scholarly journals A Modular Safety System for an Insulin Dose Recommender: A Feasibility Study

2019 ◽  
Vol 14 (1) ◽  
pp. 87-96 ◽  
Author(s):  
Chengyuan Liu ◽  
Parizad Avari ◽  
Yenny Leal ◽  
Marzena Wos ◽  
Kumuthine Sivasithamparam ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Dose ◽  
Safety System ◽  
Target Range ◽  
Percentage Time ◽  
Viable Solution ◽  
System Functioning ◽  
Safety Constraint

Background: Delivering insulin in type 1 diabetes is a challenging, and potentially risky, activity; hence the importance of including safety measures as part of any insulin dosing or recommender system. This work presents and clinically evaluates a modular safety system that is part of an intelligent insulin dose recommender platform developed within the EU-funded PEPPER project. Methods: The proposed safety system is composed of four modules which use a novel glucose forecasting algorithm. These modules are predictive glucose alerts and alarms; a predictive low-glucose basal insulin suspension module; an advanced rescue carbohydrate recommender for resolving hypoglycemia; and a personalized safety constraint applied to insulin recommendations. The technical feasibility of the proposed safety system was evaluated in a pilot study including eight adult subjects with type 1 diabetes on multiple daily injections over a duration of six weeks. Glycemic control and safety system functioning were compared between the two-weeks run-in period and the end point at eight weeks. A standard insulin bolus calculator was employed to recommend insulin doses. Results: Overall, glycemic control improved over the evaluated period. In particular, percentage time in the hypoglycemia range (<3.0 mmol/l) significantly decreased from 0.82% (0.05-4.79) at run-in to 0.33% (0.00-0.93) at endpoint ( P = .02). This was associated with a significant increase in percentage time in target range (3.9-10.0 mmol/l) from 52.8% (38.3-61.5) to 61.3% (47.5-71.7) ( P = .03). There was also a reduction in number of carbohydrate recommendations. Conclusion: A safety system for an insulin dose recommender has been proven to be a viable solution to reduce the number of adverse events associated to glucose control in type 1 diabetes.

scholarly journals Classification of Postprandial Glycemic Status with Application to Insulin Dosing in Type 1 Diabetes—An In Silico Proof-of-Concept

Sensors ◽  
2019 ◽  
Vol 19 (14) ◽  
pp. 3168 ◽  
Author(s):  
Cappon ◽  
Facchinetti. ◽  
Sparacino. ◽  
Georgiou ◽  
Herrero
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Real Time ◽  
In Silico ◽  
Blood Glucose Concentration ◽  
Insulin Dose ◽  
Target Range ◽  
Glycemic Status ◽  
Meal Time

In the daily management of type 1 diabetes (T1D), determining the correct insulin dose to be injected at meal-time is fundamental to achieve optimal glycemic control. Wearable sensors, such as continuous glucose monitoring (CGM) devices, are instrumental to achieve this purpose. In this paper, we show how CGM data, together with commonly recorded inputs (carbohydrate intake and bolus insulin), can be used to develop an algorithm that allows classifying, at meal-time, the post-prandial glycemic status (i.e., blood glucose concentration being too low, too high, or within target range). Such an outcome can then be used to improve the efficacy of insulin therapy by reducing or increasing the corresponding meal bolus dose. A state-of-the-art T1D simulation environment, including intraday variability and a behavioral model, was used to generate a rich in silico dataset corresponding to 100 subjects over a two-month scenario. Then, an extreme gradient-boosted tree (XGB) algorithm was employed to classify the post-prandial glycemic status. Finally, we demonstrate how the XGB algorithm outcome can be exploited to improve glycemic control in T1D through real-time adjustment of the meal insulin bolus. The proposed XGB algorithm obtained good accuracy at classifying post-prandial glycemic status (AUROC = 0.84 [0.78, 0.87]). Consequently, when used to adjust, in real-time, meal insulin boluses obtained with a bolus calculator, the proposed approach improves glycemic control when compared to the baseline bolus calculator. In particular, percentage time in target [70, 180] mg/dL was improved from 61.98 (± 13.89) to 67.00 (± 11.54; p < 0.01) without increasing hypoglycemia.

