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Indian Journal of Medical Informatics. 2007; 2(1): 3 |
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Short CommunicationApplication of the web-based diabetes patient data management system for epidemiological and clinical analysis
Sonali S. Ranade1, Dr. Dileep N. Deobagkar2 and Dr. Deepti Deobagkar3
1 Research Fellow2 Professor 3 Professor & Head Molecular Biology Research Laboratory & Centre for Advanced Studies Department of Zoology, University of Pune, Pune 411007, India. |
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AbstractThe web-based application system developed using Oracle 8 and ASP 3.0, for data management of diabetes patients, was used for epidemiological study and clinical analysis. Interactive, form based web pages were developed for querying the database online. This article describes four examples of application of this system for data analysis of the diabetes patients. Data was extracted from this database system with the help of the query system (SQL) and the study of inheritance pattern of diabetes mellitus in Western Indian population was done by analysing the family history of diabetes patients. Also the correlation of blood glucose and serum cholesterol in type 2 diabetic patients was analysed by querying the database and generating graphs and report which gave the values of fasting glucose and cholesterol of the patients. The reports thus generated were analysed by statistical methods using SPSS software. Study of symptoms of diabetes and prevalence of diabetic complications such as hypertension, ischemic heart, and neuropathy was also done. Thus the application developed to store, update and manage the medical and clinical records of the diabetes patients to assist the healthcare providers, was also applied for population and clinical studies. Key words: diabetes data management system, medical informatics application, patient database |
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Introduction
It is evident that web-based decision support tools have improved the parameters of diabetes care [1] and computerized information systems are now used extensively in clinical care which helps in diabetes management as well as in population studies [2]. Health care services can be electronically delivered for efficient management of diabetes [3]. Diabetes care management in patients can be effectively carried out with the help of computerization [4-6].
Diabetes being a multifactorial disorder, a diabetes patient needs to be monitored for a number of clinical parameters such as blood sugar, cholesterol, insulin, blood pressure; environmental parameters such as stress, diet, exercise etc. The diabetes patient data management system was therefore developed [7] using Oracle 8 and ASP 3.0 (Active Server Pages) to enable efficient management of the voluminous data generated during treating a diabetes patient. With a view that the medical specialist can access the patient data from any geographical location, this system was developed using a web-based approach. This web-enabled software gives the authorised health provider an access to the entire treatment and response history of the patient at a given instance. Thus it takes care of the security issue as accession authority is checked for every web-page for that particular session. This system is form based, menu driven and the data could be entered into the system by filling in the forms e.g. patient's personal details, medical check up details which includes information about the patient's condition, treatment rendered, pathological test details such as blood sugar, urine sugar, lipid profile, routine urine test etc. The system has provision to print the prescription and the pathological test reports which could be given to the patients. The database system is fully searchable through the search options which are developed using SQL (Structured Query Language). Interactive, form based web pages were developed for querying the database online. Figure 2-5 and Figure 7-8; represents the screens for the search pages and their results.
This system thus provides the facility to analyse the stored data with the help of query system by generating reports and graphs with selected parameters. We have made the use of this feature of the system and studied the epidemiological [8] and clinical aspects of a group of diabetes patients. This article describes four examples of the application of the system developed for diabetes patient data management. This system at present holds data of 500 diabetes patients.
This study was carried out with the help of Diabetic Association of India, Pune branch.
Epidemiological Study
This study was carried out in the year 2004-05 and 300 families were included in this study [8]. The data regarding the family history of the diabetes patient was entered into the diabetes patient data management system as and when the patient was interviewed, through the form (Figure 1). Figure 1 shows a part of the form used for entering the personal details of the patient such as name, contact details, family and medical history etc. into the database system.
Reports were generated by querying the database either using the search page or by using SQL. For example, for preparing a report having list of cases where only father was diabetic following query was run:
SELECT P_ID, P_SEX FROM DPATIENT_MASTER WHERE FATHER_DM='Yes' and MOTHER _DM IS NULL
Figure 2 and Figure 3 show the search page and result screen for Incidence of Diabetes.
The various reports generated were as follows:
- Incidence of diabetes in males and females.
- Range of age of onset (e.g. 11 to 20 years, 21 to 30 years) of type 1 and type 2 diabetes for males and females.
- List of cases where only father was diabetic, only mother was diabetic and cases where both the parents were diabetic.
- Number of families with diabetes history, number of families without any history and number of families where history was not known to the patient.
These reports were exported as excel files and statistical analysis was done using t-test, chi square test with the help of SPSS software. The details regarding this study were published in Journal of Association of Physicians of India [8]. The results of this study can be summarised as follows. In case of Type 1 DM 38% patients were males and 62% were females, while 53% Type 2 DM cases were males and 47% were females. Both the parents, when diabetic conferred equal risk of inheriting diabetes in offspring (Chi-square value=1.11 with 1 d.f.). The sex ratio of offspring suffering from diabetes was not influenced when only one of the parents was diabetic. However it was observed that the male offspring were highly susceptible when both parents were diabetic (Chi-square value=4.55 with 1 d.f.). 37% cases of Type 1 DM and 58% cases of Type 2 DM showed family history of the disease. A decrease in age of onset of diabetes was significantly observed with successive generations.
