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Nemat H, Khadem H, Elliott J, Benaissa M. Data-driven blood glucose level prediction in type 1 diabetes: a comprehensive comparative analysis. Sci Rep 2024; 14:21863. [PMID: 39300118 DOI: 10.1038/s41598-024-70277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/14/2024] [Indexed: 09/22/2024] Open
Abstract
Accurate prediction of blood glucose level (BGL) has proven to be an effective way to help in type 1 diabetes management. The choice of input, along with the fundamental choice of model structure, is an existing challenge in BGL prediction. Investigating the performance of different data-driven time series forecasting approaches with different inputs for BGL prediction is beneficial in advancing BGL prediction performance. Limited work has been made in this regard, which has resulted in different conclusions. This paper performs a comprehensive investigation of different data-driven time series forecasting approaches using different inputs. To do so, BGL prediction is comparatively investigated from two perspectives; the model's approach and the model's input. First, we compare the performance of BGL prediction using different data-driven time series forecasting approaches, including classical time series forecasting, traditional machine learning, and deep neural networks. Secondly, for each prediction approach, univariate input, using BGL data only, is compared to a multivariate input, using data on carbohydrate intake, injected bolus insulin, and physical activity in addition to BGL data. The investigation is performed on two publicly available Ohio datasets. Regression-based and clinical-based metrics along with statistical analyses are performed for evaluation and comparison purposes. The outcomes show that the traditional machine learning model is the fastest model to train and has the best BGL prediction performance especially when using multivariate input. Also, results show that simply adding extra variables does not necessarily improve BGL prediction performance significantly, and data fusion approaches may be required to effectively leverage other variables' information.
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Affiliation(s)
- Hoda Nemat
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, S1 3JD, UK.
| | - Heydar Khadem
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, S1 3JD, UK
| | - Jackie Elliott
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2RX, UK
- Diabetes and Endocrine Centre, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, UK
| | - Mohammed Benaissa
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, S1 3JD, UK
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2
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Lubasinski N, Thabit H, Nutter PW, Harper S. Blood Glucose Prediction from Nutrition Analytics in Type 1 Diabetes: A Review. Nutrients 2024; 16:2214. [PMID: 39064657 PMCID: PMC11280346 DOI: 10.3390/nu16142214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Type 1 Diabetes (T1D) affects over 9 million worldwide and necessitates meticulous self-management for blood glucose (BG) control. Utilizing BG prediction technology allows for increased BG control and a reduction in the diabetes burden caused by self-management requirements. This paper reviews BG prediction models in T1D, which include nutritional components. METHOD A systematic search, utilizing the PRISMA guidelines, identified articles focusing on BG prediction algorithms for T1D that incorporate nutritional variables. Eligible studies were screened and analyzed for model type, inclusion of additional aspects in the model, prediction horizon, patient population, inputs, and accuracy. RESULTS The study categorizes 138 blood glucose prediction models into data-driven (54%), physiological (14%), and hybrid (33%) types. Prediction horizons of ≤30 min are used in 36% of models, 31-60 min in 34%, 61-90 min in 11%, 91-120 min in 10%, and >120 min in 9%. Neural networks are the most used data-driven technique (47%), and simple carbohydrate intake is commonly included in models (data-driven: 72%, physiological: 52%, hybrid: 67%). Real or free-living data are predominantly used (83%). CONCLUSION The primary goal of blood glucose prediction in T1D is to enable informed decisions and maintain safe BG levels, considering the impact of all nutrients for meal planning and clinical relevance.
