Dynamic Bayesian networks for prediction of health status and treatment effect in patients with chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the most common blood cancer in adults. The course of CLL and patients' response to treatment are varied. This variability makes it difficult to select the most appropriate treatment regimen and predict the progression of the disease. This work was aimed at developing and validating dynamic Bayesian networks (DBNs) to predict changes of the health status of patients with CLL and progression of the disease over time. Two DBNs were developed and implemented i.e. Health Status Network (HSN) and Treatment Effect Network (TEN). Based on the literature data and expert knowledge we identified relationships linking the most important factors influencing the health status and treatment effects in patients with CLL. The developed networks, and in particular TEN, were able to predict probability of survival in patients with CLL, which was in line with the survival data collected in large medical registries. The networks can be used to personalize the predictions, taking into account a priori knowledge concerning a particular patient with CLL. The proposed approach can serve as a basis for the development of artificial intelligence systems that facilitate the choice of treatment that maximizes the chances of survival in patients with CLL.

Digital Planimetry With a New Adaptive Calibration Procedure Results in Accurate and Precise Wound Area Measurement at Curved Surfaces.

BACKGROUND: The purpose of this study was to determine the accuracy of wound area measurement at a curved surface using a digital planimetry (DP) with the newly proposed adaptive calibration. METHODS: Forty wound shapes were printed and placed at the side surfaces of cylinders with diameters of 9.4 and 6.2 cm. Area measurements were carried out using a commercial device SilhouetteMobile (Aranz, New Zealand) and the planimetric app Planimator. Planimetric area measurements were carried out using 2 one-dimensional calibration markers placed above and below the wound shape. The method of adaptive calibration for DP was described. Reference area values of wound shapes were obtained by pixel counting on digital scans made with an optical scanner. Relative errors (REs) and relative differences (RDs) for area measurements were analyzed. RESULTS: The median of REs for the DP with adaptive calibration (DPwAC) was equal to 0.60% and was significantly smaller than the median for the SilhouetteMobile device (SMD) (2.65%), and significantly smaller than the median for the DP (2.23%). The SD of RDs for the DPwAC of 0.87% was considerably lower than for the SMD (6.45%), and for the DP without adaptive calibration (2.51%). The mean of RDs for the DPwAC (0.082%) was not significantly different from zero, which means that the systematic error was not present for the DPwAC. CONCLUSIONS: The use of the adaptive calibration in DP to measure the areas at curved surface resulted in a significant increase of accuracy and precision, and removal of systematic error. The DPwAC revealed 4.4 times lower error and 7.4 times higher precision of area measurement at curved surfaces than the SMD.

Insulin, but Not Metformin, Supports Wound Healing Process in Rats with Streptozotocin-Induced Diabetes.

PURPOSE: Optimal glycemic control is crucial for proper wound healing in patients with diabetes. However, it is not clear whether other antidiabetic drugs support wound healing in mechanisms different from the normalization of blood glucose control. We assessed the effect of insulin and metformin administration on the wound healing process in rats with streptozotocin-induced diabetes. METHODS: The study was conducted on 200 male Wistar rats with streptozotocin-induced diabetes. In the last phase of the study, 45 rats, with the most stable glucose levels in the range of 350-500 mg/dL, were divided into three groups: group I received human non-protamine insulin subcutaneously (5 IU/kg body mass) once a day, group II received metformin intragastrically (500 mg/kg b.m.), and group III (control) was given saline subcutaneously. After 14 days of antidiabetic treatment, a 2 cm × 2 cm thin layer of skin was cut from each rat's dorsum and a 4 cm disk with a hole in its center was sewn in to stabilize the skin and standardize the healing process. The wound healing process was followed up for 9 days, with assessment every 3 days. Biopsy samples were subjected to hematoxylin and eosin staining and immunohistochemical assays. RESULTS: Analysis of variance revealed significant influence of treatment type (insulin, control, or metformin) on the relative change in wound surface area. The wound healing process in rats treated with insulin was more effective than in the metformin and control groups. Wound tissue samples taken from the insulin-treated animals presented significantly lower levels of inflammatory infiltration. Immunohistochemical assessment showed the greatest density of centers of proliferation Ki-67 in insulin-treated animals. CONCLUSION: These results suggest that an insulin-based treatment is more beneficial than metformin, in terms of accelerating the wound healing process in an animal model of streptozocin-induced diabetes.

