decrease evening medium-acting insulin’. A clinical model is being developed to allow predictions of the patient’s blood glucose profile to be generated based on these adjustments. Clinical scenarios taken from postgraduate teaching cases have been used to compare the advice given by the computer with that of four independent diabetologists. The results of seven case studies are presented.