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Affiliation(s)
- Nicole Lubasinski
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
| | - Hood Thabit
- Diabetes, Endocrine and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS, Manchester M13 9WL, UK;
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Science, The University of Manchester, Manchester M13 9NT, UK
| | - Paul W. Nutter
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
| | - Simon Harper
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
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Pavan J, Noaro G, Facchinetti A, Salvagnin D, Sparacino G, Del Favero S. A strategy based on integer programming for optimal dosing and timing of preventive hypoglycemic treatments in type 1 diabetes management. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108179. [PMID: 38642427 DOI: 10.1016/j.cmpb.2024.108179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/29/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND OBJECTIVES One of the major problems related to type 1 diabetes (T1D) management is hypoglycemia, a condition characterized by low blood glucose levels and responsible for reduced quality of life and increased mortality. Fast-acting carbohydrates, also known as hypoglycemic treatments (HT), can counteract this event. In the literature, dosage and timing of HT are usually based on heuristic rules. In the present work, we propose an algorithm for mitigating hypoglycemia by suggesting preventive HT consumption, with dosages and timing determined by solving an optimization problem. METHODS By leveraging integer programming and linear inequality constraints, the algorithm can bind the amount of suggested carbohydrates to standardized quantities (i.e., those available in "off-the-shelf" HT) and the minimal distance between consecutive suggestions (to reduce the nuisance for patients). RESULTS The proposed method was tested in silico and compared with competitor algorithms using the UVa/Padova T1D simulator. At the cost of a slight increase of HT consumed per day, the proposed algorithm produces the lowest median and interquartile range of the time spent in hypoglycemia, with a statistically significant improvement over most competitor algorithms. Also, the average number of hypoglycemic events per day is reduced to 0 in median. CONCLUSIONS Thanks to its positive performances and reduced computational burden, the proposed algorithm could be a candidate tool for integration in a DSS aimed at improving T1D management.
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Affiliation(s)
- J Pavan
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - G Noaro
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - A Facchinetti
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - D Salvagnin
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - G Sparacino
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - S Del Favero
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
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Dave D, Vyas K, Branan K, McKay S, DeSalvo DJ, Gutierrez-Osuna R, Cote GL, Erraguntla M. Detection of Hypoglycemia and Hyperglycemia Using Noninvasive Wearable Sensors: Electrocardiograms and Accelerometry. J Diabetes Sci Technol 2024; 18:351-362. [PMID: 35927975 PMCID: PMC10973850 DOI: 10.1177/19322968221116393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Monitoring glucose excursions is important in diabetes management. This can be achieved using continuous glucose monitors (CGMs). However, CGMs are expensive and invasive. Thus, alternative low-cost noninvasive wearable sensors capable of predicting glycemic excursions could be a game changer to manage diabetes. METHODS In this article, we explore two noninvasive sensor modalities, electrocardiograms (ECGs) and accelerometers, collected on five healthy participants over two weeks, to predict both hypoglycemic and hyperglycemic excursions. We extract 29 features encompassing heart rate variability features from the ECG, and time- and frequency-domain features from the accelerometer. We evaluated two machine learning approaches to predict glycemic excursions: a classification model and a regression model. RESULTS The best model for both hypoglycemia and hyperglycemia detection was the regression model based on ECG and accelerometer data, yielding 76% sensitivity and specificity for hypoglycemia and 79% sensitivity and specificity for hyperglycemia. This had an improvement of 5% in sensitivity and specificity for both hypoglycemia and hyperglycemia when compared with using ECG data alone. CONCLUSIONS Electrocardiogram is a promising alternative not only to detect hypoglycemia but also to predict hyperglycemia. Supplementing ECG data with contextual information from accelerometer data can improve glucose prediction.
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Affiliation(s)
- Darpit Dave
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Kathan Vyas
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
| | - Kimberly Branan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Siripoom McKay
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Clinical Care Center, Houston, TX, USA
| | - Daniel J. DeSalvo
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Clinical Care Center, Houston, TX, USA
| | - Ricardo Gutierrez-Osuna
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
| | - Gerard L. Cote
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Madhav Erraguntla
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
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Wen S, Li H, Tao R. A 2-dimensional model framework for blood glucose prediction based on iterative learning control architecture. Med Biol Eng Comput 2023; 61:2593-2606. [PMID: 37395886 DOI: 10.1007/s11517-023-02866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023]
Abstract
The accurate, timely, and personalized prediction for future blood glucose (BG) levels is undoubtedly needed for further advancement of diabetes management technologies. Human inherent circadian rhythm and regular lifestyle resulting in similarity of daily glycemic dynamics play a positive role in the prediction of blood glucose. Inspired by the iterative learning control (ILC) method in the field of automatic control, a 2-dimensional (2-D) model framework is constructed to predict the future blood glucose levels by taking both the short-range information within a day (intra-day) and long-range information between days (inter-day) into account. In this framework, the radial basis function neural network was applied to capture nonlinear relationships in glycemic metabolism, that is, short-range temporal dependence and long-range contemporaneous dependence on previous days. We build models for each patient, and the models were tested on the in silico datasets at various prediction horizons (PHs). The learning model developed in the 2-D framework successfully increases the accuracy and reduces the delay of predictions. This modeling framework provides a new point of view for BG level prediction and contributes to the development of personalized glucose management, such as hypoglycemia warning and glycemic control.
