The Organization and Display of Blood Glucose Measurement

Information

Matthew I. Kim, M.D.

Johns Hopkins University

Division of Endocrinology and Metabolism

Division of Health Sciences Informatics

Data Management Issues• Blood glucose measurements

– Volume– Currency

• Insulin prescriptions– Flux– Decentralization

• Evaluation– Integration– Abstraction

B DL HS

57 seconds

Design• Clinical

• Operational

• Integrated

• Explanatory

• Flexible

• Vector graphics

Breakfast Lunch Dinner Bedtime Breakfast

32 U5 R 25 N 11 H 17 L

Intermediate-acting

Long-acting

Short-actingR

H

N

L

U

= Regular

= Humalog

= Lente

= Ultralente

= NPH

32 U5 R 25 N 11 H 17 L

Intermediate-acting

Long-acting

Short-actingR

H

N

L

U

= Regular

= Humalog

= Lente

= Ultralente

= NPH

16 인슐린 5 Actrapid 25 Protaphane

32 U5 R 25 N 11 H 17 L

Breakfast Lunch Dinner Bedtime Breakfast

6 R

Breakfast Lunch Dinner Bedtime Breakfast

+

15 N

4 H

200

100

50

150

200

100

50

150

200

100

50

150

200

100

50

150

200

100

50

150

85 mg/dl 40 mg/dl 350 mg/dl 53, 85, 90, 160 mg/dl

200

100

50

150142200

100

50

150

193

200

100

50

150

82

200

100

50

150

232

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200

100

50

150105

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+

11 H

200

100

50

150

200

100

50

150

141

198

25 N

17 L

200

100

50

150

+

+

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200

100

50

150

200

100

50

150

200

100

50

150

63

227

122

131

15 N

6 R

11 N

5 R

200

100

50

1501218 H

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200

100

50

150

997 H

200

100

50

150

202

7 H

9 L

200

100

50

150

199

1. Selection of test cases

2. Establishment of reference standards

3. Comparison study

Evaluation

Test cases• Queried IN-TOUCH® Microsoft Access

database – 100 measurements within 90 days– Clustering within pre-meal time blocks– Identified 43 cases

• Reviewed medical records

Test cases• 5 test cases

B L D HS B L D

HSB D B D

B L D

Type 1

Type 2

Gestational

Reference Standards• Logbook views

– 100 contiguous blood glucose measurements

• Insulin prescriptions – Standard terminology

• 5 practicing endocrinologists

• Recommendations– Incremental changes in doses– Changes in frequency of measurement

Reference standards• Accepted

– 4 out of 5 reviewers• 85% - all 5

– Direction of changes in doses– Timing of changes in frequency of measurement

Comparison study

PGY2 and PGY3 Osler Medicine Residents

n = 20

Session 1 Session 2

• Recommendations– Incremental changes in doses– Changes in frequency of measurement

• Completion times

Subjects

Logbook

Display

Comparison study• Responses

– Direction of changes in doses– Timing of changes in frequency of measurement

• Data – Correct responses– Incorrect responses– Completion times

• Analysis– Paired t-test, 2-tailed

Correct

Incorrect

*** = p < 0.05

= p < 0.01

Time

Correct

Incorrect

Time

3:47

HSB D

*** = p < 0.05

= p < 0.01

Correct

Incorrect

Time

3:47 1:32

HSB D

**

*** = p < 0.05

= p < 0.01

**

Correct

Incorrect

*** = p < 0.05

= p < 0.01

Time

Correct

Incorrect

Time

3:31

B L D HS

*** = p < 0.05

= p < 0.01

Correct

Incorrect

Time

3:31 1:30

B L D HS*

**

**

*** = p < 0.05

= p < 0.01

Correct

Incorrect

*** = p < 0.05

= p < 0.01

Time

Correct

Incorrect

3:08

B D

*** = p < 0.05

= p < 0.01

Time

Correct

Incorrect

3:08 1:19

B D**

**

*** = p < 0.05

= p < 0.01

**

Time

Correct

Incorrect

*** = p < 0.05

= p < 0.01

Time

Correct

Incorrect

Time

4:30

B L D

*** = p < 0.05

= p < 0.01

Correct

Incorrect

Time

4:30 1:32

B L D**

**

*** = p < 0.05

= p < 0.01

**

Correct

Incorrect

*** = p < 0.05

= p < 0.01

Time

Correct

Incorrect

Time

4:32

B L D

*** = p < 0.05

= p < 0.01

Correct

Incorrect

Time

4:32 3:11

B L D

**

**

**

*** = p < 0.05

= p < 0.01

www.mikim.net/development/bloodglucose.html

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Before

After

Breakfast

Lunch

Dinner

Bedtime!!!

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Before Breakfast

!!!

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