Performance and control of physiological parameters for diabetes mellitus

糖尿病是一种常见的慢性病，是一个日益严重的公共卫生问题。加拿大的数据(来自加拿大统计局)显示，2001年，4.1%的成年人(12岁及以上的人)被诊断为糖尿病。大多数与糖尿病相关的长期健康问题，如肾病、视网膜病变和神经病变，都是由持续的高血糖(血糖11.0 mmol/L)引起的。因此，为了稳定这种情况，口服药物失败的I型糖尿病患者或II型糖尿病患者需要外源性胰岛素。目前，对他们最常见的医疗治疗建议每天测量三到四次毛细血管血糖(CBG)，并进行等量的皮下胰岛素注射。在临床实践中，很难评估某种剂量策略是否最佳，甚至更难评估患者的血糖控制情况。因此，本研究的目的是探索一种控制算法，旨在优化给药策略，为临床医生和患者提供一种性能衡量标准。本项目的创新之处在于利用先进的建模和控制理论对糖尿病患者的依从性进行绩效评估。这项研究的独特之处在于，它可能被许多医生用于患者护理，而不需要昂贵的设备。这项研究将提供一个量化数据，向医生和患者展示目前的做法是好是坏。预期结果是每日或每周CBG控制的绩效衡量标准。对于已知依从性较差的患者，医生将能够建议最低CBG测试应该是什么，以及对于特定患者的CBG结果，什么剂量策略将是最佳的。通过这些步骤和结果，将通过提高患者的总体依从性和实现更好的血糖控制来实现该项目的长期目标。其影响将是降低糖尿病患者与血管并发症相关的死亡率和发病率。

Diabetes mellitus is a common chronic disease that is an ever-increasing public health issue. Canadian data (from Statistics Canada) shows that in 2001, 4.1% of adults (people 12 years of age and older) were diagnosed with diabetes. Most of the long-term health problems associated with diabetes, such as nephropathy, retinopathy, and neuropathy, result from the sustained hyperglycemia (blood glucose > 11.0 mmol/L).  To stabilize this condition, exogenous insulin is required for Type I diabetics or Type II diabetics who have failed oral medications. Currently, the most common medical treatment for them recommends three to four daily capillary blood glucose (CBG) measurements, and an equivalent number of subcutaneous insulin injections. In clinical practice, it is difficult to assess whether a certain dosing strategy is optimal or not, and even more even to assess how well a patient is doing in his or her glucose control. Therefore, the objective of this research is to investigate a control algorithm that aims at optimizing the dosing strategy and provide a performance measure for clinicians and patients. The novelty of this project is utilizing advanced modeling and control theory in performance assessment of patient compliance for diabetic control. The uniqueness of this research is in its potential use by many physicians for patient care without fancy equipment. This research will provide a quantification to show to both physicians and patients how good or poor the current practice is. The expected outcome is a performance measure for CBG control on a daily or weekly basis. In patients who are known to be poorly compliant, physicians will be able to recommend what the minimum CBG testing should be and what dosing strategy would be optimal for a particular patient's CBG results. Through these steps and results, the long-term objective of this project will be achieved by improving overall patient compliance and achieving better glycemic control. The impact will be in the reduction of mortality and morbidity related to vascular complications for patients with diabetes.