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Affiliation(s)
- Shuang Wen
- College of Information Sciences and Engineering, Northeastern University, No. 11 St. 3, Wenhua Road, Heping District, Shenyang, 110819, People's Republic of China
| | - Hongru Li
- College of Information Sciences and Engineering, Northeastern University, No. 11 St. 3, Wenhua Road, Heping District, Shenyang, 110819, People's Republic of China.
| | - Rui Tao
- College of Information Sciences and Engineering, Northeastern University, No. 11 St. 3, Wenhua Road, Heping District, Shenyang, 110819, People's Republic of China
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Mosquera-Lopez C, Ramsey KL, Roquemen-Echeverri V, Jacobs PG. Modeling risk of hypoglycemia during and following physical activity in people with type 1 diabetes using explainable mixed-effects machine learning. Comput Biol Med 2023; 155:106670. [PMID: 36803791 DOI: 10.1016/j.compbiomed.2023.106670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/19/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Physical activity (PA) can cause increased hypoglycemia (glucose <70 mg/dL) risk in people with type 1 diabetes (T1D). We modeled the probability of hypoglycemia during and up to 24 h following PA and identified key factors associated with hypoglycemia risk. METHODS We leveraged a free-living dataset from Tidepool comprised of glucose measurements, insulin doses, and PA data from 50 individuals with T1D (6448 sessions) for training and validating machine learning models. We also used data from the T1Dexi pilot study that contains glucose management and PA data from 20 individuals with T1D (139 session) for assessing the accuracy of the best performing model on an independent test dataset. We used mixed-effects logistic regression (MELR) and mixed-effects random forest (MERF) to model hypoglycemia risk around PA. We identified risk factors associated with hypoglycemia using odds ratio and partial dependence analysis for the MELR and MERF models, respectively. Prediction accuracy was measured using the area under the receiver operating characteristic curve (AUROC). RESULTS The analysis identified risk factors significantly associated with hypoglycemia during and following PA in both MELR and MERF models including glucose and body exposure to insulin at the start of PA, low blood glucose index 24 h prior to PA, and PA intensity and timing. Both models showed overall hypoglycemia risk peaking 1 h after PA and again 5-10 h after PA, which is consistent with the hypoglycemia risk pattern observed in the training dataset. Time following PA impacted hypoglycemia risk differently across different PA types. Accuracy of hypoglycemia prediction using the fixed effects of the MERF model was highest when predicting hypoglycemia during the first hour following the start of PA (AUROCVALIDATION = 0.83 and AUROCTESTING = 0.86) and decreased when predicting hypoglycemia in the 24 h after PA (AUROCVALIDATION = 0.66 and AUROCTESTING = 0.68). CONCLUSION Hypoglycemia risk after the start of PA can be modeled using mixed-effects machine learning to identify key risk factors that may be used within decision support and insulin delivery systems. We published the population-level MERF model online for others to use.
