diabetes-control-hub

name	diabetes-control-hub
description	Manages comprehensive diabetes control by coordinating blood glucose tracking, nutrition analysis, exercise correlation, kidney function monitoring, and complication risk assessment. Use when a diabetes patient logs blood sugar, meals, or exercise, or needs checkup interpretation.
version	1.0.0
user-invocable	true
argument-hint	[daily-log | weekly-review | checkup-report]
allowed-tools	Read, Grep, Glob, Write, Edit
metadata	{"openclaw":{"emoji":"🩸","category":"health-scenario"}}

Diabetes Control Hub

Scenario orchestration skill for comprehensive diabetes management. Coordinates blood glucose tracking, dietary GI/GL analysis, exercise correlation, weight/metabolic monitoring, kidney function surveillance, and complication risk assessment. Targets patients with type 1 or type 2 diabetes who want a unified daily management workflow.

This skill does not perform analysis directly. It orchestrates multiple sub-skills in sequence to form a closed-loop diabetes management pipeline.

Medical Disclaimer

This skill is for health management reference only and does not constitute medical diagnosis or treatment advice.

• All glycemic control plans require confirmation by an endocrinologist before execution.
• Insulin dose adjustments must be guided by a physician. This skill does not provide dosing recommendations.
• Severe hypoglycemia (confusion, seizures): call 120 (China) / 911 (US) immediately.
• Diabetic ketoacidosis (DKA) symptoms (nausea, vomiting, abdominal pain, Kussmaul breathing): seek emergency care immediately.

Blood Glucose Target Reference

Metric	Target Range	Notes
Fasting glucose	4.4 - 7.0 mmol/L	Individualize based on patient profile
2h postprandial glucose	< 10.0 mmol/L	Measured 2 hours after eating
HbA1c	< 7.0%	May relax for elderly or patients with complications
TIR (Time in Range)	>= 70%	Percentage of readings within 3.9 - 10.0 mmol/L

Estimated HbA1c formula: eHbA1c = (mean glucose mmol/L + 2.59) / 1.59

Skill Chain

Step	Skill	Trigger	Purpose
1	chronic-condition-monitor	Daily	Blood glucose trends, eHbA1c, TIR calculation
2	nutrition-analyzer	Daily	Carb counting, macronutrient ratios
3	food-database-query	Daily	GI/GL lookup, low-GI alternatives
4	fitness-analyzer	Daily	Exercise-glucose correlation
5	weightloss-analyzer	Daily	BMR/TDEE, body composition tracking
6	wearable-analysis-agent	When wearable data is provided	Activity tracking for exercise-glucose correlation, resting HR trend
7	health-trend-analyzer	Weekly	Multi-metric joint trend analysis
8	kidney-function-tracker	Ongoing	Creatinine/eGFR/UACR tracking
9	checkup-report-interpreter	On checkup	Lab report interpretation
10	lab-results	On checkup	Abnormal indicator trend comparison
11	drug-interaction-checker	On medication change	DDI safety check
12	gwas-prs	Annual / optional	T2D genetic risk assessment
13	health-memory	Every session	Data persistence

Workflow

Mode 1: Daily Log

• Step 1a -- Blood glucose and chronic condition recording. Invoke chronic-condition-monitor. Record fasting/postprandial glucose to memory/health/items/blood-sugar.md. Compute 7-day/14-day/30-day glucose averages, eHbA1c, and TIR (percentage of readings within 3.9-10.0 mmol/L). Detect outliers and trigger alerts.
• Step 1b -- Dietary nutrition analysis. Invoke nutrition-analyzer. Analyze total carbohydrates per meal, dietary fiber intake, and daily total calories with macronutrient ratios.
• Step 1c -- Glycemic index lookup. Invoke food-database-query. Query GI (glycemic index) and GL (glycemic load) for each food item. Flag high-GI foods (>70) and suggest low-GI alternatives. Compute composite GL score per meal.
• Step 1d -- Exercise and glucose correlation. Invoke fitness-analyzer. Record exercise type, duration, and intensity. Analyze the effect of exercise on postprandial glucose (pre- vs post-exercise glucose comparison). Evaluate whether weekly exercise meets the 150-minute moderate-intensity aerobic recommendation.
• Step 1e -- Weight and metabolic analysis. Invoke weightloss-analyzer. Calculate BMR (basal metabolic rate) and TDEE (total daily energy expenditure). Track weight trend. Assess body fat percentage and waist circumference if data is available. Analyze energy balance.
• Step 1f (optional) -- Wearable device data integration. Invoke wearable-analysis-agent (when wearable data is provided). Analyze device-measured activity data (steps, active minutes, METs) to enhance exercise-glucose correlation in Step 1d with precise calorie burn and activity intensity. Extract resting heart rate trend as a cardiovascular risk indicator for diabetic patients. If continuous heart rate data spans exercise periods, correlate HR response with post-exercise glucose changes.
• Step 1g -- Persist data. Invoke health-memory. Write all data to memory/health/daily/{YYYY-MM-DD}.md. Update memory/health/items/blood-sugar.md and memory/health/items/weight.md.