Accuracy of Automatic Carbohydrate, Protein, Fat and Calorie Counting Based on Voice Descriptions of Meals in People with Type 1 Diabetes.

The aim of this work was to assess the accuracy of automatic macronutrient and calorie counting based on voice descriptions of meals provided by people with unstable type 1 diabetes using the developed expert system (VoiceDiab) in comparison with reference counting made by a dietitian, and to evaluate the impact of insulin doses recommended by a physician on glycemic control in the study’s participants. We also compared insulin doses calculated using the algorithm implemented in the VoiceDiab system. Meal descriptions were provided by 30 hospitalized patients (mean hemoglobin A1c of 8.4%, i.e., 68 mmol/mol). In 16 subjects, the physician determined insulin boluses based on the data provided by the system, and in 14 subjects, by data provided by the dietitian. On one hand, differences introduced by patients who subjectively described their meals compared to those introduced by the system that used the average characteristics of food products, although statistically significant, were low enough not to have a significant impact on insulin doses automatically calculated by the system. On the other hand, the glycemic control of patients was comparable regardless of whether the physician was using the system-estimated or the reference content of meals to determine insulin doses.

Ways to increase precision and accuracy of wound area measurement using smart devices: Advanced app Planimator.

INTRODUCTION: Wound surface area measurement is important as therapeutic decisions may depend on the change of wound surface area over time. Digital planimetry is a popular technique in wound area measurement. It is accurate and repeatable when calibration is performed with 2 rulers placed at opposite sides of a wound. The aim of the current study was improving accuracy and precision of wound area measurement using capabilities of smart devices. METHODS: The correction of area measurement based on calculated camera tilt angle and the calculation of calibration coefficient of linear dimensions as weighted average were proposed. These and other improvements were applied in the Planimator app for Android, which was then used in the study. Accuracy and precision of the Planimator app were compared to the Visitrak device, the SilhouetteMobile device, the AreaMe software, and to the digital planimetry based on 2-ruler calibration with pictures taken by the smartphone, compact, and D-SLR cameras. Areas of 40 wound shapes of area ranged from 0.14 to 31.72 cm2 were measured with each device. Medians of relative errors (REs) were compared in the accuracy tests and standard deviations (SDs) of relative differences (RDs) were compared in the tests of precision. RESULTS: The median of REs for the Planimator app was not significantly different from the medians of REs for the digital planimetry based on pictures from the compact or D-SLR cameras, but it was significantly lower than the medians of REs for the Visitrak and SilhouetteMobile devices, the AreaMe software and the digital planimetry based on pictures from a smartphone camera. The SD of RDs for the Planimator app was not significantly different from the SDs of RDs for the digital planimetry based on pictures from the compact or D-SLR cameras, but it was significantly lower than the SDs of RDs for the Visitrak and SilhouetteMobile devices, the AreaMe software and the digital planimetry based on pictures from a smartphone camera. The Planimator app installed at a smartphone revealed to be 2-fold more accurate and 1.5-fold more precise than the measurements with using ImageJ software based on pictures taken with the same smartphone. CONCLUSIONS: The Planimator app occurred to have the same accuracy and precision as measurements with digital planimetry with 2-ruler calibration and based on pictures from a compact camera or a D-SLR camera. This app showed better accuracy and precision than the Visitrak and SilhouetteMobile devices, the AreaMe software and the digital planimetry based on pictures from a smartphone camera.

Efficacy of automatic bolus calculator with automatic speech recognition in patients with type 1 diabetes: A randomized cross-over trial.