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Affiliation(s)
- Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA.
| | - Katrina L Ramsey
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Valentina Roquemen-Echeverri
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter G Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
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Della Cioppa A, De Falco I, Koutny T, Scafuri U, Ubl M, Tarantino E. Reducing high-risk glucose forecasting errors by evolving interpretable models for Type 1 diabetes. Appl Soft Comput 2023. [DOI: 10.1016/j.asoc.2023.110012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Naveena S, Bharathi A. A new design of diabetes detection and glucose level prediction using moth flame-based crow search deep learning. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lian K, Feng H, Liu S, Wang K, Liu Q, Deng L, Wang G, Chen Y, Liu G. Insulin quantification towards early diagnosis of prediabetes/diabetes. Biosens Bioelectron 2022; 203:114029. [DOI: 10.1016/j.bios.2022.114029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
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Mosquera-Lopez C, Jacobs PG. Incorporating Glucose Variability into Glucose Forecasting Accuracy Assessment Using the New Glucose Variability Impact Index and the Prediction Consistency Index: An LSTM Case Example. J Diabetes Sci Technol 2022; 16:7-18. [PMID: 34490793 PMCID: PMC8875041 DOI: 10.1177/19322968211042621] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In this work, we developed glucose forecasting algorithms trained and evaluated on a large dataset of free-living people with type 1 diabetes (T1D) using closed-loop (CL) and sensor-augmented pump (SAP) therapies; and we demonstrate how glucose variability impacts accuracy. We introduce the glucose variability impact index (GVII) and the glucose prediction consistency index (GPCI) to assess the accuracy of prediction algorithms. METHODS A long-short-term-memory (LSTM) neural network was designed to predict glucose up to 60 minutes in the future using continuous glucose measurements and insulin data collected from 175 people with T1D (41,318 days) and evaluated on 75 people (11,333 days) from the Tidepool Big Data Donation Dataset. LSTM was compared with two naïve forecasting algorithms as well as Ridge linear regression and a random forest using root-mean-square error (RMSE). Parkes error grid quantified clinical accuracy. Regression analysis was used to derive the GVII and GPCI. RESULTS The LSTM had highest accuracy and best GVII and GPCI. RMSE for CL was 19.8 ± 3.2 and 33.2 ± 5.4 mg/dL for 30- and 60-minute prediction horizons, respectively. RMSE for SAP was 19.6 ± 3.8 and 33.1 ± 7.3 mg/dL for 30- and 60-minute prediction horizons, respectively; 99.6% and 97.6% of predictions were within zones A+B of the Parkes error grid at 30- and 60-minute prediction horizons, respectively. Glucose variability was strongly correlated with RMSE (R≥0.64, P < 0.001); GVII and GPCI demonstrated a means to compare algorithms across datasets with different glucose variability. CONCLUSIONS The LSTM model was accurate on a large real-world free-living dataset. Glucose variability should be considered when assessing prediction accuracy using indices such as GVII and GPCI.
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Affiliation(s)
- Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
- Clara Mosquera-Lopez, PhD, 3303 SW Bond Avenue, Portland, OR 97239, USA.
| | - Peter G. Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Seo W, Park SW, Kim N, Jin SM, Park SM. A personalized blood glucose level prediction model with a fine-tuning strategy: A proof-of-concept study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106424. [PMID: 34598081 DOI: 10.1016/j.cmpb.2021.106424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The accurate prediction of blood glucose (BG) level is still a challenge for diabetes management. This is due to various factors such as diet, personal physiological characteristics, stress, and activities influence changes in BG level. To develop an accurate BG level predictive model, we propose a personalized model based on a convolutional neural network (CNN) with a fine-tuning strategy. METHODS We utilized continuous glucose monitoring (CGM) datasets from 1052 professional CGM sessions and split them into three groups according to type 1, type 2, and gestational diabetes mellitus (T1DM, T2DM, and GDM, respectively). During the preprocessing, only CGM data points were utilized, and future BG levels of four different prediction horizons (PHs, 15, 30, 45, and 60 min) were used as output. In training, we trained a general CNN and a multi-output random forest regressor using a hold-out method for each group. Next, we developed two personalized models: (1) by fine-tuning the general CNN on partial sample points of each CGM dataset, and (2) by learning a CNN from scratch on the points. RESULTS For all groups, the fine-tuned CNN showed the lowest average root mean squared error, average mean absolute percentage error, highest average time gain (PH = 15 and 60 min in T1DM) and highest percentage in region A of Clarke error grid analysis at all PHs. In the performance comparison between the fine-tuned CNN and other models, we found that the fine-tuned CNN improved the performance of the general CNN in most cases and outperformed the scratch CNN at all PHs in all groups, making the fine-tuning strategy was useful for accurate BG level prediction. We analyzed all cases of four predictive patterns in each group, and found that the input BG level trend and the BG level at the time of prediction were related to the future BG level trend. CONCLUSIONS We demonstrated the efficacy of the fine-tuning method in a large number of CGM datasets and analyzed the four predictive patterns. Therefore, we believe that the proposed method will significantly contribute to the development of an accurate personalized model and the analysis for its predictions.