Additional Insulin for Coping with Fat- and Protein-Rich Meals in Adolescents with Type 1 Diabetes: The Protein Unit

2020 ◽  
Author(s):  
Roland Schweizer ◽  
Susann Herrlich ◽  
Martina Lösch-Binder ◽  
Michaela Glökler ◽  
Magdalena Heimgärtner ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
G Protein ◽  
Insulin Dose ◽  
Dietary Fats ◽  
Target Range ◽  
Pump Therapy ◽  
Glucose Levels ◽  
Protein Rich ◽  
Carbohydrate Unit

Abstract Objective Dietary proteins raise blood glucose levels; dietary fats delay this rise. We sought to assess the insulin amount required to normalize glucose levels after a fat- and protein-rich meal (FPRM). Methods Sixteen adolescents (5 female) with type 1 diabetes (median age: 18.2 years; range: 15.2–24.0; duration: 7.1 years; 2.3–14.3; HbA1c: 7.2%; 6.2–8.3%) were included. FPRM (carbohydrates 57 g; protein 92 g; fat 39 g; fibers 7 g; calories 975 Kcal) was served in the evening, with 20 or 40% extra insulin compared to a standard meal (SM) (carbohydrates 70 g; protein 28 g; fat 19 g; fibers 10 g; calories 579 Kcal) or carbohydrates only. Insulin was administered for patients on intensified insulin therapy or as a 4-hour-delayed bolus for those on pump therapy. The 12-hour post-meal glucose levels were compared between FPRM and SM, with the extra insulin amount calculated based on 100 g proteins as a multiple of the carbohydrate unit. Results Glucose levels (median, mg/dL) 12-hour post-meal with 20% extra insulin vs. 40% vs. insulin dose for SM were 116 vs. 113 vs. 91. Glucose-AUC over 12-hour post-meal with 20% extra insulin vs. 40% vs. insulin dose for SM was 1603 mg/dL/12 h vs. 1527 vs. 1400 (no significance). Glucose levels in the target range with 20% extra insulin vs. 40% were 60% vs. 69% (p=0.1). Glucose levels <60 mg/dL did not increase with 40% extra insulin. This corresponds to the 2.15-fold carbohydrate unit for 100 g protein. Conclusions We recommend administering the same insulin dose given for 1 carbohydrate unit (10 g carbs) to cover 50 g protein.

Serum leptin concentrations in children with type 1 diabetes mellitus: Relationship to body mass index, insulin dose, and glycemic control

Metabolism ◽  
2002 ◽  
Vol 51 (3) ◽  
pp. 292-296 ◽  
Author(s):  
Ashraf T. Soliman ◽  
Magdi Omar ◽  
Hala M. Assem ◽  
Ibrahim S. Nasr ◽  
Mohamed M. Rizk ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Body Mass Index ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Body Mass ◽  
Insulin Dose ◽  
Serum Leptin

scholarly journals Liraglutide as additional treatment for type 1 diabetes

2011 ◽  
Vol 165 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Ajay Varanasi ◽  
Natalie Bellini ◽  
Deepti Rawal ◽  
Mehul Vora ◽  
Antoine Makdissi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Dose ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Additional Treatment ◽  
The Body ◽  
The Mean ◽  
Bolus Insulin

ObjectiveTo determine whether the addition of liraglutide to insulin to treat patients with type 1 diabetes leads to an improvement in glycemic control and diminish glycemic variability.Subjects and methodsIn this study, 14 patients with well-controlled type 1 diabetes on continuous glucose monitoring and intensive insulin therapy were treated with liraglutide for 1 week. Of the 14 patients, eight continued therapy for 24 weeks.ResultsIn all the 14 patients, mean fasting and mean weekly glucose concentrations significantly decreased after 1 week from 130±10 to 110±8 mg/dl (P<0.01) and from 137.5±20 to 115±12 mg/dl (P<0.01) respectively. Glycemic excursions significantly improved at 1 week. The mean s.d. of glucose concentrations decreased from 56±10 to 26±6 mg/dl (P<0.01) and the coefficient of variation decreased from 39.6±10 to 22.6±7 (P<0.01). There was a concomitant fall in the basal insulin from 24.5±6 to 16.5±6 units (P<0.01) and bolus insulin from 22.5±4 to 15.5±4 units (P<0.01).In patients who continued therapy with liraglutide for 24 weeks, mean fasting, mean weekly glucose concentrations, glycemic excursions, and basal and bolus insulin dose also significantly decreased (P<0.01). HbA1c decreased significantly at 24 weeks from 6.5 to 6.1% (P=0.02), as did the body weight by 4.5±1.5 kg (P=0.02).ConclusionLiraglutide treatment provides an additional strategy for improving glycemic control in type 1 diabetes. It also leads to weight loss.

