DIABETES TECHNOLOGY & THERAPEUTICSVolume 7, Number 5, 2005© Mary Ann Liebert, Inc.

Diabetes Website Review: www.2aida.org

KAREN REED, B.Sc.1 and ELDON D. LEHMANN, Ph.D., F.R.C.R.2

ABSTRACT

Previous Diabetes Information Technology & WebWatch columns have addressed the use ofdiabetes simulators, and, in particular, aspects of the AIDA software. AIDA is a freeware com-puter program, which simulates the interaction of carbohydrates and insulin administered inpeople with insulin-dependent (type 1) diabetes mellitus. The program is intended to be usedas an educational support tool, and is available via the Internet without charge fromwww.2aida.org. In this article, the AIDA Website is described and reviewed in terms of bothcontent and functionality. This popular non-commercial Internet site provides free access to adownloadable PC version of AIDA, as well as access to a Web-based version of the simulatorthat can be run online (accessible directly at: www.2aida.net). User feedback suggests that theWebsite and the AIDA software have been of significant interest and value to many patients,their relatives and carers, students, and a variety of health-care professionals and researchers.The interactive and dynamic nature of the simulations adds a real-life dimension to the Web-based educational material, and the software is complemented by a substantial amount of sup-porting information at the Website. The on-going collection of subjective feedback continues toprovide anecdotal evidence of the utility of the software, and this will hopefully be corroboratedby results from more formal and objective evaluations. The future potential of diabetes simula-tors, in both education and research, is becoming increasingly apparent, and the AIDA Websiteis evolving accordingly.

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INTRODUCTION

THE AIDA WEBSITE (at: www.2aida.org) is anindependent, non-commercial site that

hosts downloads of the AIDA diabetes simula-tion software (Fig. 1). AIDA is a freeware com-

puter program that enables the interactive sim-ulation of plasma insulin and blood glucoselevels for educational purposes.

A number of previous publications, includ-ing Diabetes Information Technology andWebWatch columns, have described aspects of

1Reed Biomedical, Rotorua, New Zealand.2Department of Radiology, St. George’s Hospital, London and Department of Imaging (MRU), Imperial College of

Science, Technology and Medicine (NHLI), Royal Brompton Hospital, London, United Kingdom.The AIDA software referred to in this report is an independent, non-commercial development that is being made

available free-of-charge via the Internet—at a dot org (.org) not-for-profit Website—as a non-commercial contribu-tion to continuing diabetes education. Dr. Lehmann is a co-developer of the AIDA diabetes simulator and AIDA on-line, and Webmaster of the www.2aida.org and www.2aida.net Websites.

Diabetes Information Technology & WebWatch

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AIDA, such as its development,1–3 its use,4 itspossible clinical utility as a teaching tool,5–7 andits potential use in research.8,9 User feedbackhas also been documented.10–15 In this articlewe review the AIDA Website, and highlight anumber of its attributes, centred around the di-abetes simulation software.

The site was initially developed with the pri-mary purpose of making the AIDA softwareavailable free-of-charge via the Internet. Sincethe launch of the original AIDA Web pages in1996, over 450,000 visits have been logged, andwell over 90,000 copies of the program have beendownloaded gratis. AIDA has attracted wide-spread international interest, with visits loggedfrom more than 115 countries worldwide. Thenotion that AIDA holds appeal for patients, rel-atives, students, and health-care professionalsalike is also supported by the wide range of In-ternet addresses recorded in the site log files, andfrom the user feedback that has been received,which is documented at the Website.

Some of the key events relating to the historyand development of the Website are sum-marised in Table 1, and a number of its note-worthy features are highlighted in this article.

WEBSITE STRUCTURE AND FUNCTION

The AIDA Website is well structured andeasy to navigate. The various sections areclearly organised, and the main menus andlinks render all parts of the site easily accessi-ble. The site does not use any complex Java™scripts or Flash™ graphics, so even the mostbasic of browsers will be able to access the Web-site. A number of viewing options are avail-able—such as larger frames (Fig. 2), or noframes (Fig. 3)—and these add to the user-friendliness of the site.