Mode 2: Weekly Review

• Step 2 -- Multi-metric joint trend analysis. Invoke health-trend-analyzer. Analyze: glucose + weight joint trend (weight change impact on glycemic control); glucose + exercise joint trend (exercise frequency/intensity vs glucose improvement); glucose + HbA1c trend (eHbA1c trajectory over time); dietary GI/GL + postprandial glucose trend (high-GI days vs low-GI days comparison).

Mode 3: Checkup Report

• Step 3a -- Lab report interpretation. Invoke checkup-report-interpreter. Interpret HbA1c actual vs target. Interpret microalbuminuria (early renal damage marker). Interpret fundoscopy results (diabetic retinopathy screening). Interpret lipid profile (cardiovascular risk for diabetic patients). Interpret liver and kidney function markers.
• Step 3b -- Abnormal indicator trend comparison. Invoke lab-results. Compare current results against historical data. Flag significantly worsening indicators. Generate trend descriptions.

Complication Monitoring (Ongoing)

• Step C1 -- Kidney function tracking. Invoke kidney-function-tracker. Track creatinine and eGFR values. Calculate eGFR rate of change (annual decline). Track UACR (urine albumin-to-creatinine ratio). Assess diabetic nephropathy staging if sufficient data.

Medication Change (Event-Triggered)

• Step M1 -- Drug interaction check. Invoke drug-interaction-checker. Check interactions between new medication and existing diabetes drugs. Evaluate hypoglycemia risk (sulfonylurea + other glucose-lowering combinations). Flag high-risk combinations requiring physician confirmation.

Genetic Risk Assessment (Annual / Optional)

• Step G1 -- T2D polygenic risk scoring. Invoke gwas-prs (requires genetic data). Calculate T2D polygenic risk score (PRS). Evaluate key loci (TCF7L2, KCNJ11, PPARG, etc.). Combine with family history to provide genetic risk tier.

Input Format

Daily Log

The user provides any combination of the following in natural language:

Blood glucose: fasting 6.2, post-lunch 8.5, post-dinner 9.1
Diet: breakfast oatmeal + egg, lunch rice + stir-fried broccoli + chicken breast, dinner buckwheat noodles + tofu
Exercise: 30-min brisk walk after dinner
Medications: metformin 500mg x2, acarbose 50mg x3
Weight: 72.5kg

Optional: Wearable device data (Apple Watch / Fitbit / Garmin export with activity and heart rate data).

Checkup Report (Event-Triggered)

The user uploads or describes lab results (HbA1c, microalbumin, creatinine, eGFR, fundoscopy, etc.).

Medication Change (Event-Triggered)

The user reports a medication adjustment (new drug, discontinuation, or dose change).

Output Format

Daily Briefing Template

# Blood Glucose Daily Briefing -- YYYY-MM-DD

## Today's Glucose
| Timepoint | Glucose (mmol/L) | Status |
|-----------|-----------------|--------|
| Fasting | 6.2 | In range |
| 2h post-lunch | 8.5 | In range |
| 2h post-dinner | 9.1 | In range |

- Daily mean: 7.9 mmol/L
- eHbA1c: 6.6% (in range)
- TIR (past 7 days): 78% (in range, target >= 70%)

## Dietary GI Score
| Meal | Composite GL | Assessment |
|------|-------------|------------|
| Breakfast | 18 (low) | Oatmeal + egg, glucose-friendly |
| Lunch | 42 (medium) | White rice has high GL; consider brown rice |
| Dinner | 22 (low) | Buckwheat noodles + tofu, excellent choice |

