AJP - Endocrinology and Metabolism, Vol 254, Issue 2 E237-E242, Copyright © 1988 by American Physiological Society
Compliance in microcomputer-assisted conventional insulin therapy: computer simulation study results
S. Sozzi, T. Strack, M. Schulz and A. M. Albisser
Biomedical Research Division, Hospital for Sick Children, Toronto, Ontario, Canada.
Compliance in diabetes self-management is a complex issue. It involves the
interdependent daily actions of self-measurement of blood glucose and
adherence to a prescribed schedule of daily activities. This impacts
strongly on lifestyle because it necessitates precise meal timing as well
as control of size and carbohydrate content. We sought to identify how
strongly relaxing the lifestyle constraints per se would impact the ability
to achieve improved metabolic control. To isolate these effects from those
that result from poor measurement compliance, we used a computer simulator
called OMNI et al. Furthermore, to standardize the "clinical" therapy, a
second microprocessor device called an "Insulin Dosage Computer" was used
to adjust insulin doses based on the usual clinical practice of four times
a day precibal blood glucose measurements. Ten type 1 diabetic patients
were stimulated and each followed for 120 simulated days. In each such
subject, the simulation was repeated three times to include three different
levels of lifestyle compliance ranging from excellent to poor. In all three
protocols, starting from a level of poor control of diabetes, mean blood
glucose values were significantly improved without significant differences
after 120 days of computer-simulated treatment. Only the standard
deviations, expressing the fluctuations of blood glucose and hence its
stability, increased with decreasing lifestyle compliance. This computer
simulation predicts that consistent self-monitoring of four blood glucose
values per day is the cornerstone of diabetic self-control and that the use
of these data according to a standardized therapeutic algorithm for insulin
adjustment may successfully stabilize even patients with poor lifestyle
compliance. Clinical studies must follow.
