Computers and diabetes therapy: key variables and quality of data for clinical decision-making

Approaches to clinical decision-making in diabetes have undergone a revolution over the past decade. Since the introduction of reflectance meters and subsequently the addition of a micro chip to store glucose data, clinical decision-making by both the professional and person with diabetes has significantly changed. The memory-based reflectance meter made it possible to collect, aggregate and interpret self-monitored blood glucose values at a level of reliability and accuracy heretofore impossible to obtain. With the ability to collect self-monitored blood glucose values and transmit these data to micro computers has come the development of different approaches to the interpretation of these data. Innovations, such as the Ambulatory Glucose Profile and the Modal Day permit the expression of blood glucose values as dynamic entities. Using this means of representation, blood glucose over time can be thought of as a measure of change having such properties as variability and oscillation. By viewing blood glucose from this innovative perspective it may be possible to reexamine the relationship between insulin dose and glucose level and thereby improve clinical decision-making.