Performance and control of physiological parameters for diabetes mellitus

糖尿病是一种常见的慢性疾病，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）被诊断患有糖尿病。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（血糖值为11.0 mmol/L）引起的。为了稳定这种情况，口服药物治疗失败的1型或2型糖尿病患者需要外源性胰岛素。目前，最常见的治疗方法是每天测量三到四次毛细血管血糖（CBG），并注射等量的皮下胰岛素。在临床实践中，很难评估某种给药策略是否最佳，甚至更难以评估患者的血糖控制情况。因此，本研究的目的是研究一种旨在优化给药策略的控制算法，并为临床医生和患者提供绩效衡量标准。该项目的新颖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有可能被许多医生用于没有花哨设备的病人护理。这项研究将提供一种量化的方法，向医生和病人展示目前的做法是好是坏。预期的结果是每天或每周对CBG控制的绩效衡量。对于依从性较差的患者，医生将能够建议最低的CBG测试应该是多少，以及哪种剂量策略对特定患者的CBG结果是最佳的。通过这些步骤和结果，本项目的长期目标将通过提高患者的整体依从性和实现更好的血糖控制来实现。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.