The main feature of the Website is undoubt-edly the diabetes simulation software. TheWebsite enables anyone with access to the In-

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FIG. 1. AIDA Website (www.2aida.org) home page showing the left and bottom menu (frame) bars for site navi-gation. A link to the AIDA U.S. mirror site (accessible directly at: www.2aida.net/welcome) is also provided.

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ternet to download AIDA free-of-charge. Thedownloadable version of AIDA was primarilydesigned for IBM-compatible personal com-puters (PCs), but it has also been shown towork on Apple Macintosh (Mac) computersrunning PC emulation software (Fig. 4).

The Website also hosts an online Web-basedversion of the simulation program, calledAIDA online (accessible directly at: www.2aida.net), which is an attractive alternative formany people. In theory, the online simulatorcan be accessed from any computer, anywhere

in the world, provided the computer is con-nected to the Internet and has a suitable graph-ical display. Apple Mac users who do not havean appropriate PC emulator can also use AIDAonline to run simulations for free in their Webbrowser window. Furthermore, AIDA onlinereportedly works well with WebTV. The intro-duction of the Web-based software, therefore,has inevitably widened the potential audiencefor the AIDA diabetes simulation approach.

The simulation software is accompanied bya wealth of supporting information and guidesfor its use. Indeed, the Website provides muchmore than just access to a diabetes simulator;there are over 200 Web pages of information,plus a whole series of portable document for-mat (.pdf) articles. Table 2 outlines the organi-sation of the principal content at the AIDAWebsite. Much of the informational content hasbeen published elsewhere in the scientific lit-erature in various forms.1–17 However, collec-tively the software and accompanying infor-mation form an integrated and cohesive unit,and the Website functions well as a dynamicentity.

USING THE AIDA SIMULATOR

Main features of AIDA

The main features of AIDA are common toboth the downloadable and online versions ofthe software. Simulation parameters—whichcan be changed—and other options are ex-plained briefly in simple terms for the non-clin-ical user; these are the data that the model usesto help simulate the insulin–carbohydrate in-teractions and blood glucose responses.

AIDA comes complete with 40 case scenar-ios that can be run, adapted, and modified tosuit the user. Examples of running simulationsusing these case scenarios have been describedpreviously elsewhere.4 In addition to the casescenarios provided with the software packageand online simulator, users can define theirown case scenarios, if desired.

A knowledge-based system has also been in-corporated into AIDA in order to identify poten-tial problems in the observed blood glucose data.A list of possible suggestions is generated, whichcan provide a basis for further simulations.2,3

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TABLE 1. HISTORY OF KEY DEVELOPMENTS

AT THE AIDA WEBSITE

March/April 1996AIDA PC program first made available for betatesting by e-mail and on the Web at a UK-baseddiabetes Website

June 1996AIDA v4.0 became available for general release asfreeware software

August 1998Following 8 months of beta-testing the Web-baseddiabetes simulator, AIDA online, was formallylaunched

October 1999Due to continuing interest in AIDA, a dedicatedregistration/announcement e-mail list was set up,accessible now via: subscribe@2aida.org

July 2000A new version of the PC AIDA software (AIDA v4.3)was released, containing a number of technicalimprovements

October 2000AIDA Website was moved to its own dedicated Webaddress (at: www.2aida.org)

July 2001A U.S. mirror site for the AIDA Website waslaunched, hosted from Baltimore, MD athttp://us.2aida.org

August 2001AIDA v4.3a placed on general freeware release

September 2001AIDA online2 (version 2) became available forgeneral use. This updated version of the Web-baseddiabetes simulator incorporated HbA1c levels for theonline diabetes simulations, and provided user-definable bounds or ranges on the blood glucosegraphs

October 2001Diabetes/Insulin Tutorial became available at theAIDA Website, accessible directly at:www.2aida.org/tutorial

July 2002AIDA U.S. mirror site moved to a new, larger, fasterfacility in California with considerably greaterbandwidth (at: www.2aida.net/welcome)

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Running the downloadable version of AIDA

There are numerous links throughout theWebsite inviting visitors to download the lat-est version of AIDA (v4.3a). The download pro-cess is fast, and the self-extracting installationfile (file size approximately 1 Mb), when exe-cuted, installs the DOS (Disk Operating Sys-tem)-based software in a matter of minutes.