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Affiliation(s)
- Wonju Seo
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Republic of Korea.
| | - Sung-Woon Park
- Division of Endocrinology and Metabolism, Department of Medicine, CHA Gangnam Medical Center, CHA University, Republic of Korea
| | - Namho Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Republic of Korea.
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea.
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Republic of Korea; Department of Electrical Engineering, Pohang University of Science and Technology, Republic of Korea; Institute of Convergence Science, Yonsei University, Republic of Korea.
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Diouri O, Cigler M, Vettoretti M, Mader JK, Choudhary P, Renard E. Hypoglycaemia detection and prediction techniques: A systematic review on the latest developments. Diabetes Metab Res Rev 2021; 37:e3449. [PMID: 33763974 PMCID: PMC8519027 DOI: 10.1002/dmrr.3449] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/08/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023]
Abstract
The main objective of diabetes control is to correct hyperglycaemia while avoiding hypoglycaemia, especially in insulin-treated patients. Fear of hypoglycaemia is a hurdle to effective correction of hyperglycaemia because it promotes under-dosing of insulin. Strategies to minimise hypoglycaemia include education and training for improved hypoglycaemia awareness and the development of technologies to allow their early detection and thus minimise their occurrence. Patients with impaired hypoglycaemia awareness would benefit the most from these technologies. The purpose of this systematic review is to review currently available or in-development technologies that support detection of hypoglycaemia or hypoglycaemia risk, and identify gaps in the research. Nanomaterial use in sensors is a promising strategy to increase the accuracy of continuous glucose monitoring devices for low glucose values. Hypoglycaemia is associated with changes on vital signs, so electrocardiogram and encephalogram could also be used to detect hypoglycaemia. Accuracy improvements through multivariable measures can make already marketed galvanic skin response devices a good noninvasive alternative. Breath volatile organic compounds can be detected by dogs and devices and alert patients at hypoglycaemia onset, while near-infrared spectroscopy can also be used as a hypoglycaemia alarms. Finally, one of the main directions of research are deep learning algorithms to analyse continuous glucose monitoring data and provide earlier and more accurate prediction of hypoglycaemia. Current developments for early identification of hypoglycaemia risk combine improvements of available 'needle-type' enzymatic glucose sensors and noninvasive alternatives. Patient usability will be essential to demonstrate to allow their implementation for daily use in diabetes management.
