The Virtual Model for Diabetes Outcomes -- Archimedes  

Imagine going into a restaurant and you look at the menu and you see your favorite entree, “Barbequed Ribs and a large Baked Potato with a chocolate cake for desert.  Before you order you pull out your palm computer and put the information in and it tells you that if you eat that meal, you will need to exercise for 1 and one half hour to keep your blood sugars in the normal range and if you do not, you increase your risk for blindness over the next couple of years by 26%.  You decide on the salmon with vegetables, which will prolong your life for 12 days, 45 years from now. 

You go to the doctor and the doctor puts all of your information into a software program called “Archimedes”.  Age, disease states, lifestyle, family history, income, medications, and even the doctor’s information gets entered.  Then he asks the computer questions; if I prescribe Pravachol 20mgm and Altace 5mgm, and change the insulin to 20 units at bedtime instead of 12 units, what will be the results?  Can I prevent a heart attack over the next 5, 10 or 20 years?  What can the doctor prescribe and what lifestyle changes does the patient have to make to improve their quality of life over the next couple of years or their lifetime?  That could be eventually what Archimedes will do.

 Recently,  I had the opportunity to talk with Richard Kahn, PhD, Chief Scientific and Medical Officer for the American Diabetes Association about Archimedes and what it could mean for patients with diabetes.

 Clinicians faced with prioritizing therapy for multiple morbidities, e.g., hypertension, dyslipidemia, and hyperglycemia, may soon have assistance sorting out treatment options from a powerful model shown to accurately predict outcomes of various health care interventions.

 Archimedes, developed by the Bio-mathematics Unit of the Management Institute, Kaiser Permanente, has been powered with the results of clinical research and epidemiological studies, such as the Framingham Heart Study.

 These data, in combination with the demographics of simulated members from a virtual health care world, and information about different treatments, progression of diseases, as well as personnel, facilities, and logistics of medical centers, allow users to experiment with different interventions, individually or in combination, and explore the effects on health, logistical, and economic outcomes. 

Archimedes attempts to reproduce biological and clinical events at the level on which clinical management decisions are made. Currently, the program includes complete models of coronary artery disease, congestive heart failure, diabetes, and their interactions.  

Outcomes can be compared with current practices or among proposed treatments. Variables include tests and treatments and changes in the processes that determine how these are delivered; providers, facilities, equipment, and supplies used in disease management; policies and protocols used in every intervention; and all associated costs.  

To see if Archimedes really works, they input data from previously done studies, where they already knew the results to see if Archimedes could predict the same results as the actual study?  As an example, they input the UKPDS study data and then Archimedes was able to predict the change in number of men that would have retinopathy in 10 years, if you lowered the HbA1c from 10 to 7%.   Archimedes came up with the same number as the UKPDS study did, but it didn’t have to enroll 20,000 patients at a cost of millions of dollars. 

The Association and Kaiser are exploring the applications of this program with support from Bristol-Myers Squibb.  Richard Kahn, PhD, Chief Scientific and Medical Officer for the American Diabetes Association, said Archimedes holds great promise for people with diabetes. “For example, we can use this model to determine how many heart attacks could be prevented by lowering average blood glucose levels, or for illustrating to patients how they can reduce their risk of complications by making gradual lifestyle changes.” 

Right now, one of the things that Archimedes is looking at is the Diabetes Prevention Study.  It will take the results of the 3-year study and look at the possible results if it was extended to 10 years without actually doing it for 10 years. 

Don’t bother looking for Archimedes on the software shelf’s soon.  Right now it is too complex and too large to allow it to be put on a CD or a Palm (PDA) and sold.  But, it is just a matter of time when you will be able to see exactly what you can do and at what cost and how much time it will take for you to improve your quality of life. 

 “I hope the insurance companies never find out about this, so please don’t tell anyone, shhhhsh”.

Steve Freed, Publisher

www.diabetesincontrol.com

 

 

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