📖 Clinical Manual & User Guide
Diabot Clinical User Guide
Step-by-step clinical workflows, parameter thresholds, and safety rules for physicians.
1. Continuous Physician Consultation (`/assistant`)
The Consultation Engine acts as an AI Endocrinology Fellow providing doctor-to-doctor clinical guidance grounded in published ADA 2024, KDIGO 2022, RSSDI 2022, and ICMR guidelines.
How to Use:
- Initial Query: Type complex scenarios (e.g. "64yo male with eGFR 38, HbA1c 8.8%, and ASCVD. What is the pharmacotherapy strategy?") or click any preset chip.
- Multi-Turn Continuity: Ask follow-up questions without restarting (e.g. "What if eGFR drops to 24?" or "How should I titrate Ozempic weekly?").
- Structure of Responses: Every consultation note provides Indications → Renal Dosing Matrix → Landmark Trial Evidence (FLOW, SUSTAIN-6, DAPA-CKD) → Contraindications → Exact PDF Page Citations.
2. Cardiorenal Patient Phenotyper (`/phenotyper`)
Evaluates multi-morbid patients and generates personalized HbA1c targets and KDIGO renal matrices.
| KDIGO eGFR Stage | eGFR Range | Metformin Mandatory Action | SGLT2 Inhibitor Action |
|---|---|---|---|
| G1 / G2 | ≥ 60 mL/min | Full dose up to 2,000–2,550 mg/day (Annual check) | Cardiorenal protection if ASCVD / CKD |
| G3a | 45–59 mL/min | Standard dose up to 2,000 mg/day (Monitor q3–6m) | Strongly recommended (DAPA-CKD / EMPA) |
| G3b | 30–44 mL/min | MANDATORY DOSE CAP: 1,000 mg/day (Do not initiate) | Strongly recommended down to eGFR 20 |
| G4 / G5 | < 30 mL/min | STRICTLY CONTRAINDICATED (Fatal Lactic Acidosis) | Do not initiate if <20; transition to Linagliptin/Insulin |
3. Insulin Dosing, CGM AGP & Polypharmacy Suite (`/calculator`)
A. Dynamic Insulin Calculations (500 & 1800 Rules):
- Total Daily Dose (TDD): $0.5\text{ U/kg}$ for T1DM; $0.6\text{ U/kg}$ for T2DM with insulin resistance.
- Insulin-to-Carb Ratio (ICR): $\text{ICR} = 500 / \text{TDD}$ (Grams of carbs covered by 1 unit of rapid-acting insulin).
- Insulin Sensitivity Factor (ISF): $\text{ISF} = 1800 / \text{TDD}$ (mg/dL glucose drop per 1 unit of rapid-acting insulin).
- Meal Bolus Formula: $\text{Bolus} = (\text{Meal Carbs} / \text{ICR}) + (\text{Current BG} - \text{Target BG}) / \text{ISF}$.
B. Continuous Glucose Monitoring (CGM) AGP Consensus:
- Time In Range (TIR 70–180 mg/dL): Target > 70% (> 16h 48m/day); Target > 50% in frail elderly; 63–140 mg/dL in pregnancy.
- Time Below Range (TBR Level 1 < 70 mg/dL): Target < 4% (< 58m/day).
- Time Below Range (TBR Level 2 < 54 mg/dL): Target < 1% (< 14m/day).
- Glycemic Variability (%CV): Goal ≤ 36.0% (Values > 36% indicate high risk of severe hypoglycemia).
- Glucose Management Indicator (GMI): $\text{GMI (\%)} = 3.31 + (0.02392 \times \text{Mean Glucose in mg/dL})$.
C. 'Triple Whammy' Polypharmacy Safety Guard:
- Hazard: Co-prescribing [ACEi/ARB] + [Diuretic or SGLT2i] + [NSAID] (e.g., Telmisartan + Dapagliflozin + Diclofenac).
- Mechanism: Afferent vasoconstriction (NSAID) + Efferent vasodilation (ARB) + Volume depletion → Loss of glomerular filtration pressure → 300% increase in Acute Tubular Necrosis (AKI).
- Mandatory Rule: Immediately stop NSAIDs in patients taking ACEi/ARB or SGLT2 inhibitors and substitute with Paracetamol.