BACKGROUND: Patients using an insulin pump as part of their diabetes treatment need to calculate insulin bolus doses to compensate for a meal. Some patients do not modify their meal boluses according to changes in the amount and composition of food products in a meal. The lack of correct meal boluses leads to unstable, and therefore harmful, blood glucose levels. The aim of the present study was to test a system supporting bolus determination based on a voice description of a meal. METHODS: The bolus calculator developed (VoiceDiab) consists of a smartphone application and three remote servers for automatic speech recognition, text analysis, and insulin dosage calculation. Forty-four people with type 1 diabetes (T1D) treated with continuous subcutaneous insulin infusion finished the randomized cross-over study. Patients were randomly allocated to the group in which the VoiceDiab system supported bolus calculation or to an unsupported group, in which patients or their caregivers calculated boluses. After a 14-day washout period, patients from the supported group were switched to the unsupported group, whereas those in the unsupported group were switched to the supported group. RESULTS: There was a significant difference between the supported and unsupported groups in the percentage of patients with 2-h postprandial glycemia within the 70-180 mg/dL range (58.6% vs 46.6%, respectively; P = 0.031). CONCLUSIONS: The VoiceDiab system improves postprandial glucose control without increasing the time in hyperglycemia or hypoglycemia. Therefore, it may be useful in the treatment of patients with diabetes on intensive insulin therapy.

The First Use of Bolus Calculator With Speech Analyzer.

BACKGROUND: The insulin therapy in type 1 diabetes involves a wide array of restrictions in patients and their families. One of those is a difficulty in estimation of the insulin dose programmed for each meal. The purpose of the study is an assessment of functionalities related to the expert system VoiceDiab-a calculator of meal boluses. METHODS: The sample group composed of 54 patients, aged 3-52, all suffering from type 1 diabetes, treated with the insulin pump, taking part in the clinics RCT (for adults and a pediatrician), with a randomized allocation to a surveyed group and cross-over. The research methodology was based upon questionnaires and open-ended questions. RESULTS: 40% of respondents recognized the application's usefulness as high (18 of 47), giving it 10 points, and easy to use (70%). Disadvantages of this app comprised lack of some products in the application database (n = 23), troubles with the mobile range ( n = 4), and no option of a manual data input for processing purposes (n = 23). Advantages, that have been mentioned the most frequently included facilitation of measurements (n = 7), enhanced life quality of the patient (n = 8), and a guarantee of prompt and thorough calculations (n = 22). Of the surveyed individuals, 50% reached their diet, while 100% gave a top grade to the application, claiming it had contributed to a more efficient metabolic control. CONCLUSION: The pilot scheme of the expert system VoiceDiab has potential to become an application, facilitating dosing of the meal insulin and improving the comfort and safety of insulin administering. However, it needs to be modified, as mentioned by the users who have tested the system.

A Randomized Controlled Study of an Insulin Dosing Application That Uses Recognition and Meal Bolus Estimations.

BACKGROUND: Throughout the insulin pump therapy, decisions of prandial boluses programming are taken by patients individually a few times every day, and, moreover, this complex process requires numerical skills and knowledge in nutrition components estimation. The aim of the study was to determine the impact of the expert system, supporting the patient's decision on meal bolus programming, on the time in range of diurnal glucose excursion in patients treated with continuous subcutaneous insulin infusion (CSII). METHODS: The crossover, randomized study included 12 adults, aged 19 to 53, with type 1 diabetes mellitus, duration ranging from 7 to 30 years. Patients were educated in complex food counting, including carbohydrate units (CU) and fat-protein units (FPU). Subsequently, they were randomly allocated to the experimental group (A), which used the expert software named VoiceDiab, and the control group (B), using a manual method of meal-bolus estimation. RESULTS: It was found that 66.7% of patients within the A group statistically reported a relevant increase in the percentage (%) of sensor glucose (SG) in range (TIR 70-180 mg/dl), compared to the B group. TIR (median) reached 53.9% in the experimental group (A) versus 44% within the control group (B), P < .05. The average difference in the number of hypoglycemia episodes was not statistically significant (-0.2%, SD 11.6%, P = .93). The daily insulin requirement in both groups was comparable-the average difference in total daily insulin dose between two groups was 0.26 (SD 7.06 IU, P = .9). CONCLUSION: The expert system in meal insulin dosing allows improvement in glucose control without increasing the rates of hypoglycemia or the insulin requirement.

Human endothelial cells hollow fiber membrane bioreactor as a model of the blood vessel for in vitro studies.