In essence, using the DOS-based software isstraightforward—users select or change dataparameters and press the escape key to viewgraphical representations of insulin regimenand carbohydrate intake, the resulting simu-lated blood glucose levels, and a computedhaemoglobin A1c (HbA1c) value. Pressing theescape key again returns to the data entry form.The electronic user guide provided with theAIDA package contains a handy quick startguide, and the demonstration version also pro-

vides a useful introduction to the scope and ca-pabilities of the software. The demonstrationwalks users through the first of the case sce-narios and goes some way to help bridge thegap between the DOS-based and Web-basedsimulations. User experience of the PC soft-ware has previously been described else-where.10,11,13–15

Running AIDA online

The Web-based version of the diabetes simu-lator—called AIDA online—can be accessedfrom the “On-Line Simulation” link on the left-hand main menu (or directly at: www.2aida.net). Standard Web browser software is em-ployed—using a mouse to navigate—and this isperhaps more familiar to many people than thekey and tab functions employed by the DOS-based PC software. The data for a selected pre-

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FIG. 2. Larger frames version of the AIDA site menus providing easier Website navigation for visitors with sightdifficulties. This screenshot is from the AIDA U.S. mirror site, including a link back to the AIDA European Websiteat: www.2aida.org hosted from London, UK.

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FIG. 3. No frames (menus) view of the AIDA Website showing some of the awards won by the AIDA and AIDAonline sites. Navigation is facilitated by the pull-down menu on the upper right of the screen (“Select AIDA Webpage here”). Making a choice and clicking on the �Go� button will display the selected Web page.

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FIG. 4. Information for Apple Macintosh users showing examples of AIDA v4 operating with VirtualPC and Soft-Windows personal computer emulation software.

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stored case scenario can be automatically loadedas a starting point. Running the simulation (i.e.,clicking on the run simulation button) yields anumber of graphs depicting plasma insulin andblood glucose levels in relation to the insulin reg-imen and dosing, and timing and quantity of carbohydrates consumed. Other changeable pa-rameters, such as insulin sensitivity, renal func-tion, body mass, and so on, are taken into ac-count by the simulation model. The data entryform is returned on the same page, so that fur-ther modifications can be made to the scenario,and the simulation re-run. Usefully, previoussimulations are indicated on the graphs, so thatthe effects of the changes that have been madecan easily be seen. As with the downloadablesoftware, an HbA1c value is also computed, giv-ing an overall indication of improvement (or oth-erwise!) of blood glucose control in the simulatedpatient.

The “Quick Simulation” option in the mainmenu guides the user through the first case sce-

nario and provides a useful introduction to theworkings of the online simulation software. In-troductory graphics are explained, and illus-trate the case scenario with blood glucose leveland carbohydrate intake on one graph, and in-sulin level, with insulin dose and timing, andinsulin type, indicated on a second graph; thisis essentially the baseline simulation. The ad-ditional commentary and suggestions help ori-entate the first-time user with the software andalso help to direct the necessary thought pro-cesses. A variety of user reviews of AIDA on-line have been published elsewhere,12 as havefurther details about how AIDA online actuallyworks.18

Selecting “Fast-Track Menu” from the mainmenu takes the user to a series of further ex-ample simulations in which the baseline simu-lation has already been performed. The menuprovides links to 14 selected case scenarios thatalso link in with the diabetes/insulin tutorial(see below).