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Affiliation(s)
- Omar Diouri
- Department of Endocrinology, Diabetes, NutritionMontpellier University HospitalMontpellierFrance
- Department of PhysiologyInstitute of Functional Genomics, CNRS, INSERMUniversity of MontpellierMontpellierFrance
| | - Monika Cigler
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | | | - Julia K. Mader
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - Pratik Choudhary
- Department of Diabetes and Nutritional SciencesKing's College LondonLondonUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Eric Renard
- Department of Endocrinology, Diabetes, NutritionMontpellier University HospitalMontpellierFrance
- Department of PhysiologyInstitute of Functional Genomics, CNRS, INSERMUniversity of MontpellierMontpellierFrance
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Felizardo V, Garcia NM, Pombo N, Megdiche I. Data-based algorithms and models using diabetics real data for blood glucose and hypoglycaemia prediction - A systematic literature review. Artif Intell Med 2021; 118:102120. [PMID: 34412843 DOI: 10.1016/j.artmed.2021.102120] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM Hypoglycaemia prediction play an important role in diabetes management being able to reduce the number of dangerous situations. Thus, it is relevant to present a systematic review on the currently available prediction algorithms and models for hypoglycaemia (or hypoglycemia in US English) prediction. METHODS This study aims to systematically review the literature on data-based algorithms and models using diabetics real data for hypoglycaemia prediction. Five electronic databases were screened for studies published from January 2014 to June 2020: ScienceDirect, IEEE Xplore, ACM Digital Library, SCOPUS, and PubMed. RESULTS Sixty-three eligible studies were retrieved that met the inclusion criteria. The review identifies the current trend in this topic: most of the studies perform short-term predictions (82.5%). Also, the review pinpoints the inputs and shows that information fusion is relevant for hypoglycaemia prediction. Regarding data-based models (80.9%) and hybrid models (19.1%) different predictive techniques are used: Artificial neural network (22.2%), ensemble learning (27.0%), supervised learning (20.6%), statistic/probabilistic (7.9%), autoregressive (7.9%), evolutionary (6.4%), deep learning (4.8%) and adaptative filter (3.2%). Artificial Neural networks and hybrid models show better results. CONCLUSIONS The data-based models for blood glucose and hypoglycaemia prediction should be able to provide a good balance between the applicability and performance, integrating complementary data from different sources or from different models. This review identifies trends and possible opportunities for research in this topic.
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Affiliation(s)
- Virginie Felizardo
- Instituto de Telecomunicações, Covilhã, Portugal; Universidade da Beira Interior, Covilhã, Portugal.
| | - Nuno M Garcia
- Instituto de Telecomunicações, Covilhã, Portugal; Universidade da Beira Interior, Covilhã, Portugal.
| | - Nuno Pombo
- Instituto de Telecomunicações, Covilhã, Portugal; Universidade da Beira Interior, Covilhã, Portugal.
| | - Imen Megdiche
- IRIT, Institut de Recherche en Informatique de Toulouse, Toulouse University, France.
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Faccioli S, Facchinetti A, Sparacino G, Pillonetto G, Del Favero S. Linear Model Identification for Personalized Prediction and Control in Diabetes. IEEE Trans Biomed Eng 2021; 69:558-568. [PMID: 34347589 DOI: 10.1109/tbme.2021.3101589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Type-1 diabetes (T1D) is a metabolic disease, characterized by impaired blood glucose (BG) regulation, which forces patients to multiple daily therapeutic actions, the most critical of which is exogenous insulin administration. T1D management can considerably benefit of mathematical models enabling accurate BG predictions and effective/safe automated insulin delivery. In building these models, dealing with large inter- and intra-patient variability in glucose-insulin dynamics represents a major challenge. The aim of the present work is to assess linear black-box methods, including a novel non-parametric methodology, for learning individualized models of glucose response to insulin and meal, suitable for model-based prediction and control. METHODS We focus on data-driven techniques for linear model-learning and compare the state-of-art parametric pipeline, exploring all its degrees of freedom (including population vs. individualized parameter identification, model class chosen among ARX/ARMAX/ARIMAX/Box-Jenkins, model order selection criteria, etc.), with a novel non-parametric approach based on Gaussian regression and stable spline kernel. By using data collected in 11 T1D individuals, we evaluate effectiveness of the different models by measuring root mean squared error (RMSE), coefficient of determination (COD), and time gain of the associated BG predictors. RESULTS Among the tested approaches, the non-parametric technique results in the best prediction performance: median RMSE=29.8mg/dL, and median COD=57.4%, for a prediction horizon (PH) of 60 min. With respect to the state-of-the-art parametric techniques, the non-parametric approach grants a COD improvement of about 2%, 7%, 21%, and 41% for PH = 30, 60, 90, and 120 min (paired-sample t-test p 0.001, p=0.003, p=0.03, and p=0.07 respectively). CONCLUSION Non-parametric linear model-learning grants statistically significant improvement with respect to the state-of-art parametric approach. The higher PH, the more pronounced the improvement. SIGNIFICANCE The use of a linear non-parametric model-learning approach for model-based prediction and control could bring to a more prompt, safe and effective T1D management.
