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
The Organization and Display of Blood Glucose Measurement Information Matthew I. Kim, M.D. Johns Hopkins University Division of Endocrinology and Metabolism.
Dec 22, 2015
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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
Breakfast Lunch Dinner Bedtime Breakfast
200
100
50
150105
Breakfast Lunch Dinner Bedtime Breakfast
+
11 H
200
100
50
150
200
100
50
150
141
198
25 N
17 L
200
100
50
150
+
+
Breakfast Lunch Dinner Bedtime Breakfast
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
Breakfast Lunch Dinner Bedtime Breakfast
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
135
Before
After
Breakfast
Lunch
Dinner
Bedtime!!!
135
Before Breakfast
!!!
135
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