Human endothelial cells are used in experimental models for studying in vitro pathophysiological mechanisms of different diseases. We developed an original bioreactor, which can simulate human blood vessel, with capillary polysulfone membranes covered with the human umbilical vein endothelial cells (HUVECs) and we characterized its properties. The elaborated cell seeding and culturing procedures ensured formation of a confluent cell monolayer on the inside surface of capillaries within 24 h of culturing under the shear stress of 6.6 dyn/cm(2). The optimal density of cells to be seeded was 60,000 cells/cm(2). Labeling HUVECs with carboxyfluorescein succinimidyl ester (CFSE) did not influence cells' metabolism. Flow cytometry-based analysis of HUVECs stained with CFSE demonstrated that in a presence of the shear stress cells' proliferation was much inhibited (after 72 h proliferation index was equal to 1.9 and 6.2 for cultures with and without shear stress, respectively) and the monolayer was formed mainly due to migration and spreading of cells that were physiologically elongated in a direction of the flow. Monitoring of cells' metabolism showed that HUVECs cultured in a presence of the shear stress preferred anaerobic metabolism and they consumed 1.5 times more glucose and produced 2.3 times more lactate than the cells cultured under static conditions. Daily von Willebrand factor production by HUVECs was near 2 times higher in a presence of the shear stress. The developed model can be used for at least 3 days in target studies under conditions mimicking the in vivo state more closely than the static HUVEC cultures.

Wound Area Measurement with Digital Planimetry: Improved Accuracy and Precision with Calibration Based on 2 Rulers.

INTRODUCTION: In the treatment of chronic wounds the wound surface area change over time is useful parameter in assessment of the applied therapy plan. The more precise the method of wound area measurement the earlier may be identified and changed inappropriate treatment plan. Digital planimetry may be used in wound area measurement and therapy assessment when it is properly used, but the common problem is the camera lens orientation during the taking of a picture. The camera lens axis should be perpendicular to the wound plane, and if it is not, the measured area differ from the true area. RESULTS: Current study shows that the use of 2 rulers placed in parallel below and above the wound for the calibration increases on average 3.8 times the precision of area measurement in comparison to the measurement with one ruler used for calibration. The proposed procedure of calibration increases also 4 times accuracy of area measurement. It was also showed that wound area range and camera type do not influence the precision of area measurement with digital planimetry based on two ruler calibration, however the measurements based on smartphone camera were significantly less accurate than these based on D-SLR or compact cameras. Area measurement on flat surface was more precise with the digital planimetry with 2 rulers than performed with the Visitrak device, the Silhouette Mobile device or the AreaMe software-based method. CONCLUSION: The calibration in digital planimetry with using 2 rulers remarkably increases precision and accuracy of measurement and therefore should be recommended instead of calibration based on single ruler.

A network meta-analysis of progression free survival and overall survival in first-line treatment of chronic lymphocytic leukemia.

BACKGROUND: A limited evidence exists regarding comparisons of clinical effectiveness of available therapies for first-line treatment of chronic lymphocytic leukemia (CLL). METHODS: We compared available therapies for treatment-naïve, symptomatic CLL regarding progression free survival (PFS) and overall survival (OS) in all the identified random control trials and in subgroups composed of younger/fit and older/unfit patients, using a Bayesian network meta-analysis. RESULTS: In younger/fit patients we obtained median of projected mean PFS of: 19, 26, 31, 43, 51 and 75months for chlorambucil, fludarabine, alemtuzumab, fludarabine with cyclophosphamide (FC), bendamustine and fludarabine with cyclophosphamide and rituximab (FCR), respectively. We noted median OS of: 59, 66, 66, 70months for FC, chlorambucil, FCR and fludarabine, respectively. In older/unfit patients we noted PFS of: 16, 17, 24, 30, 60months for chlorambucil, fludarabine and chlorambucil with ofatumumab (OClb) or rituximab (RClb) or obinutuzumab (GClb), respectively. We obtained median OS of: 44, 58, 59 and 90months for fludarabine, RClb, chlorambucil and GClb, respectively. CONCLUSIONS: Our results suggest that: (1) FCR has higher potential of preventing CLL progression in younger/fit patients over four therapy options, which were subject of previous meta-analysis but also over bendamustine; (2) in these patients FCR does not entail prolonging of OS in comparison with chlorambucil and it is outperformed by fludarabine; (3) in older/unfit patients GClb demonstrates longer projected PFS than all assessed comparators; (4) in this group GClb has also the highest potential of increasing OS.

