Objective: Several strategies to reduce the duration of post-prandial hyperglycemia in type 1 diabetes (T1D) open-loop therapy have been developed in the recent years. Although these heuristics proved to be valid options accounting for continuous glucose monitoring (CGM) trend, they present some limitations and lack of personalization, calling for a more efficient solution. Method: We developed DR-CIB, a novel algorithm for post-prandial corrective insulin bolus (CIB) suggestion based on a preventive trigger threshold exploiting the “risk of hyperglycemia” and a personalized CIB timing retrieved from patients’ specific glucose-insulin dynamics. DR-CIB has been assessed on a dataset consisting of 49 daily CGM traces recorded in real-life conditions using ReplayBG, a novel digital twinning tool that allows a retrospective assessment of alternative insulin therapies using real data. As comparators we evaluated state-of-the-art approaches proposed by Aleppo (AL), Bruttomesso (BR), and Ziegler (ZI). Efficacy of glucose control was quantified by temporal, risk, and hyperglycemic event metrics. Result: Compared to literature methods, DR-CIB significantly reduces time spent in hyperglycemia when compared to AL and BR (33.52% vs 39.76% and 36.32%, respectively); significantly reduces daily injected insulin (5.97U vs 7.5U), glycemia risk index (37.78 vs 40.78) and time spent in hypoglycemia (75th percentile from 10.23% to 1.74%) when compared to ZI, resulting overall in a safer solution. Conclusion: We proposed DR-CIB, a dynamic risk-based algorithm which allow preventive actions for ahead-in-time management of hyperglycemic events and overcome some literature limitations proposing a patient-specific timing for CIB. DR-CIB proved to be a valid alternative to the most recent heuristic literature guidelines reducing the time spent in hyperglycemia and the hyperglycemic events duration without increasing the time below hypoglycemic threshold.
DR-CIB: an Algorithm for the Preventive Administration of Corrective Insulin Boluses in Type 1 Diabetes based on Dynamic Risk Concept and Patient-Specific Timing
E. Pellizzari;F. Prendin;G. Cappon;A. Facchinetti
2023
Abstract
Objective: Several strategies to reduce the duration of post-prandial hyperglycemia in type 1 diabetes (T1D) open-loop therapy have been developed in the recent years. Although these heuristics proved to be valid options accounting for continuous glucose monitoring (CGM) trend, they present some limitations and lack of personalization, calling for a more efficient solution. Method: We developed DR-CIB, a novel algorithm for post-prandial corrective insulin bolus (CIB) suggestion based on a preventive trigger threshold exploiting the “risk of hyperglycemia” and a personalized CIB timing retrieved from patients’ specific glucose-insulin dynamics. DR-CIB has been assessed on a dataset consisting of 49 daily CGM traces recorded in real-life conditions using ReplayBG, a novel digital twinning tool that allows a retrospective assessment of alternative insulin therapies using real data. As comparators we evaluated state-of-the-art approaches proposed by Aleppo (AL), Bruttomesso (BR), and Ziegler (ZI). Efficacy of glucose control was quantified by temporal, risk, and hyperglycemic event metrics. Result: Compared to literature methods, DR-CIB significantly reduces time spent in hyperglycemia when compared to AL and BR (33.52% vs 39.76% and 36.32%, respectively); significantly reduces daily injected insulin (5.97U vs 7.5U), glycemia risk index (37.78 vs 40.78) and time spent in hypoglycemia (75th percentile from 10.23% to 1.74%) when compared to ZI, resulting overall in a safer solution. Conclusion: We proposed DR-CIB, a dynamic risk-based algorithm which allow preventive actions for ahead-in-time management of hyperglycemic events and overcome some literature limitations proposing a patient-specific timing for CIB. DR-CIB proved to be a valid alternative to the most recent heuristic literature guidelines reducing the time spent in hyperglycemia and the hyperglycemic events duration without increasing the time below hypoglycemic threshold.
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