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
L
D
HS
57 seconds
Design
•
•
•
•
•
•
Clinical
Operational
Integrated
Explanatory
Flexible
Vector graphics
Breakfast
Lunch
Dinner
Bedtime
Breakfast
5R
11 H
25 N
17 L
32 U
5R
11 H
R = Regular
25 N
17 L
32 U
Short-acting
H = Humalog
N = NPH
Intermediate-acting
L = Lente
U = Ultralente
Long-acting
5R
11 H
25 N
R = Regular
17 L
32 U
Short-acting
H = Humalog
N = NPH
Intermediate-acting
L = Lente
U = Ultralente
5 Actrapid
Long-acting
25 Protaphane
16 인슐린
Breakfast
Lunch
Dinner
Bedtime
Breakfast
Lunch
Dinner
Bedtime
Breakfast
6R
Breakfast
15 N
+
4H
200
150
100
50
200
200
200
200
150
150
150
150
100
100
100
100
50
50
50
50
85 m g/dl
40 m g/dl
350 m g/dl
53, 85, 90, 160 m g/dl
200
142
200
150
150
100
100
50
50
200
82
193
232
200
150
150
100
100
50
50
Breakfast
Lunch
Dinner
Bedtime
Breakfast
Bedtime
Breakfast
200
17 L
105
150
100
50
Breakfast
Lunch
Dinner
200
141
25 N
150
100
50
+
198
11 H
200
150
100
50
Breakfast
Lunch
Dinner
Bedtime
Breakfast
200
15 N
122
150
100
50
+
200
6R
150
63
100
50
227
200
150
11 N
100
50
+
200
5R
131
150
100
50
Breakfast
Lunch
Dinner
Bedtime
Breakfast
200
8H
121
150
100
50
200
7H
150
99
100
50
202
7H
200
150
100
50
199
9L
200
150
100
50
Evaluation
1. Selection of test cases
2. Establishment of reference standards
3. Comparison study
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
Type 1
B
L
D
HS
B
D
HS
B
L
D
Type 2
B
Gestational
B
L
D
D
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
Subjects
Session 1
PGY2 and PGY3 Osler
Medicine Residents
Logbook
n = 20
Display
• Recommendations
– Incremental changes in doses
– Changes in frequency of measurement
• Completion times
Session 2
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
Time
*
**
= p < 0.05
= p < 0.01
B
D
HS
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
3:47
B
D
HS
Correct
**
Incorrect
Time
*
**
**
= p < 0.05
= p < 0.01
3:47
1:32
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
B
L
D
HS
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
3:31
*
B
L
D
HS
Correct
**
Incorrect
Time
*
**
**
= p < 0.05
= p < 0.01
3:31
1:30
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
B
D
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
3:08
**
B
D
Correct
**
Incorrect
Time
**
*
**
= p < 0.05
= p < 0.01
3:08
1:19
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
B
L
D
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
4:30
B
L
D
**
Correct
**
Incorrect
Time
*
**
**
= p < 0.05
= p < 0.01
4:30
1:32
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
B
L
D
Correct
Incorrect
Time
*
**
= p < 0.05
= p < 0.01
4:32
**
B
L
D
Correct
**
Incorrect
**
Time
*
**
= p < 0.05
= p < 0.01
4:32
3:11
www.mikim.net/development/bloodglucose.html
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135
Before
Breakfast
After
Lunch
135
Before
Dinner
!!!
Bedtime
!!!
Breakfast