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TABLE 2. SUMMARY OF THE MAIN CONTENT OF THE AIDA WEBSITE (WWW.2AIDA.ORG)

Using the Website Optimise viewing—frames optionsAIDA NewsFrequently asked questions (FAQ)Site mapSearch facility

Using AIDA Caveats/warningsDownload PC software

Installation informationOn-line simulation

About AIDA onlineHow AIDA online worksQuick simulationFast-track menu

Available insulinsPump usageDiabetes/insulin tutorial

Additional supporting information for health-care Clinical useprofessionals and researchers Research use

EvaluationPublications (.pdf format)Technical guideModel graphics

Communication between website developers Register to receive e-mail updatesand end users Guestbook comments

Help with AIDAWhy people download AIDAUser reviews“Sound bites”

Other miscellaneous Web pages Information for Apple Macintosh UsersLeaflet/flyer briefly describing AIDAPrivacy policy

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THE AIDA SIMULATION MODEL ANDLIMITATIONS OF AIDA

AIDA has been developed using a patho-physiological compartmental model of insulinand carbohydrate (glucose) interaction.1,3 The

model is described in detail in the technicalguide at the Website (at: www.2aida.org/tech-nical), and is also depicted in pictorial andgraphical forms in the “Model Graphics” sec-tion (Fig. 5). A basic knowledge of the as-sumptions and concepts underlying the model

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FIG. 5. Graphical representation of the AIDA model. Clicking on any of the numbered organs on the man figureyields further information about that model organ function.

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is helpful to understanding the limitations ofthe simulator, hence the warnings and caveats,and the associated disclaimer.

Caveats and warnings

The fact that certain caveats need to be readand understood is consistently reinforcedthroughout the Website (see: www.2aida.org/caveats) (Fig. 6). Essentially, these caveats arefounded on the principles and underlying as-sumptions of the AIDA model, which is notsufficiently refined for individual patient sim-ulation.16,17,19 This is not surprising given theintricate complexities and diversity of humanmetabolism under any given set of circum-stances. Therefore, AIDA is expressly for useas an educational tool, and not for generatingindividual therapeutic advice or treatmentplanning. Throughout the Website, patients arerepeatedly encouraged to consult with theirhealth-care professional before making anychanges to their own treatment regimen.

Insulins covered by AIDA

AIDA was originally developed before in-sulin analogues had become available. Al-

though the insulins listed in the “Available In-sulins” section cover a broad range, the rapid-acting insulin analogues, such as Humalog (in-sulin lispro) and Novorapid (insulin aspart),and the longer-acting basal insulin glargine(Lantus) are not yet incorporated into the cur-rent simulation model. Website visitors are in-vited to join the low-volume AIDA registra-tion/announcement list—by sending a blanke-mail to: subscribe@2aida.org—to be in-formed when these insulins are added to theAIDA software.

Insulin pump therapy

Although the AIDA model does not explic-itly cater for insulin pump usage, some usershave described being able to gain useful in-formation from the software by setting ap-propriate basal levels of insulin, and thenadding in extra insulin boluses. Some of thesuggestions that have been provided in feed-back from insulin pump users have been re-produced at the site. This exemplifies the wayin which user feedback is contributing to thevalue of the software and its continued de-velopment.

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AIDA on-line allows visitors to simulate - in a Web browser window - the bloodglucose effects of changes in insulin and diet for example diabetic patients.

However the information presented at this site is for general use only and is notintended to provide individual blood glucose predictions, personal medical advice,

or substitute for the advice of a health-care professional. If you have questionsabout the information offered here, concerns about individual health matters, or

about the management of your diabetes - please consult your doctor.

Diabetes practices and regimens can vary between countries, hospitals / clinics, & specialists. Therefore what may be encouraged in one setting may not be so recommended in another. This insulin tutorial is not meant to provide a didactic (regimented / fixed) plan for using insulin. Rather the tutorial intends to show some ways of doing things, and provide some explanations as to why things may be done in a certain way. Furthermore it is hoped that this tutorial may encourage people to think a bit more about what insulin regimens are possible, & how they might be improved and / or tailored for an individual. In all this remember that people's mileage may vary - so what works for one person may not be appropriate for someone else. Therefore, as with all medical information on the Web, it is important that you consult your doctor or diabetes specialist before considering acting on any of the information discussed in this tutorial.