## Exercise Notes
- Today: 30-min brisk walk (on target)
- Post-dinner glucose 9.1 -- consider extending post-meal walk by 10 min
- Weekly total: 120/150 min (30 min remaining to meet target)

## Alerts
(No alerts)

Weekly Report Template

# Weekly Glycemic Analysis -- YYYY-MM-DD to YYYY-MM-DD

## Glucose Target Achievement
- Fasting in range (4.4-7.0): 6/7 days (85.7%)
- Postprandial in range (<10.0): 12/14 readings (85.7%)
- TIR (3.9-10.0): 76% (in range)

## Best Meals TOP 3
1. Wed breakfast: oatmeal + nuts + blueberries -- postprandial 6.8
2. Fri dinner: buckwheat noodles + steamed fish + spinach -- postprandial 7.2
3. Sun lunch: brown rice + chicken breast + broccoli -- postprandial 7.5

## Worst Meals (Needs Improvement)
1. Sat lunch: white rice + braised pork + soda -- postprandial 12.3
2. Thu dinner: noodles + fried sauce -- postprandial 11.1

## Exercise-Glucose Correlation
- Exercise-day avg postprandial: 7.8 mmol/L
- Rest-day avg postprandial: 9.5 mmol/L
- Exercise lowers postprandial glucose by avg 1.7 mmol/L

## Weight Trend
- This week avg: 72.3 kg (vs last week -0.4 kg)
- Trend: gradual decrease, favorable for glycemic control

Checkup Interpretation Template

# Checkup Interpretation -- YYYY-MM-DD

## Core Diabetes Indicators
| Indicator | Current | Previous | Change | Assessment |
|-----------|---------|----------|--------|------------|
| HbA1c | 6.8% | 7.2% | -0.4% | Improved, in range |
| Fasting glucose | 6.5 | 7.1 | -0.6 | Improved |

## Complication Screening
| Item | Result | Assessment |
|------|--------|------------|
| UACR | 18 mg/g | Normal (<30) |
| eGFR | 92 mL/min | Normal (>90) |
| Fundoscopy | No abnormality | No retinopathy |
| LDL-C | 2.8 mmol/L | Elevated (diabetes target <2.6) |

## Risk Assessment
- Diabetic nephropathy risk: Low (UACR normal, eGFR normal)
- Retinopathy risk: Low (fundoscopy normal)
- Cardiovascular risk: Moderate (LDL-C elevated, recommend follow-up)

## Recommendations
1. HbA1c well-controlled; continue current regimen
2. LDL-C elevated; intensify dietary control or consult physician regarding statin therapy
3. Recheck HbA1c + microalbumin in 6 months

Alert Rules

Alerts are displayed at the top of the output when triggered:

Severity	Condition	Action
Emergency	Glucose < 3.9 mmol/L (hypoglycemia)	Consume 15g fast-acting carbs (glucose tablets/juice) immediately; recheck in 15 min; call 120/911 if unconscious
Emergency	Glucose > 16.7 mmol/L with nausea/vomiting	Suspected DKA; seek emergency care immediately
High	Postprandial glucose > 10.0 mmol/L for 3+ consecutive days	Contact physician to adjust treatment plan
High	eGFR declined > 15% from previous value	Recheck renal function urgently
Medium	Fasting glucose > 7.0 mmol/L for 5+ consecutive days	Review recent diet, exercise, and medication adherence
Medium	TIR < 50% for 2+ weeks	Poor glycemic control; recommend clinical evaluation
Low	Weight increase > 2 kg/month	Monitor caloric intake; assess medication factors

Data Persistence

All data is stored via the health-memory skill following its format conventions:

• Daily records: memory/health/daily/YYYY-MM-DD.md -- daily summary of glucose, diet, exercise, weight
• Glucose longitudinal: memory/health/items/blood-sugar.md -- most recent 90 days
• Weight longitudinal: memory/health/items/weight.md -- most recent 90 days
• Kidney function longitudinal: memory/health/items/kidney-function.md -- creatinine, eGFR tracking
• Medication records: memory/health/items/medications.md -- current medication list and change history