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van den Boorn M, Lagerburg V, van Steen SCJ, Wedzinga R, Bosman RJ, van der Voort PHJ. The development of a glucose prediction model in critically ill patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 206:106105. [PMID: 33979752 DOI: 10.1016/j.cmpb.2021.106105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE The aim of the current study is to develop a prediction model for glucose levels applicable for all patients admitted to the ICU with an expected ICU stay of at least 24 h. This model will be incorporated in a closed-loop glucose system to continuously and automatically control glucose values. METHODS Data from a previous single-center randomized controlled study was used. All patients received a FreeStyle Navigator II subcutaneous CGM system from Abbott during their ICU stay. The total dataset was randomly divided into a training set and a validation set. A glucose prediction model was developed based on historical glucose data. Accuracy of the prediction model was determined using the Mean Squared Difference (MSD), the Mean Absolute Difference (MAD) and a Clarke Error Grid (CEG). RESULTS The dataset included 94 ICU patients with a total of 134,673 glucose measurements points that were used for modelling. MSD was 0.410 ± 0.495 for the model, the MAD was 5.19 ± 2.63 and in the CEG 99.8% of the data points were in the clinically acceptable regions. CONCLUSION In this study a glucose prediction model for ICU patients is developed. This study shows that it is possible to accurately predict a patient's glucose 30 min ahead based on historical glucose data. This is the first step in the development of a closed-loop glucose system.
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Affiliation(s)
- M van den Boorn
- OLVG, Department of Intensive Care, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - V Lagerburg
- OLVG, Medical Physics, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - S C J van Steen
- OLVG, Department of Intensive Care, Oosterpark 9, 1091 AC Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Endocrinology, Meibergdreef 9, Amsterdam, Netherlands
| | - R Wedzinga
- OLVG, Department of Intensive Care, Oosterpark 9, 1091 AC Amsterdam, The Netherlands; OLVG, Medical Physics, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - R J Bosman
- OLVG, Department of Intensive Care, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - P H J van der Voort
- University of Groningen, University Medical Center Groningen, Department of Intensive Care, Hanzeplein 2, 9713GZ Groningen, The Netherlands
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Dave D, DeSalvo DJ, Haridas B, McKay S, Shenoy A, Koh CJ, Lawley M, Erraguntla M. Feature-Based Machine Learning Model for Real-Time Hypoglycemia Prediction. J Diabetes Sci Technol 2021; 15:842-855. [PMID: 32476492 PMCID: PMC8258517 DOI: 10.1177/1932296820922622] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypoglycemia is a serious health concern in youth with type 1 diabetes (T1D). Real-time data from continuous glucose monitoring (CGM) can be used to predict hypoglycemic risk, allowing patients to take timely intervention measures. METHODS A machine learning model is developed for probabilistic prediction of hypoglycemia (<70 mg/dL) in 30- and 60-minute time horizons based on CGM datasets obtained from 112 patients over a range of 90 days consisting of over 1.6 million CGM values under normal living conditions. A comprehensive set of features relevant for hypoglycemia are developed and a parsimonious subset with most influence on predicting hypoglycemic risk is identified. Model performance is evaluated both with and without contextual information on insulin and carbohydrate intake. RESULTS The model predicted hypoglycemia with >91% sensitivity for 30- and 60-minute prediction horizons while maintaining specificity >90%. Inclusion of insulin and carbohydrate data yielded performance improvement for 60-minute but not for 30-minute predictions. Model performance was highest for nocturnal hypoglycemia (~95% sensitivity). Shortterm (less than one hour) and medium-term (one to four hours) features for good prediction performance are identified. CONCLUSIONS Innovative feature identification facilitated high performance for hypoglycemia risk prediction in pediatric youth with T1D. Timely alerts of impending hypoglycemia may enable proactive measures to avoid severe hypoglycemia and achieve optimal glycemic control. The model will be deployed on a patient-facing smartphone application in an upcoming pilot study.
