Diabetes Simulators: Ready for Prime Time?
AbstractAnalysis Diabetes Simulators: Ready for Prime Time? DARRELL M. WILSON, M.D. D Irrefutable evidence demonstrates that good glycemic control significantly reduces the risk for developing many of the devastating longterm complications of diabetes. Conversely, limitations inherent in the current methods for providing insulin replacem ent make euglycemia a very dangerous proposition for most type 1 diabetics because of the risk of severe hypoglycemia. Normal beta cells within the pancreas modulate insulin secretion, responding in minutes to small changes in blood glucose concentrations. This tight feedback loop maintains blood glucose concentrations within a narrow range. Current clinical insulin regimes pale in comparison. Patients, and often their families, face a substantial challenge as they tread the narrow path between low- and high-glucose concentrations each day. Using a handful of glucose determinations each day, they must integrate diet and activity with a bewildering array of possible exogenous insulin preparations and doses to forge a reasonable level of glycemic control. Given this complexity, patients and providers alike seek a clear-cut set of rules to guide them to euglycem ia. Given our increasing understanding of physiology and the massive computing capability on our desktops, an algorithm to predict glucose concentrations does not seem,