Computer-assisted Insulin Dosage Adjustment
Computer-assisted Insulin Dosage Adjustment
复制标题
计算机辅助胰岛素剂量调整
作者：
A. Schiffrin;M. Mihic;B. Leibel;A. Albisser
我们报告我们的第一次经验，一个新的微处理器设备，以协助个人糖尿病患者在调整胰岛素治疗。该计算机重200 g，可以持续接收、存储和分析患者输入的毛细血管血糖（CBG）数据。根据旨在使餐前CBG水平达到医生设定的任何所需目标值的算法，建议改变短效和中效胰岛素的注射混合物。在本研究中，餐前目标血糖水平设定为110 mg/dl。选择7名年龄在11至43岁之间的（I型）胰岛素依赖性糖尿病个体参与首次使用BCMC（Better Control Medical Computers，Inc.，多伦多，安大略，加拿大）门诊病人的计算机。所有受试者都关注糖尿病控制，并充分了解并全面实践了手动胰岛素剂量调整方案的使用，该方案基于我们糖尿病诊所目前教授的每日104次CBG估计。在自我调节控制期的最后7天，他们的平均± SEM CBG水平（早餐、午餐、晚餐和睡前零食前测量）分别为178 ± 20、187 ± 35、208 ± 22和207 ± 13 mg/dl。在对照期后，立即给予他们该装置，并指导他们输入血糖数据的程序，以及遵循制造商关于胰岛素剂量的建议。实验期为8 wk，结果评价同前。因此，在开始每天使用该仪器8周后，所有血糖值均显著下降（P < 0.005-0.05），接近正常值：分别为116 ± 9、110 ± 6、148 ± 15和135 ± 9 mg/dl。与此同时，主餐前测量的体重变异性也显著降低（P < 0.01）。在这2个月期间，每个受试者的糖化血红蛋白A1分数也下降，该组的平均值从11.7 ± 0.5%下降到9.6 ± 0.3%（P < 0.005）。（正常值上限为9.0%）。生活方式的改变既不必要，也不鼓励。对每名受试者调整了两次混合胰岛素的单独注射剂量，但总体而言，只有早餐时的平均中效胰岛素从28 ± 3 U显著增加到39 ± 5 U（P < 0.05）。实验期结束后，7名患者中的6名立即退回了该装置，随后恢复了与对照期类似的手动剂量调整。在该随访期间，代谢控制恶化，如在所有受试者中的糖化血红蛋白增加所证明的，除了一名保留该装置的受试者，并且其中该糖尿病控制指数在正常范围内的水平保持不变> 18个月。我们从这些研究中得出结论，基于微处理器的设备可以接收、存储和解释患者输入的CBG测量值，并参考这些数据推荐胰岛素治疗的日常变化。在8周的时间内，这些剂量变化明显改善血糖控制。在这方面，平均餐前糖化血红蛋白及其变异性以及糖化血红蛋白分数（代谢控制的所有关键指标）均降低。根据这些发现，似乎计算机的使用可以很好地为糖尿病患者及其医生提供一种新的实用方法，通过直接优化常规胰岛素治疗来显著改善代谢控制。
We report our first experience with a new microprocessor device for assisting individuals with diabetes in the adjustment of insulin therapy. The computer weighs 200 g and can receive, store, and analyze patient-entered capillary blood glucose (CBG) data on an ongoing basis. Changes in the injected mixtures of short- and intermediate-acting insulins are recommended according to algorithms designed to bring the premeal CBG levels to any desired target value set by the physician. Throughout the present study, the premeal target glucose level was set to 110 mg/dl. Seven (type I) insulin-dependent diabetic individuals ranging in age from 11 to 43 yr were selected to participate in the first use of a BCMC (Better Control Medical Computers, Inc., Toronto, Ontario, Canada) computer on an outpatient basis. All subjects were concerned about diabetes control and were fully informed about as well as thoroughly practiced in the use of manual insulin dosage adjustment schemes, based on ≈ 4 times daily CBG estimation, as currently taught in our diabetes clinics. During the last 7 days of the control period of self-adjustment, their mean ± SEM CBG levels (measured before breakfast, lunch, dinner, and bedtime snack) were, respectively, 178 ± 20, 187 ± 35, 208 ± 22, and 207 ± 13 mg/dl. Immediately after the control period they were given the device and were instructed in the procedure for entering glycemic data and following manufacturer's recommendations in regard to insulin dosages. This experimental period lasted 8 wk and the outcome was assessed as before. Thus, 8 wk after starting daily use of the instrument, all glycemic values measured as before had fallen significantly (P < 0.005–0.05) closer to normal: 116 ± 9, 110 ± 6, 148 ± 15, and 135 ± 9 mg/dl, respectively. Concurrently there was also a significant (P < 0.01) reduction in the variability of glycemia measured before the main meals. During this 2-mo interval, glycosylated hemoglobin A1 fractions also fell in each subject and for the group the mean fell from 11.7 ± 0.5% to 9.6 ± 0.3% (P < 0.005). (Upper limit of normal was 9.0%.) Changes in life-style were neither necessary nor encouraged. Individual-injected insulin dosages in the twicedaily mixtures were modified for each subject, but overall for the group, only the mean intermediateacting insulin at breakfast was increased significantly from 28 ± 3 to 39 ± 5 U (P < 0.05). Immediately after the experimental period, the device was returned by 6 of 7 patients, who thereafter reverted to manual-dosage adjustment similar to the control period. During this follow-up period, metabolic control deteriorated, as evidenced by increases in glycosylated hemoglobin in all except the one subject who kept the device and in whom this index of diabetes control has remained unchanged at a level in the normal range for > 18 mo. We conclude from these studies that a microprocessor-based device can receive, store, and interpret patient-entered CBG measurements and in reference to these data recommend day-to-day changes in insulin therapy. Over a period of 8 wk, these dosage changes clearly improved glycemic control. In this regard, reductions occurred in both the mean premeal glycemia and its variability, as well as in the glycosylated hemoglobin fractions, all key indices of metabolic control. In light of these findings, it appears that the use of a computer may well provide both the concerned individual with diabetes mellitus and his physician with a new and practical method for significantly improving metabolic control by directly optimizing conventional insulin therapy.
早晨胰岛素注射部位和时间在 1 型糖尿病中的作用。
DOI：
10.1016/s0022-3476(83)80577-0
发表时间：
1983
期刊：
The Journal of pediatrics
影响因子：
--
作者：
Witt,MF;White,NH;Santiago,JV
通讯作者：
Santiago,JV