FIG. 6. Caveats/warnings provided at the AIDA Website: (a) AIDA online the Web-based diabetes simulator ac-cessible directly at: www.2aida.net and (b) the Diabetes/Insulin Tutorial accessible directly at: www.2aida.org/tutorial.

a

b

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The AIDA developers are currently workingon a version of the software, which will enablemore sophisticated pump regimens and proto-cols to be simulated.

A SIMULATION-AIDED TUTORIAL

The diabetes/insulin tutorial, based in parton an introductory course for patients with in-sulin-dependent (type 1) diabetes,20 is an in-teractive educational tool of potential value topatients and health-care students, and likely ofinterest to health-care professionals in educa-tion as well.

The tutorial, accessible directly at: www.2aida.org/tutorial, is a step-by-step guide, cur-rently comprising four sections. It starts offwith the basics, but soon progresses to in-depthconsiderations of various insulin and dietarytreatment regimens. The first section looks athow different insulins can be used in the man-agement of diabetes. It considers insulin regi-mens, and various types and combinations ofinsulin. The second section addresses “con-ventional” and “intensive” insulin therapy anddosage adjustment. The third section adds mealplanning and carbohydrate counting, while thefourth section takes a look at glucose in theurine in relation to blood glucose levels, and il-lustrates the importance and utility of bloodglucose monitoring as opposed to taking spoturine glucose measurements.

Whilst the user is working through the textualinformation pages, the diabetes simulator is runin a separate window. Therefore the user is ableto create and work with the scenarios as de-scribed in the tutorial, whilst referring to the tu-torial pages independently. Running simulationsin parallel adds a unique interactive element thatengages the user and helps to make the learningprocess more effective and enjoyable.

In addition, the dynamic and interactive na-ture of the tutorial emphasises the numerouspossibilities for adapting insulin therapy to suitthe individual—an important concept for pa-tients, carers, and health professionals to ap-preciate—no insulin treatment regimen is set instone. Again, the necessary caveats and warn-ings are emphasised to ensure that the infor-mation is used in an appropriate way.

SPECTRUM OF USES OF AIDA

The potential uses of AIDA are numerous,and its widespread appeal is depicted by theuser-generated feedback described in the sec-tions entitled “Why people download AIDA”(accessible directly at: www.2aida.org/why),“User reviews” (at: www.2aida.org/reviews),and “Sound Bites.” These sections together en-able Website visitors to get a flavour for the in-terest in, and utility of, the AIDA software.

Personal use/self-learning tool

As part of an on-going data collection pro-cess, people who download AIDA are asked tovolunteer details about what they hope to beable to achieve with the software. The resultantcomments, featured in the section entitled“Why people download AIDA,” suggest thatmany people with diabetes, and their relativesand carers, are hoping to learn more about in-sulin therapy and its possibilities, as it appliesto their own circumstances.21,22 In the vast ma-jority of cases, the caveats appear to have beenread and understood. Thus, although AIDA issuitable only as an educational tool, and shouldnot be used for individual therapy planning, itis nevertheless considered a popular resourcewithin the patient community.

Furthermore, although the diabetes simula-tor has been developed using a model of in-sulin-dependent (type 1) diabetes mellitus, inwhich insulin is totally lacking, it may still beof value to those people with non–insulin-de-pendent (type 2) diabetes, who wish to learnmore about the dynamics of insulin therapy—as long as the underlying assumptions and as-sociated caveats are understood.

Clinical use

Selected details of experience and feedbackfrom health-care professionals that have beencollected and published in the literature are re-produced at the Website (accessible directly at:www.2aida.org/clinical). These provide realexamples of the clinical utility of the AIDA soft-ware. A number of health-care educators areincorporating AIDA into their teaching pro-grams and have reported positive feedbackfrom their students.