Study of correlation between blood glucose and serum cholesterol
The data of fasting glucose and serum cholesterol level was entered into the diabetes patient data management system through the respective forms. Graphs were generated which showed that with the increase in fasting glucose, there was a corresponding rise in the fasting serum cholesterol level in case of some patients. Reports were generated of the patients who showed a positive correlation and of the patients who did not show any correlation. These reports were exported as excel files and statistical analysis was done using SPSS software as it was done for epidemiological study. 327 type 2 diabetic patients (101 females & 226 males) of age between 40-65 years, were included in this study. 68% of the type 2 diabetic patients (73 females & 149 males) showed a positive correlation between fasting blood glucose and serum cholesterol levels. Pearson's correlation (r) value was determined to be 0.317 (p=0.00). 32% of the diabetic patients (28 females & 77 males) did not show any correlation (r= -0.096, p=0.174) between the glucose and serum cholesterol levels.
Study of complications of diabetes
Diabetes mellitus is associated with various complications such as hypertension, ischemic heart disease, neuropathy, retinopathy, nephropathy and congestive heart failure. We studied the occurrence of these complications in the diabetes patients. Data was entered into the database through the associated diseases form. With help of the search page developed to extract information about the associated diseases and the SQL, we analysed the prevalence of these diabetic complications in the patients. Figure 4 and Figure 5 show the search page and result screen for searching the associated diseases.
In this study, 94 patients were included out of which 90 (56 males & 34 females) were type 2 and 4 were type 1 (2 males & 2 females) diabetes patients. Table 1 summarises the results of this study and Figure 6 gives the percentage of occurrence of the diabetes complications in graphical format.
Thus this study shows that prevalence of hypertension (33%) and ischemic heart (31%) was the most in this sample under investigation.
Study of symptoms of diabetes
Very often, diabetes mellitus goes undiagnosed as many of its symptoms seem to be harmless. However, recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes. We studied the frequency of occurrence of the following symptoms of diabetes in a group of 242 patients of which 31 were type 1 diabetes patients and 211 were type 2 patients:
- Appetite increased/ Appetite decreased
- Weight gain/ Weight Loss
- Frequent urination
- Excessive thirst
The database was queried with help of the search page for symptoms and the SQL; and the analysis was carried out for the occurrence of the above symptoms in the diabetes patients. Figure 7 and Figure 8 show the search page and result screen for searching the symptoms.
233 diabetes patients were included in this study (31 Type 1 DM & 202 Type 2 DM). 5 Type 1 DM patients and 43 Type 2 DM patients did not show any symptoms of the onset of the disorder. Table 2 summarises the results of study of symptoms of diabetes and Figure 9 gives the percentage of incidence of the symptoms of diabetes in graphical format.
From the Figure 9 it can be concluded that frequent urination (36%) was the most common symptom of diabetes observed in this set of population under study.
Conclusion
Thus this system, apart from managing the day to day data of the diabetes patient, can be used for epidemiological and clinical research. It could also find application in the comparison between the patients under similar ailments, drug therapy, biochemical and genetic/familial backgrounds etc. It can be used for a comparative analysis of the diabetes patients involving various criteria such as age of onset, sex, symptoms, type of diabetes and associated diseases. Such study will generate valuable insights into the pattern of disease, response of the patients to medical treatment and will provide prognostic and diagnostic parameters. It can be also used for keeping the follow up of group of patients for selected parameters for a longer duration and generate reports with the help of query system which in turn can be used for further research. It can form a base for pharmaceutical industry in the field of clinical trials. Moreover as the system has the potential to store and retrieve data of a large population, it has application in clinical areas through data mining.
Acknowledgements
We acknowledge the financial support from University Grants Commission and Department of Science and Technology FIST Grant from Government of India, New Delhi. The generous help and support from Dr. Ramesh Godbole and Diabetic Association of India, Pune branch is gratefully acknowledged.
References
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Paper received on 20/10/2007; accepted on 14/11/2007
Correspondence:
Dr. Deepti D. DeobagkarProfessor & Head
Department of Zoology
University of Pune
Pune 411007, India
Email: dddeo AT unipune.ernet.in
Tel: +91 20 25601300
+91 20 25698432
Fax: +91 20 25690617
This Open Access article is available at: http://ijmi.org/index.php/ijmi/article/view/y07i1a2
© 2007 Author(s); licensee Indian Journal of Medical Informatics under Creative Commons Attribution-No Derivative Works 3.0 License .