Correlation Between Glycemic Control and Physical Activity Level in Adolescents and Children With Type 1 Diabetes

2015 ◽  
Vol 12 (2) ◽  
pp. 232-237 ◽  
Author(s):  
Cristiane Petra Miculis ◽  
Wagner De Campos ◽  
Margaret Cristina da Silva Boguszewski
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Physical Activity Level ◽  
Sedentary Time ◽  
Insulin Dose ◽  
Fasting Blood Glucose ◽  
Activity Level ◽  
Sleeping Time

Background:The aim of this study was to correlate glycemic control (GC) and variables of physical activity levels (PAL) in children with type 1 diabetes mellitus (T1DM).Methods:Fifty children and adolescents with T1DM were selected. Personal and medical data for the patients were collected. Physical evaluations of body weight and sexual maturation were undertaken. Bouchard’s questionnaire was applied to evaluate PAL as well as for time spent on physical activities.Results:Sixty-four percent of the subjects were sexually mature. Differences were observed between females and males in insulin dose, duration of light physical activity, and sleeping time (P < .05). Ninety percent presented poor GC and 80% had a low PAL. Fasting blood glucose (FBG) was significantly correlated with PAL, with sedentary time, and with sleeping time. Glycated hemoglobin (HbA1c) was significantly correlated with sedentary time and sleeping time. Among the three groups of PAL (insufficient × moderate × active) there were differences in HbA1c (%), FBG (mg/dL), duration of disease (years), and insulin dose (UI/kg/day) (P < 0.001).Conclusion:GC was significantly correlated with PAL. Among the three groups of physical activity level, the most active group was seen to have the best GC.

scholarly journals Basal Insulin Dose in Adults with Type 1 Diabetes Mellitus on Insulin Pumps in Real-Life Clinical Practice: A Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Bartłomiej Matejko ◽  
Aneta Kukułka ◽  
Beata Kieć-Wilk ◽  
Agnieszka Stąpór ◽  
Tomasz Klupa ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Basal Insulin ◽  
Hba1c Level ◽  
Metabolic Diseases ◽  
Insulin Dose ◽  
Real Life ◽  
Pump Therapy ◽  
Single Center Experience

Introduction. Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. The recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control. Materials and Methods. We included 260 consecutive patients with T1DM (159 women and 101 men) treated with continuous subcutaneous insulin infusion at the Department of Metabolic Diseases, Krakow, Poland. Data were downloaded from patients’ pumps and collected from medical records. We analyzed the settings of BI and the association of %BI with HbA1c level. Linear regression was performed. Results. The mean age of T1DM individuals was 26.6 ± 8.2 years, BMI was 23.1 ± 3.0 kg/m2, T1DM duration was 13.3 ± 6.4 years, and HbA1c level was 7.4%. There were 69.6% (n=181) of T1DM patients with %BI in the recommended range. The T1DM duration and HbA1c level of patients with a %BI <30% (n=23) was 9.5 years and 6.4%, respectively; for a %BI of 30–50%, it was 13.2 years and 7.4%; and for a %BI >50% (n=56), it was 15.8 years and 7.8% (p<0.001 for both three-group comparisons). Multiple regression identified %BI among independent predictors of the HbA1c level. Conclusion. In this real-life analysis, the recommendations concerning %BI dosing were not followed by almost one-third of adult T1DM patients. Low %BI was associated with better glycemic control; however, this requires further confirmation.

scholarly journals Sex differences over time for glycemic control, pump use and insulin dose in patients aged 10–40 years with type 1 diabetes: a diabetes registry study

2021 ◽  
Vol 9 (2) ◽  
pp. e002494
Author(s):  
Claudia Boettcher ◽  
Sascha R Tittel ◽  
Thomas Meissner ◽  
Bettina Gohlke ◽  
Rainer Stachow ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Sex Differences ◽  
Glycemic Control ◽  
Metabolic Control ◽  
Insulin Pump ◽  
Insulin Dose ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Migrant Background

IntroductionTo evaluate sex differences in people with type 1 diabetes concerning changes in glycemic control and trends in insulin pump use and insulin dose over two decades in adolescents and one-and-a-half decades in adults.Research design and methodsPeople aged 10–20 years (data years 1999–2018) and 21–40 years (data years 2004–2018) with type 1 diabetes were identified in the Diabetes Prospective Follow-up Registry (DPV). All available patients’ data sets of the respective period were used for linear regression analyses to investigate trends in HbA1c, pump use, insulin doses and body mass index SD scores (BMI-SDS) in females and males. In addition, stratification by migrant background was made for the adolescent group.ResultsIn the youth group (n=68 662), both boys and girls showed an HbA1c decrease over the period examined. After stratification for migrant background, an HbA1c convergence between boys and girls was seen in those without migrant background as of 2016. Usage of insulin pumps increased continuously from 3% (boys and girls) to 47% (boys) and 54% (girls), respectively. The daily insulin dose in units per kilogram body weight and day increased continuously from 1999 to 2018. An insulin dose leveling between boys and girls occurred. BMI-SDS consistently increased in girls whereas only slight variations were observed in boys.The adult group (n=15 380) showed constant HbA1c sex differences from 2004 to 2018 with lower HbA1c level in females. The use of insulin pump therapy rose from 18% to 35% (males) and 30% to 50% (females).ConclusionsThe gap in metabolic control between boys and girls with type 1 diabetes seems to close, but predominantly in adolescents without a migrant background. Improved HbA1c was associated with increased insulin pump use, especially in girls.In adult patients, sex differences in metabolic control and insulin pump use persist: women show constantly lower HbA1c values and higher insulin pump use.

