Diabetes management software

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Example 1: An electronic logbook that can collect and manage data from multiple sources Logbook 1.JPG
Example 1: An electronic logbook that can collect and manage data from multiple sources
Example 2: Data plots of blood glucose readings useful to analyze patterns and improve insulin delivery Standard day data plot 1.JPG
Example 2: Data plots of blood glucose readings useful to analyze patterns and improve insulin delivery
Example 3: Charts prepared to look for patterns and improve insulin delivery Trend analysis 1.JPG
Example 3: Charts prepared to look for patterns and improve insulin delivery
Example 4: A summary of a "pumping day" including total insulin delivered and blood glucose testing statistics Pumping day 1.JPG
Example 4: A summary of a "pumping day" including total insulin delivered and blood glucose testing statistics
Example 7: A plot utilizing data from a continuous glucose monitoring system. Continuous glucose monitoring.png
Example 7: A plot utilizing data from a continuous glucose monitoring system.
Example 8. Blood Glucose Prediction trace without CGM, utilizing data from a blood glucose meter, insulin and carb intake Blood Glucose Prediction trace without CGM.png
Example 8. Blood Glucose Prediction trace without CGM, utilizing data from a blood glucose meter, insulin and carb intake

Diabetes Management Software refers to software tools that run on personal computers and personal digital assistants to help persons with Type 1 and Type 2 diabetes manage the data associated with:

Contents

Features and uses

Conducting regular self-management tasks such as medication and insulin intake, blood sugar checkup, diet observance, and physical exercise are really demanding. [1] This is why the use of diabetes-related apps for the purposes of recording diet and medication intake or blood glucose level is promising to improve the health condition for the patients. [2] There are many products available to help maintain records and analyze trends related to diabetes care. Some support a single diabetes tool such as one manufacturers glucose meter, [3] while others are intended to interface with many manufacturers products. [4] Some diabetes management software is free to download or can be used on-line, while others are for sale (or shareware). Some are simple and easy to use for a single user, while others have very powerful features that support many users in a clinical setting. [5] The emergence of user-friendly mobile devices has resulted in renewed interest in diabetes mobile applications, and there is a 2011 review article of the currently available features compared against evidence-based recommendations for diabetes self-management. [6]

Depending on the product selected, there are a variety of features [7] which include:

Examples

Logbook

Example 1 shows a logbook can combine readings from multiple meters (such as one at home and another at work or school) in one place. Breakfast, lunch, and dinner readings are lined up vertically to help look for trends. The logbook automatically colors the box red for a low blood sugar, and blue for a high blood sugar. In the example chart, a pattern is easy to visualize: mornings tend to be a bit high (more insulin is needed at night) and there is a pattern of lows occurring after dinner (perhaps dinner insulin or the afternoon basal rates could be turned down).

Standard day data plots

The Standard day data plots, see example 2, shows that trends are easy to see. The blood glucose readings are plotted at their level versus the time of day. Multiple days are plotted on top of each other, creating a scatter of points. In the example shown, it is easy to see the glycemic excursions to high blood sugars following breakfast and lunch. Once identified, this can be improved by using a faster acting insulin, or injecting insulin 20 minutes before eating, or by selecting carbohydrates to eat that are slower to peak in the bloodstream.

Pie charts

Example 3 shows that pie charts are a quick way to judge performance of insulin doses throughout the day relative to the goal of keeping 75% of premeal blood glucose readings within boundaries. Sub-charts automatically break down to breakfast, lunch, dinner, and late night, as well as show pre-meal versus post-meal statistics. In the example pie chart shown, it appears there is an opportunity to improve morning lows and afternoon highs with insulin adjustments.

Daily views

Example 4 evaluates the delivery from an insulin pump, showing blood glucose plots along the top, carbohydrates eaten (bubbles in the middle of the chart), basal and bolus insulin delivered at the bottom. This is a good example of the flexibility in lifestyle afforded to an insulin pump user as carbohydrates are not "scheduled" to match insulin profiles, and yet the glycemic excursions are well controlled. In this chart, it is also easy to see that the pump user had a meal at 3pm but forgot to test blood glucose beforehand.