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Research use

The “Research Use” section of the Website(accessible directly at: www.2aida.org/research)illustrates some applied uses of AIDA as a datasimulator in original research.8 For example,AIDA has been used by others to generate datafor the further development and testing of theirown decision support prototypes.9 As pointedout at the Website, using simulator-generateddata has been described as removing “all the ethical and practical problems associatedwith collecting data from real patients,”23 andprovides a way of generating a large volumeof data to train and evaluate other computerprototypes.

EVALUATION

The Website developers have already col-lected a substantial amount of anecdotal evi-dence in terms of user experience, but this issubjective. In today’s era of evidence-basedpractice, it is appropriate that the clinical util-ity of the AIDA software be objectively dem-onstrated in randomised controlled trials(RCTs). The evaluation section of the Website(www.2aida.org/evaluate) provides an outlineprospective methodology for formally evaluat-ing the educational utility of an interactive di-abetes simulator, such as AIDA.24

A proof-of-concept, or pilot study, using thesuggested protocol has already demonstratedthe feasibility of using an RCT approach for theevaluation of educational diabetes simulationsoftware such as AIDA,25 and issues sur-rounding the use of such RCTs have been dis-cussed elsewhere.26,27 Larger-scale trials in-volving more patients in more centres areneeded, and the Website clearly strives to en-gage health-care professionals in this activity.

SUPPORTING INFORMATION

The Website contains a large number of Webpages of supporting information, plus free on-line access to a considerable number of papersthat have been published in the medical andcomputing literature (the latter can be accessedvia the “Research Use” section, or directly at:www.2aida.org/articles).

The “Frequently Asked Questions” (FAQ)section—which can be accessed from the left-hand main menu and directly at: www.2aida.org/faq—also provides a substantial amountof supplementary and interesting informationconcerning the Website, and the developmentand use of the AIDA diabetes simulator.

If visitors cannot find the information thatthey are looking for, then using the efficientsearch facility—again, accessed from the mainmenu, or directly at: www.2aida.org/search—will likely point them in the right direction.

For American, Australasian, Pacific, and FastEast Asian users of AIDA, a U.S. mirror site hasbeen set up in California accessible directly at:www.2aida.net/welcome.

FUTURE DEVELOPMENTS

The AIDA software is effectively a prototype,or “work in progress,” and the on-going de-velopment is mirrored in developments at theWebsite, which is continually evolving. Visi-tors to the site are encouraged to contributecomments and feedback in relation to any ofthe Website features. Links to the AIDA feed-back (at: www.2aida.org/feedback) and con-tact/guestbook forms (at: www.2aida.org/guestbook) are numerous and can be foundthroughout the site, inviting visitors—patientsand health-care professionals alike—to com-municate views on the current use or potentialfurther development of AIDA as an educa-tional tool.

New insulins, exercise/stress levels, andmany other features may be incorporated intofuture versions of AIDA. Software for insulinpump therapy has already been discussed. In-terested users are invited to sign up to trial fu-ture beta releases of the AIDA software at theWebsite (at: www.2aida.org/beta).

In all of the sections at the Website, visitors arealso invited to register their general interest inthe software, and join the e-mail notification list,which will keep them up-to-date with the latestdevelopments. Further information is availableat: www.2aida.org/register. Registration is free,and the list volume is very low.

In addition, an open invitation exists for any-one who believes he or she may be able to help

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with activities relating to the further develop-ment of the AIDA Website/software, and anindependent “Help with AIDA” e-mail an-nouncement list is in operation to facilitate this.Further information is available at: www.2aida.org/help. To subscribe send a blank e-mail noteto: help@2aida.org.