Validation of a hemoglobin A1c model in patients with type 1 and type 2 diabetes and its use to go beyond the averaged relationship of hemoglobin A1c and mean glucose level.

BACKGROUND: Glycated hemoglobin A1c (HbA1c) has been used as an index of glycemic control in the management, guidance, and clinical trials of diabetic patients for the past 35 years. The aim of this study was to validate the HbA1c model in patients with type 1 and type 2 diabetes and to use it to support interpretation of HbA1c in different clinical situations. METHODS: The HbA1c model was identified in 30 patients (15 with type 1 diabetes and 15 with type 2 diabetes) by estimating the overall glycation rate constant (k), based on results of continuous glucose monitoring. The model was validated by assessing its ability to predict HbA1c changes in cultures of erythrocytes in vitro and to reproduce results of the A1C-Derived Average Glucose (ADAG) study. The model was used to simulate the influence of different glucose profiles on HbA1c. RESULTS: The mean k was equal to 1.296 ± 0.216 × 10(-9) l mmol(-1) s(-1) with no difference between type 1 and type 2 diabetes. The mean coefficient of variation of k was equal to 16.7%. The model predicted HbA1c levels in vitro with a mean absolute difference less than 0.3% (3.3 mmol/mol). It reproduced the linear relationship of HbA1c and mean glucose levels established in the ADAG study. The simulation experiments demonstrated that during periods of unstable glycemic control, glycemic profiles with the same mean glucose might result in much different HbA1c levels. CONCLUSIONS: Patients with type 1 and type 2 diabetes are characterized by the same mean value of k, but there is considerable interindividual variation in the relationship of HbA1c and mean glucose level. Results suggest that reciprocal changes in glycation rate and the life span of erythrocytes exist in a wide range of HbA1c values. Thus, for an average patient with diabetes, no modifications of parameters of the glycation model are required to obtain meaningful HbA1c predictions. Interpreting HbA1c as a measure of the mean glucose is fully justified only in the case of stable glycemia. The model and more frequent tests of HbA1c might be used to decrease ambiguity of interpreting HbA1c in terms of glycemic control.

A new smartphone-based method for wound area measurement.

Proper wound healing can be assessed by monitoring the wound surface area. Its reduction by 10 or 50% should be achieved after 1 or 4 weeks, respectively, from the start of the applied therapy. There are various methods of wound area measurement, which differ in terms of the cost of the devices and their accuracy. This article presents an originally developed method for wound area measurement. It is based on the automatic recognition of the wound contour with a software application running on a smartphone. The wound boundaries have to be traced manually on transparent foil placed over the wound. After taking a picture of the wound outline over a grid of 1 × 1 cm, the AreaMe software calculates the wound area, sends the data to a clinical database using an Internet connection, and creates a graph of the wound area change over time. The accuracy and precision of the new method was assessed and compared with the accuracy and precision of commercial devices: Visitrak and SilhouetteMobile. The comparison was performed using 108 wound shapes that were measured five times with each device, using an optical scanner as a reference device. The accuracy of the new method was evaluated by calculating relative errors and comparing them with relative errors for the Visitrak and the SilhouetteMobile devices. The precision of the new method was determined by calculating the coefficients of variation and comparing them with the coefficients of variation for the Visitrak and the SilhouetteMobile devices. A statistical analysis revealed that the new method was more accurate and more precise than the Visitrak device but less accurate and less precise than the SilhouetteMobile device. Thus, the AreaMe application is a superior alternative to the Visitrak device because it provides not only a more accurate measurement of the wound area but also stores the data for future use by the physician.

Microdialysis monitoring of glucose, lactate, glycerol, and pyruvate in patients with diabetic ketoacidosis.