scholarly journals Autonomous and Continuous Adaptation of a Bihormonal Bionic Pancreas in Adults and Adolescents With Type 1 Diabetes

2014 ◽  
Vol 99 (5) ◽  
pp. 1701-1711 ◽  
Author(s):  
Firas H. El-Khatib ◽  
Steven J. Russell ◽  
Kendra L. Magyar ◽  
Manasi Sinha ◽  
Katherine McKeon ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Controlled Trial ◽  
Insulin Dose ◽  
Total Daily Dose ◽  
Insulin Requirements ◽  
Daily Insulin Dose ◽  
And Shifts ◽  
The Impact

Context: A challenge for automated glycemic control in type 1 diabetes (T1D) is the large variation in insulin needs between individuals and within individuals at different times in their lives. Objectives: The objectives of the study was to test the ability of a third-generation bihormonal bionic pancreas algorithm, initialized with only subject weight; to adapt automatically to the different insulin needs of adults and adolescents; and to evaluate the impact of optional, automatically adaptive meal-priming boluses. Design: This was a randomized controlled trial. Setting: The study was conducted at an inpatient clinical research center. Patients: Twelve adults and 12 adolescents with T1D participated in the study. Interventions: Subjects in each age group were randomized to automated glycemic control for 48 hours with or without automatically adaptive meal-priming boluses. Main Outcome Measures: Mean plasma glucose (PG), time with PG less than 60 mg/dL, and insulin total daily dose were measured. Results: The 48-hour mean PG values with and without adaptive meal-priming boluses were 132 ± 9 vs 146 ± 9 mg/dL (P = .03) in adults and 162 ± 6 vs 175 ± 9 mg/dL (P = .01) in adolescents. Adaptive meal-priming boluses improved mean PG without increasing time spent with PG less than 60 mg/dL: 1.4% vs 2.3% (P = .6) in adults and 0.1% vs 0.1% (P = 1.0) in adolescents. Large increases in adaptive meal-priming boluses and shifts in the timing and size of automatic insulin doses occurred in adolescents. Much less adaptation occurred in adults. There was nearly a 4-fold variation in the total daily insulin dose across all cohorts (0.36–1.41 U/kg · d). Conclusions: A single control algorithm, initialized only with subject weight, can quickly adapt to regulate glycemia in patients with TID and highly variable insulin requirements.

The relationship of glycemic control, insulin dose, and race with hypoglycemia in youth with type 1 diabetes

2020 ◽  
Vol 34 (6) ◽  
pp. 107519
Author(s):  
Stuart Chalew ◽  
Jodi Kamps ◽  
Brittney Jurgen ◽  
Ricardo Gomez ◽  
James Hempe
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Dose ◽  
Relationship Of ◽  
The Relationship

Vitamin D status in Egyptian children with type 1 diabetes and the role of vitamin D replacement in glycemic control

2017 ◽  
Vol 30 (4) ◽  
Author(s):  
Mona Hafez ◽  
Mona Hassan ◽  
Noha Musa ◽  
Sahar Abdel Atty ◽  
Sally Abdel Azim
Keyword(s):  
Vitamin D ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Dose ◽  
Insulin Metabolism ◽  
Insulin Requirements ◽  
Daily Insulin Dose ◽  
Egyptian Children ◽  
High Glucose Level

AbstractBackground:The association of low serum 25 hydroxy cholecalciferol (25OHD) levels with high glucose level and diminished insulin sensitivity suggests that vitamin D (VD) may modulate insulin metabolism. The aim of the study was to screen for vitamin D deficiency (VDD) in pediatric patients with type 1 diabetes (T1D) and study the effect of VD supplementation on their glycemic control and insulin requirements.Methods:A prospective cohort study including 50 patients with T1D. VD level was assessed initially and after 3 months of VD supplementation (in those with VDD). HbAResults:Fifty patients with T1D were included with mean diabetes duration of 4.11±2.34 years. VD level ranged from 0.2 to 33 ng/mL. VD status correlated significantly with daily insulin dose (p=0.030, r=0.306) and HbAConclusions:VD was highly prevalent in Egyptian T1D patients. VD supplementation improved glycemic control at 3 months after therapy with no reduction in insulin requirements.

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