As a relatively new feature the AIDA v4.3aTurbo Pascal source code that has been used toprogram the DOS-based diabetes simulatorand knowledge-based system is being madefreely available for download for non-com-mercial purposes via the AIDA Website. In thisway the AIDA authors hope to foster the fur-ther development and enhancement of the di-abetes simulation approach, particularly for re-search and educational use. Further informa-tion about this novel development can befound in Lehmann28 and at www.2aida.org/sourcecode on the Web.

DISCUSSION

Websites provide a convenient way of mak-ing educational information and tools availableto a wide audience. The Internet is now awashwith good diabetes information sites29; how-ever, to a large extent educational materialsavailable via the Internet tend to be in basic tex-tual or graphical formats (such as slide pre-sentations). In this respect, the AIDA Websitestands out because it is both dynamic and in-teractive.

The last 2 decades have seen a considerableshift in the approach to insulin treatment regi-mens, aided by the availability of new insulinpreparations and the remodelling of diabetesself-care. Education and training in insulintreatment approaches are now essential for allthose involved in diabetes care.

The role of the AIDA Website in the educa-tional setting is not to replace any currentteaching materials, but, rather, to enhance ex-isting methods. Understanding insulin treat-ment and becoming adept in working with in-sulin treatment usually require hands-on trialand error experience. However, it is not idealto learn about diabetes treatment through ex-perimentation in real-life because of the dan-gers of hypo- and hyperglycaemia and the long

time frames involved. The simulator providesa “virtual patient” concept, which adds a real-life dimension to Web-based and paper-basedteaching materials and offers learning throughexperience, with the additional benefit of im-mediacy.

Increased use of tools such as AIDA in thehealth-care education setting may further helpto change the clinical style of diabetes man-agement from the traditional prescriptive fixedapproach (to the insulin-diet regimen) to amore realistic and versatile one.

Poor computer literacy may be perceived asa possible potential barrier to the use of theDOS version of AIDA.10,30 However, as far ascomputer software goes, it is the independentexperience of one of us (K.R.) that AIDA is rel-atively easy to use, once its purpose is under-stood, and the accompanying electronic userguide is easy to read and understand. The on-line demonstrations and tutorials are also ofgreat value in illustrating how the software canbe applied.

Possibilities for the further development ofdiabetes simulators have previously been dis-cussed elsewhere31,32; however, what can actu-ally be achieved, validated, and evaluated mayto a large extent depend on continued interestand collaboration of clinical colleagues, in ad-dition to the necessary requirement of financialand time resources. In this respect, health-careprofessionals who are interested in receivingtargeted announcements about educationaland research uses of AIDA can join a very lowvolume e-mail list by sending a blank note to:healthcarer@2aida.org. Further information isalso available directly at: www.2aida.org/healthcarers.

CONCLUSIONS

The AIDA Website provides free access to adiabetes simulator and is of potential value topatients, their relatives and carers, students,and a variety of health-care professionals andresearchers.

Simulators such as AIDA allow the reality ofchallenges facing blood glucose control to bemodelled, and enable problem-solving skills tobe developed in a virtual setting. AIDA pro-

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vides both a teaching tool for health-care edu-cators, and a learning aid for students and pa-tients, their relatives, and carers. In addition toits clinical utility as an educational tool, AIDAalso has great potential as a research tool.

The Website functions well and is user-friendly. It provides a stimulating educationalresource, and we would recommend it to any-one with an interest in diabetes and insulintherapy.

REFERENCES

1. Lehmann ED, Deutsch T: A physiological model ofglucose-insulin interaction in type 1 diabetes mellitus.J Biomed Eng 1992;14:235–242.

2. Lehmann ED, Deutsch T: AIDA2: A Mk. II automatedinsulin dosage advisor. J Biomed Eng 1993;15:201–211.

3. Lehmann ED: Development, evaluation, and usage of‘AIDA’—an interactive educational diabetes simula-tor [Ph.D. Thesis]. London: University of London/Im-perial College of Science, Technology and Medicine,2004.

4. Lehmann ED: Experience with the Internet release ofAIDA v4—an interactive educational diabetes simu-lator. Diabetes Technol Ther 1999;1:41–54.