PURPOSE: The objective was to assess glucose, lactate, glycerol, and pyruvate concentrations in the interstitial fluid of the adipose tissue as well as the glucose relative recovery coefficient in reference to capillary blood (RC) during the first two days of the standard treatment of diabetic ketoacidosis (DKA) in patients with type 1 and type 2 diabetes. MATERIALS AND METHODS: The study group consisted of 19 patients (12 with type 1 diabetes and 7 with type 2 diabetes). The metabolic state of the patients was monitored using the microdialysis technique. The analysis of variance was used to investigate whether the type of diabetes and the duration of treatment influenced the assessed parameters. RESULTS: Concentrations of all the monitored components were stable after the initial 12 h of treatment. Glucose concentration was higher and concentrations of all the other components were lower (p<0.0001) in patients with type 1 diabetes than in patients with type 2 diabetes. Significantly higher RC was observed in patients with type 1 diabetes during the initial 12 h. CONCLUSIONS: The results suggest that the standard treatment of DKA is effective in stabilizing a concentration of the studied metabolic components in the interstitial fluid in patients with type 1 and type 2 diabetes despite differences in the glucose concentration at the beginning of the treatment.

Accuracy and precision of selected wound area measurement methods in diabetic foot ulceration.

AIM: The present study assesses precision and accuracy of four selected methods of wound area measurements in diabetic foot wounds. MATERIALS AND METHODS: The areas of 16 wound shapes were measured using linear measurement with elliptical estimation (Elliptical method), using the Visitrak™ (Smith & Nephew, London, United Kingdom) device, the SilhouetteMobile™ device (ARANZ Medical Ltd., Christchurch, New Zealand), and the TeleDiaFoS system (Nalecz Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland). The actual area of a wound shape was determined with a tested scanner and specifically developed software. Accuracy of the area measurement method was assessed by the relative error (RE), whereas precision was assessed by the coefficient of variation (CV). RESULTS: The overall absolute REs were 13.3%, 6.8%, 2.1%, and 2.3% for the Elliptical method, the Visitrak device, the TeleDiaFoS system, and the SilhouetteMobile device, respectively. The accuracy of the Visitrak device was remarkably reduced for wound areas smaller than 2 cm². The overall CVs were 6.0%, 6.3%, 1.6%, and 3.1% for the Elliptical method, the Visitrak device, the TeleDiaFoS system, and the SilhouetteMobile device, respectively. The precision of the Visitrak device was revealed to be remarkably lower for small wounds (<2 cm²). CONCLUSIONS: The Elliptical method gives overestimation up to 33%; thus, it should not be used in applications where the actual wound area is an important parameter (like the prediction of wound healing). The TeleDiaFoS system and the SilhouetteMobile device showed the best accuracy of all used methods; however, the precision of the TeleDiaFoS system was revealed to be higher than the precision of the SilhouetteMobile device. The accuracy and the precision of the Visitrak device are significantly reduced for wounds smaller than 2 cm².

What we can really expect from telemedicine in intensive diabetes treatment: 10 years later.

During the last 10 years many new telematic systems aiming at support of diabetes treatment have been designed and developed. Most systems that were applied in clinical randomized trials used the classical approach, with data transfers from patients performed usually once every few days. In the few available meta-analyses of these trials, a significant improvement of the mean hemoglobin A1c was demonstrated in patients using telematic systems. However, the magnitude of this improvement in comparison with the control groups was lower than expected. This conclusion was confirmed by results of the IDEATel study involving more than 1,600 patients over a period of 5 years. It might by hypothesized that in some groups of patients continuous telecare with frequent contacts between patients and the care provider during each day should be required. This hypothesis is confirmed by the results of the clinical trials applying real-time diabetes monitoring systems. However, the increased frequency of the data transfers and checkups requires a new model for technology-supported care. The new model should connect together the ubiquitous data transfer with an automatically selected optimal frequency, the automatic assessment of the data coupled with quicker feedback from the decision support system or from the provider, and selection of the optimal time for the patient's face-to-face visit in the clinic. All this new future implementations together with already confirmed advantages of the telematic support, such as the increase of self-confidence of the patient, will hopefully give real benefits for the patients.

