SESAM-DIABETE
is an interactive educational expert system that provides personalized advice and therapeutic recommendations for insulin-requiring diabetic patients. Because of its sophisticated explanation facilities, this system is intended to complete the more traditional educational tools for diabetic patients. It has been developed using an original essential expert system, namely SESAM, itself implemented in an upper-layer of Lisp, MBX. Its control structure uses a top-down strategy to solve a problem: i.e.. it decomposes the current problem into subproblems easier to solve, this method being recursively applied to each subproblem. All information about patients is kept in a Patient Medical Record. which allows their follow-up. This system is currently available from their home for selected patients through the French telematic network TELETEL and is under clinical evaluation. 0 1989 Academic Press. Inc.
Education of diabetic patients, especially those treated by insulin, is actually considered an essential component of therapeutic action (I, 2). Such programs, aimed to teach self-care skills and behavioral strategies, are associated with a significant improvement of metabolic control of the disease and with a substantial reduction of morbidity and health care costs (3). It has been emphasized that a determinant factor of success lies in the association of continuous teaching and patient compliance (4). In this regard, the traditional approach associates educational programs provided at the hospital with books or videotapes. In order to extend the capability of these programs both in flexibility and in personalization of educational power, SESAM-DIABETE, an expert system, has been developed. As stressed in previous representative works of the domain (57), it appears that SESAM-DIABETE should be an interactive consultant system able to provide patient-customized recommendations with their related justifications and explanations (8). It thus allows the user to follow the corresponding reasoning path (9, 10). SESAM-DIABETE which runs under VAX-VMS operating system is accessible through the French Teletel network with a Minitel, a home terminal which is free and available on request.