Basal pattern control

Example 5 shows a control screen for basal delivery from an insulin pump. Time of day and basal rate in units per hour can be modified to create a custom basal rate pattern to match the insulin needs of the pump user. Icons are shown which save or read data from the PC, or to upload and download it from the pump.

Bolus control

Example 6 shows bolus control on this screen. The insulin to carbohydrate ratio is stored in the pump as a function of the meal eaten (time of day). This screen selects grams of carbohydrate as the input parameter from the user, such that the pump can calculate the insulin bolus desired from the grams entered and the insulin to carb ratio that is stored.

CGMS

Example 7 shows a data plot from a continuous glucose monitoring system (CGMS). This plot shows the blood sugar levels between meals and also during the night, when other BG testing methods using a finger prick sample would typically miss the data available between samples. CGMS data is a new technology that it intended to give immediate feedback between finger sticks and also predict (by extrapolation) what may be happening soon to give the diabetic person a chance to correct a high or low blood sugar condition before it becomes urgent. This curve also illustrates the dawn effect.

Prediction

Example 8 shows a data plot from a continuous glucose prediction system (CGPS). This plot shows the blood sugar levels between meals and also during the night, when other BG testing methods using a finger prick sample would typically miss the data available between samples. CGPS is a new technology that it intended to give immediate feedback between finger sticks and also predict what may be happening soon to give the person with diabetes a chance to correct a high or low blood sugar condition before it becomes urgent.

Globally, an estimated 422 million adults are living with diabetes mellitus, according to the latest 2016 data from the World Health Organization (WHO). Diabetes prevalence is increasing rapidly; previous 2013 estimates from the International Diabetes Federation put the number at 381 million people having diabetes. The number is projected to almost double by 2030. Type 2 diabetes makes up about 85-90% of all cases. Increases in the overall diabetes prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight. Diabetes mellitus occurs throughout the world, but is more common is type 2 diabetes in the more developed countries. The greatest increase in prevalence is, however, occurring in low and middle-income countries including in Asia and Africa, where most patients will probably be found by 2030. The increase in incidence in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the Western pattern diet). The risk of getting type 2 diabetes has been widely found to be associated with lower socio-economic position across countries. The WHO estimates that diabetes resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death. However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of associated complications (e.g. heart disease, stroke, kidney failure), which often result in premature death and are often listed as the underlying cause on death certificates rather than diabetes. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. Diabetes prevalence has been rising more rapidly in middle and low-income countries. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose. Half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will be the 7th leading cause of death in 2030 . Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes. Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications. Epidemiologic patterns of T1D by demographic, geographic, biologic, cultural and other factors in populations are presented to gain insight about the etiology, natural history, risks, and complications of T1D. Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2–5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the US by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. While significant advances have been made in the clinical care of T1D with resultant improvements in quality of life and clinical outcomes, much more needs to be done to improve care of, and ultimately find a cure for T1D. Epidemiologic studies have an important on-going role to investigate the complex causes, clinical care, prevention, and cure of T1D.

Related Research Articles

<span class="mw-page-title-main">Hypoglycemia</span> Health condition

Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose below 70 mg/dL (3.9 mmol/L), symptoms associated with hypoglycemia, and resolution of symptoms when blood sugar returns to normal. Hypoglycemia may result in headache, tiredness, clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness, nervousness, hunger, loss of consciousness, seizures, or death. Symptoms typically come on quickly.

<span class="mw-page-title-main">Insulin pump</span> Medical device to administer insulin

An insulin pump is a medical device used for the administration of insulin in the treatment of diabetes mellitus, also known as continuous subcutaneous insulin therapy. The device configuration may vary depending on design. A traditional pump includes:

Intensive insulin therapy or flexible insulin therapy is a therapeutic regimen for diabetes mellitus treatment. This newer approach contrasts with conventional insulin therapy. Rather than minimize the number of insulin injections per day, the intensive approach favors flexible meal times with variable carbohydrate as well as flexible physical activities. The trade-off is the increase from 2 or 3 injections per day to 4 or more injections per day, which was considered "intensive" relative to the older approach. In North America in 2004, many endocrinologists prefer the term "flexible insulin therapy" (FIT) to "intensive therapy" and use it to refer to any method of replacing insulin that attempts to mimic the pattern of small continuous basal insulin secretion of a working pancreas combined with larger insulin secretions at mealtimes. The semantic distinction reflects changing treatment.

