| Objectives: To establish auto-sifting system for the optimal personalized treatment planning and to explore a method and way of establishing the personalized clinical treatment planning thorough clinical epidemiology and the method of evidence-based medicine. Methods: 1. Methods of obtaining clinical data: adopting clinical epidemiology methods, following the ethical norm of clinical study, ascertaining research items, designing questionnaire tables, training research staffs, adopting retrospective studies and investigating hospitalized patients with Type 2 Diabetes of Nanfang Hospital and Zhujiang Hospital of Southern Medical University from 1998 to 2002, whose case history was input and checked by two data input staffs in order to ensure the correctness and wholeness; developing data input tools by establishing clinical data managing system. Each questionnaire was input by two data input staffs and the identifications of two data were compared by the system automatically as so to guarantee the validity and reliability. 2. Pertinent analysis of factors affecting the curative effect: sifting the degree of different factors affecting the curative effect by single-factor analysis; analyzing and sifting sensitive factors affecting the curative effect by multiple-factors logistic regression analysis; establishing formula in order to predict the curative effect. 3. Establishment of the optimal personalized treatment planning sifting system: sifting factors affecting the curative effect of different treatment planning through analyzing different treatment planning by Binary Logistic regressively, taking these personal differences as variables and establishing regression formula so as to achieve the goal of sifting treatment planning according to different personal features before treatment, developing the optimal personalized treatment planning auto-sifting system for Type 2 Diabetes by computer programming technique so as to realize computer assisting optimization for personalized treatment planning for Type 2 Diabetes. 4. Meta analysis of different treatment planning: performing an evidence-based medicine study on the curative effect of the same treatment planning in different treating center in China in order to guarantee universality of research conclusion. Results: 1. Clinical date of 4040 patient which met the condition of selection was surveyed. Among them, 2147 were from Nanfang Hospital (51%), 2063 were from Zhujiang Hospital (49%), 1830 were female (45.52%) and 2190 were male (54.48%). Their ages were 53.45±12.68 years old. The fasting blood glucose of hospital admission was 11.88±5.56 mmol/L, the postprandial blood glucose of hospital admission was 14.61±4.61mmol/L; the fasting blood glucose of discharging was 8.04±5.26mmol/L; the postprandial blood glucose of discharging was 9.49±3.20mmol/L; 2319 patients took oral antidiabetic drugs (57.96%); 2553 patients took insulin (63.51%); 2319 patients took insulin combining with oral antidiabetic drugs (10.37%); 2496 patients had total curative effect (62.09%); 1524 patients had obvious curative effect (37.91%). The distributions of age, gender, native place and medical department showed that objectives of survey had representativeness. Thus, the statistical conclusions were reliable. 2. Analysis of factors affecting the curative effect showed that factors affecting curative effect included the following from the single-factor statistical analysis: fasting blood glucose, postprandial blood glucose, diastolic pressure, DM diet and taking or not taking insulin. Other factors showed no significant differences from the single-facto perspective. After multiple-factors Binary Logistic Regression analysis, fasting blood glucose, postprandial blood glucose, age, BUN and diastolic pressure were chosen. After the chosen factors were classified by regression formula, fasting blood glucose was 62.2%, postprandial blood glucose was 63.04%, age was 63.1%, BUN was 63.1% and diastolic pressure was 63.1%. According to test of validity of regression formula, P=0.000. 3. Through regression analysis of factors affecting the curative effect of different treatment planning, the paper found that fasting blood glucose, postprandial blood glucose, diastolic pressure, age, BUN, HbAlc, whether first time DM or not and BMI were sifted sensitive factors. Different levels of these factors decided the choose of different treatment planning, which included: whether it was necessary to take oral antidiabetic drugs, whether it was necessary to take insulin, whether it was necessary to take hypertensive medicine, whether it was necessary to take medicine to lower blood lipoid and so on. If P＞0.5 in two or more regression formulas, it was necessary to take combined medicine. Thus, personalized treatment for Type 2 Diabetes was achieved. Through computer programming technique, different variables were input and computer brought out the personalized treatment planning automatically and monitored the curative effect. 4.By using Meta analysis to analyze 11 domestic thesis on the curative effect of having insulin pump and having not insulin pump, the paper found that there was significant difference between insulin pump and conventional subcutaneous injection in WMD of the curative effect on fasting blood glucose and blood glucose of 2 h. 95% CI horizontal lines were located in the left side of invalid vertical line, which showed that insulin pump could improve the fasting glucose blood and postprandial blood glucose of patients in a better way. Conclusions: 1. Clinical epidemiology methods combining with modern database technique is an effective research method, which can realize the mass storage and quick searches, actualize the function of data finding, discover new rules and guide the clinical practice. 2. On the basis of grasping mass clinical data, multiple factors regression analysis was adopted to explore related factors to the curative effect and establish regression formula of sensitive factors of different treatment planning so as to sift personalized treatment planning. 3. Modern computer programming technique can be used to perform automatic identification of multiple-factors and to establish personalized treatment planning auto-sifting system assisted by computer. According to personalized parameters of different patients, the optimal treatment planning can be sifted accurately, guidance for clinical medicine can be given and the effective rate can also be predicted. 4. Evidence-based medicine is the development and the application of clinical epidemiology. Meta analysis, which performs a comprehensive and statistical analysis and evaluation of findings of several individual researches with the same objective, can make better use of and develop the existing statistical data. This study makes up the drawbacks of single-time and single-center research by Meta analysis and suggests that there is significant difference between insulin bump and conventional subcutaneous injection in the curative effect. The insulin pump has a better curative effect. 5. Quality control of clinical research is essential. Therefore, it is necessary to adopt multiple ways and different technique in order to improve validity of the research.
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