Intelligent decision support systems for optimised diabetes.
Computers now pervade the field of medicine extensively; one recent innovation is the
development of intelligent decision support systems for inexperienced or non-specialist
pbysicians, or in some cases for use by patients. In this thesis a critical review of computer
systems in medicine, with special reference to decision support systems, is followed by a
detailed description of the development and evaluation of two new, interacting, intelligent
decision support systems in the domain of diabetes.
Since the discovery of insulin in 1922, insulin replacement therapy for the treatment of diabetes
mellitus bas evolved into a complex process; there are many different formulations of insulin
and much more information about the factors which affect patient management (e.g. diet,
exercise and progression of complications) are recognised. Physicians have to decide on the
most appropriate anti-diabetic therapy to prescribe to their patients. Insulin-treated patients also
bave to monitor their blood glucose and decide how much insulin to inject and when to inject iL
In order to help patients determine the most appropriate dose of insulin to take, a simple-to-use,
hand-held decision support system has been developed. Algorithms for insulin adjustment have
been elicited and combined with general rules of therapy to offer advice for every dose. The
utility of the system has been evaluated by clinical trials and simulation studies.
In order to aid physician management, a clinic-based decision support system has also been
developed. The system provides wide-ranging advice on all aspects of diabetes care and
advises an appropriate therapy regimen according to individual patient circumstances.
Decisions advised by the pbysician-related system have been evaluated by a panel of expert
physicians and the system has undergone informal primary evaluation within the clinic setting.
An interesting aspect of both systems is their ability to provide advice even in cases where
information is lacking or uncertain.