The following is a glossary of diabetes which explains terms connected with diabetes.

Basal rate, in biology, is the rate of continuous supply of some chemical or process. In the case of diabetes mellitus, it is a low rate of continuous insulin supply needed for such purposes as controlling cellular glucose and amino acid uptake.

<span class="mw-page-title-main">Blood sugar level</span> Concentration of glucose present in the blood (Glycaemia)

The blood sugar level, blood sugar concentration, blood glucose level, or glycemia, is the measure of glucose concentrated in the blood. The body tightly regulates blood glucose levels as a part of metabolic homeostasis.

<span class="mw-page-title-main">Glycemic index</span> Number assigned to food

The glycemic (glycaemic) index is a number from 0 to 100 assigned to a food, with pure glucose arbitrarily given the value of 100, which represents the relative rise in the blood glucose level two hours after consuming that food. The GI of a specific food depends primarily on the quantity and type of carbohydrate it contains, but is also affected by the amount of entrapment of the carbohydrate molecules within the food, the fat and protein content of the food, the amount of organic acids in the food, and whether it is cooked and, if so, how it is cooked. GI tables, which list many types of foods and their GIs, are available. A food is considered to have a low GI if it is 55 or less; high GI if 70 or more; and mid-range GI if 56 to 69.

The glycemic load (GL) of food is a number that estimates how much the food will raise a person's blood glucose level after it is eaten. One unit of glycemic load approximates the effect of eating one gram of glucose. Glycemic load accounts for how much carbohydrate is in the food and how much each gram of carbohydrate in the food raises blood glucose levels. Glycemic load is based on the glycemic index (GI), and is calculated by multiplying the weight of available carbohydrate in the food (in grams) by the food's glycemic index, and then dividing by 100.

Diabetes is a chronic disease in cats whereby either insufficient insulin response or insulin resistance leads to persistently high blood glucose concentrations. Diabetes affects up to 1 in 230 cats, and may be becoming increasingly common. Diabetes is less common in cats than in dogs. The condition is treatable, and if treated properly the cat can experience a normal life expectancy. In cats with type 2 diabetes, prompt effective treatment may lead to diabetic remission, in which the cat no longer needs injected insulin. Untreated, the condition leads to increasingly weak legs in cats and eventually to malnutrition, ketoacidosis and/or dehydration, and death.

<span class="mw-page-title-main">Reactive hypoglycemia</span> Medical condition

Reactive hypoglycemia, postprandial hypoglycemia, or sugar crash is a term describing recurrent episodes of symptomatic hypoglycemia occurring within four hours after a high carbohydrate meal in people with and without diabetes. The term is not necessarily a diagnosis since it requires an evaluation to determine the cause of the hypoglycemia.

<span class="mw-page-title-main">Type 1 diabetes</span> Form of diabetes mellitus

Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar for energy and it helps regulate glucose levels in the bloodstream. Before treatment this results in high blood sugar levels in the body. The common symptoms of this elevated blood sugar are frequent urination, increased thirst, increased hunger, weight loss, and other serious complications. Additional symptoms may include blurry vision, tiredness, and slow wound healing. Symptoms typically develop over a short period of time, often a matter of weeks if not months.

The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentrations of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity-onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

<span class="mw-page-title-main">Diabetes and pregnancy</span> Effects of pre-existing diabetes upon pregnancy

For pregnant women with diabetes, some particular challenges exist for both mother and fetus. If the pregnant woman has diabetes as a pre-existing disorder, it can cause early labor, birth defects, and larger than average infants. Therefore, experts advise diabetics to maintain blood sugar level close to normal range about 3 months before planning for pregnancy.