5. Tatti P, Lehmann ED: Utility of the AIDA diabetessimulator as an interactive educational teaching toolfor general practitioners (primary care physicians).Diabetes Technol Ther 2001;3:133–140.

6. Tatti P, Lehmann ED: Use of the AIDA diabetes sim-ulation software—www.2aida.org—as an interactiveeducational tool for teaching student nurses. DiabetesTechnol Ther 2001;3:655–664.

7. Tatti P, Lehmann ED: Using the AIDA—www.2aida.org—diabetes simulator. Part 1: Recommendedguidelines for health-carers planning to teach with thesoftware. Diabetes Technol Ther 2002;4:401–414.

8. Lehmann ED: Research use of the AIDAwww.2aida.org diabetes software simulation pro-gram: A review—Part 1. Decision support testing andneural network training. Diabetes Technol Ther2003;5:425–438.

9. Lehmann ED: Research use of the AIDA www.2aida.org diabetes software simulation program: Areview—Part 2. Generating simulated blood glucosedata for prototype validation. Diabetes Technol Ther2003;5:641–651.

10. Lehmann ED: Preliminary experience with the Inter-net release of AIDA—an interactive educational dia-betes simulator. Comput Methods Programs Biomed1998;56:109–132.

11. Lehmann ED: Spontaneous comments from users ofthe AIDA interactive educational diabetes simulator.Diabetes Educ 2000;26:633–638, 641–643.

12. Lehmann ED: User reviews of AIDA online: A Web-based interactive educational diabetes simulator. Di-abetes Technol Ther 2000;2:329–342.

13. Lehmann ED: User experience with the AIDA inter-active educational virtual diabetes patient simulator.Diabetes Technol Ther 2000;2:165–171.

14. Lehmann ED: Short user comments (‘sound bites’) re-garding usage of AIDA v4—http://www.2aida.org—an interactive educational diabetes simulator. Dia-betes Technol Ther 2000;2:663–666.

15. Lehmann ED: Further user comments regarding us-age of an interactive educational diabetes simulator(AIDA). Diabetes Technol Ther 2002;4:121–135.

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21. Lehmann ED: Why are people downloading thefreeware AIDA diabetes computing software pro-gram: A pilot study. Diabetes Technol Ther 2002;4:793–808.

22. Lehmann ED: Who is downloading the free AIDAv4.3a interactive educational diabetes computer soft-ware? A 1-year survey of 3,864 downloads. DiabetesTechnol Ther 2003;5:879–890.

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25. Tatti P, Lehmann ED: A prospective randomised-con-trolled pilot study for evaluating the teaching utilityof interactive educational diabetes simulators. Dia-betes Nutr Metab 2003;16:7–23.

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27. Tatti P, Lehmann ED: Response to Biermann: Pilotrandomised controlled trial results for evaluating theteaching utility of the AIDA diabetes software simu-lator—an overview [letter]. Diabetes Technol Ther2004;6:289–296.

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28. Lehmann ED: Development, Evaluation and Usage ofwww.2aida.org. An Interactive Educational DiabetesSimulator. AIDA Publications, London, UK. (in press).

29. Lehmann ED: Computer-assisted diabetes educationand information technology in diabetes care. In: De-Fronzo R, Ferrannini E, Keen H, Zimmet P, eds. In-ternational Textbook of Diabetes Mellitus, 3rd ed.Chichester, UK: Wiley, 2004:1639–1665.

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31. Lehmann ED: Interactive educational diabetes simu-lators: Future possibilities. Diabetes Nutr Metab1999;12:380–387.

32. Lehmann ED: Interactive educational diabetes simu-lators: A look to the future. Diabetes Technol Ther2000;2:507–511.

Address reprint requests to:Dr. Eldon D. Lehmann

c/o www.2aida.org Diabetes SimulatorDevelopment Team

P.O. Box 46104London, EC2Y 8WN, UK

E-mail: www@2aida.orgWeb: www.2aida.org/lehmann

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