Intelligent instrumentation in diabetic management.

This presentation describes the problem of insulin-dependent diabetes mellitus and the various approaches to creating intelligent instrumentation for management of this type of diabetes. The article traces closed-loop diabetes control from 1974 to the present. Development and implementation of a microprocessor device aimed at achieving this in a practical sense are described. Accordingly, a chronological description of the earliest devices and their shortcomings is given, focusing on the use of blood glucose sensors and vascular access devices. A description of open-loop diabetes control and alternative systems is presented, highlighting the fundamental limitations of subcutaneously injected or infused insulins. A practical system for optimizing conventional therapy is described, together with its design criteria and the creation of a clinical closed-loop that includes the patient. The system has to deal with the effects of diet and exercise while fulfilling the need for adjusting insulin dosages according to expert intervention. Algorithms for this purpose and a computerized approach based on a portable microprocessor expert system are highlighted.