Hemoglobin glycation rate constant in non-diabetic Individuals.

The objectives were as follows: (1) estimating mean value of the overall hemoglobin glycation rate constant (k); (2) analyzing inter-individual variability of k; (3) verifying ability of the hemoglobin A1c (HbA1c) formation model to predict changes of HbA1c during red blood cells cultivation in vitro and to reproduce the clinical data. The mean k estimated in a group of 10 non-diabetic subjects was equal to 1.257 ± 0.114 × 10(-9) L mmol(-1) s(-1). The mean k was not affected by a way of estimation of glycemia. The mean k differed less than 20% from values reported earlier and it was almost identical to the mean values calculated on basis of the selected published data. Analysis of variability of k suggests that inter-individual heterogeneity of HbA1c formation is limited or rare. The HbA1c mathematical model was able to predict changes of HbA1c in vitro resulting from different glucose levels and to reproduce a linear relationship of HbA1c and average glucose obtained in the A1C-Derived Average Glucose Study. This study demonstrates that the glycation model with the same k value might be used in majority of individuals as a tool supporting interpretation of HbA1c in different clinical situations.

Area of the diabetic ulcers estimated applying a foot scanner-based home telecare system and three reference methods.

BACKGROUND: Diabetic foot ulcer area is a basic parameter used for monitoring the wound healing and effectiveness of the treatment applied. TeleDiaFoS (developed earlier in collaboration with the Department and Clinic of Gastroenterology and Metabolic Diseases, Medical University of Warsaw, Warsaw, Poland) is one of just a few systems available that make possible monitoring of the wound size remotely based on the foot scans transmitted to the physician from a patient's home. The aim of this study was to compare the diabetic foot ulcer areas measured using TeleDiaFoS with the results obtained using three reference methods. METHODS: The reference measurements were conducted using the elliptical method with a ruler, the wound tracing method and planimetrics with the Visitrak (Smith & Nephew, London, UK) system, and the pattern-coded structured light method with the Silhouette (ARANZ Medical, Christchurch, New Zealand) system. Regression and Bland-Altman analyses were performed. The study group consisted of 23 diabetes patients with plantar foot ulcers. RESULTS: Thirty-three wounds were successfully examined. The measurement method influenced the measured area significantly (P=0.00005). The correlation coefficients between TeleDiaFoS and the ruler, Visitrak, and Silhouette methods were 0.949, 0.985, and 0.987, and the limits of agreement equaled -1.3±5.5 cm(2), -0.4±2.2 cm(2), and -0.6±2.1 cm(2), respectively. The strong linear relationships obtained can be used to convert the wound area measured with TeleDiaFoS to the corresponding value of each of the reference methods. CONCLUSIONS: The results indicate that the wound area of plantar ulcers in diabetes might be monitored effectively using the TeleDiaFoS system based on the foot scans that the patient can produce at home with no assistance of other persons.

A new imaging and data transmitting device for telemonitoring of diabetic foot syndrome patients.

BACKGROUND: Proper healing of ulcers and wounds on the feet of diabetes patients is important in order to prevent amputation. If the wound area reduction during the first 4 weeks of the treatment is not 40% or more, reevaluation of the treatment is necessary. The wound area evaluation is not complicated when the patient stays at a hospital, but when he or she goes home the physician does not have a tool allowing monitoring of the wound area. METHODS AND RESULTS: The aim of the present article is to present a new device able to take a wound picture and send it automatically to the database. This device, called the Patient's Module (PM), is also able to download data from the memories of blood pressure and blood glucose meters and send the data to the database. The PM is able to operate within the TeleDiaFoS system (developed earlier in collaboration with the Department and Clinic of Gastroenterology and Metabolic Diseases, Medical University of Warsaw, Warsaw, Poland) aimed at monitoring of treatment of patients with diabetic foot syndrome. The PM was tested on 10 type 2 diabetes patients during a 3-month period. CONCLUSIONS: The study revealed that the PM can be used as a home telemonitoring device, and the analysis of the data sent from patient's home enables the assessment of wound healing progress, giving the physician the possibility for earlier change of the treatment if the wound area reduction is not satisfactory.