Alpha-glucosidase inhibitors (AGIs) are oral anti-diabetic drugs used for diabetes mellitus type 2 that work by preventing the digestion of carbohydrates. Carbohydrates are normally converted into simple sugars (monosaccharides) by alpha-glucosidase enzymes present on cells lining the intestine, enabling monosaccharides to be absorbed through the intestine. Hence, alpha-glucosidase inhibitors reduce the impact of dietary carbohydrates on blood sugar.

Automated insulin delivery systems are automated systems designed to assist people with insulin-requiring diabetes, by automatically adjusting insulin delivery in response to blood glucose levels. Currently available systems can only deliver a single hormone—insulin. Other systems currently in development aim to improve on current systems by adding one or more additional hormones that can be delivered as needed, providing something closer to the endocrine functionality of the pancreas.

A diabetic diet is a diet that is used by people with diabetes mellitus or high blood sugar to minimize symptoms and dangerous complications of long-term elevations in blood sugar.

<span class="mw-page-title-main">Insulin (medication)</span> Use of insulin protein and analogs as medical treatment

As a medication, insulin is any pharmaceutical preparation of the protein hormone insulin that is used to treat high blood glucose. Such conditions include type 1 diabetes, type 2 diabetes, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. Insulin is also used along with glucose to treat hyperkalemia. Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle. There are various types of insulin, suitable for various time spans. The types are often all called insulin in the broad sense, although in a more precise sense, insulin is identical to the naturally occurring molecule whereas insulin analogues have slightly different molecules that allow for modified time of action. It is on the World Health Organization's List of Essential Medicines. In 2020, regular human insulin was the 307th most commonly prescribed medication in the United States, with more than 1 million prescriptions.

Sleep is important in regulating metabolism. Mammalian sleep can be sub-divided into two distinct phases - REM and non-REM (NREM) sleep. In humans and cats, NREM sleep has four stages, where the third and fourth stages are considered slow-wave sleep (SWS). SWS is considered deep sleep, when metabolism is least active.

<span class="mw-page-title-main">Diabetes</span> Group of endocrine diseases characterized by high blood sugar levels

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Untreated or poorly treated diabetes accounts for approximately 1.5 million deaths every year.

Carbohydrate counting or “carb” counting is a meal planning tool used in diabetes management to help optimize blood sugar control. It can be used with or without the use of insulin therapy. Carbohydrate counting involves determining whether a food item has carbohydrate followed by the subsequent determination of how much carbohydrate the food item has in it.

References

  1. Hood, Megan; Wilson, Rebecca; Corsica, Joyce; Bradley, Lauren; Chirinos, Diana; Vivo, Amanda (December 2016). "What do we know about mobile applications for diabetes self-management? A review of reviews". Journal of Behavioral Medicine. 39 (6): 981–994. doi:10.1007/s10865-016-9765-3. ISSN   0160-7715. PMID   27412774. S2CID   29465893.
  2. Fu, Helen NC; Adam, Terrence J; Konstan, Joseph A; Wolfson, Julian A; Clancy, Thomas R; Wyman, Jean F (2019-04-30). "Influence of Patient Characteristics and Psychological Needs on Diabetes Mobile App Usability in Adults With Type 1 or Type 2 Diabetes: Crossover Randomized Trial". JMIR Diabetes. 4 (2): e11462. doi: 10.2196/11462 . ISSN   2371-4379. PMC   6660121 . PMID   31038468.
  3. CoPilot Health Management System Archived 2011-01-22 at the Wayback Machine by Abbott Diabetes Care will download from any of their FreeStyle and Precision meters.
  4. Diabetes Partner — online diabetes management system supported by NuMedics
  5. CliniPro — administrative and clinical suite, featuring multiple diabetes management modules.
  6. Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. (2011). Features of mobile diabetes applications J Med Internet Res.;13(3):e65. PMID   21979293
  7. Diabetes Logbooks for Adults and Kids. http://www.thediabetescouncil.com/diabetes-logbook-for-adults-kids/