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Affiliation(s)
- Darpit Dave
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Daniel J. DeSalvo
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Balakrishna Haridas
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Siripoom McKay
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | | | - Chester J. Koh
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Madhav Erraguntla
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
- Madhav Erraguntla, PhD, Department of Industrial and Systems Engineering, Texas A&M University, 4021 Emerging Technology Building, College Station, TX 77843, USA.
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Dave D, Erraguntla M, Lawley M, DeSalvo D, Haridas B, McKay S, Koh C. Improved Low-Glucose Predictive Alerts Based on Sustained Hypoglycemia: Model Development and Validation Study. JMIR Diabetes 2021; 6:e26909. [PMID: 33913816 PMCID: PMC8120423 DOI: 10.2196/26909] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Predictive alerts for impending hypoglycemic events enable persons with type 1 diabetes to take preventive actions and avoid serious consequences. OBJECTIVE This study aimed to develop a prediction model for hypoglycemic events with a low false alert rate, high sensitivity and specificity, and good generalizability to new patients and time periods. METHODS Performance improvement by focusing on sustained hypoglycemic events, defined as glucose values less than 70 mg/dL for at least 15 minutes, was explored. Two different modeling approaches were considered: (1) a classification-based method to directly predict sustained hypoglycemic events, and (2) a regression-based prediction of glucose at multiple time points in the prediction horizon and subsequent inference of sustained hypoglycemia. To address the generalizability and robustness of the model, two different validation mechanisms were considered: (1) patient-based validation (model performance was evaluated on new patients), and (2) time-based validation (model performance was evaluated on new time periods). RESULTS This study utilized data from 110 patients over 30-90 days comprising 1.6 million continuous glucose monitoring values under normal living conditions. The model accurately predicted sustained events with >97% sensitivity and specificity for both 30- and 60-minute prediction horizons. The false alert rate was kept to <25%. The results were consistent across patient- and time-based validation strategies. CONCLUSIONS Providing alerts focused on sustained events instead of all hypoglycemic events reduces the false alert rate and improves sensitivity and specificity. It also results in models that have better generalizability to new patients and time periods.
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Affiliation(s)
- Darpit Dave
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Madhav Erraguntla
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Daniel DeSalvo
- Department of Pediatrics, Baylor College of Medicine / Texas Children's Hospital, Houston, TX, United States
| | - Balakrishna Haridas
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States
| | - Siripoom McKay
- Department of Pediatrics, Baylor College of Medicine / Texas Children's Hospital, Houston, TX, United States
| | - Chester Koh
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, United States
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
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Data size considerations and hyperparameter choices in case-based reasoning approach to glucose prediction. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Prendin F, Del Favero S, Vettoretti M, Sparacino G, Facchinetti A. Forecasting of Glucose Levels and Hypoglycemic Events: Head-to-Head Comparison of Linear and Nonlinear Data-Driven Algorithms Based on Continuous Glucose Monitoring Data Only. SENSORS 2021; 21:s21051647. [PMID: 33673415 PMCID: PMC7956406 DOI: 10.3390/s21051647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
Abstract
In type 1 diabetes management, the availability of algorithms capable of accurately forecasting future blood glucose (BG) concentrations and hypoglycemic episodes could enable proactive therapeutic actions, e.g., the consumption of carbohydrates to mitigate, or even avoid, an impending critical event. The only input of this kind of algorithm is often continuous glucose monitoring (CGM) sensor data, because other signals (such as injected insulin, ingested carbs, and physical activity) are frequently unavailable. Several predictive algorithms fed by CGM data only have been proposed in the literature, but they were assessed using datasets originated by different experimental protocols, making a comparison of their relative merits difficult. The aim of the present work was to perform a head-to-head comparison of thirty different linear and nonlinear predictive algorithms using the same dataset, given by 124 CGM traces collected over 10 days with the newest Dexcom G6 sensor available on the market and considering a 30-min prediction horizon. We considered the state-of-the art methods, investigating, in particular, linear black-box methods (autoregressive; autoregressive moving-average; and autoregressive integrated moving-average, ARIMA) and nonlinear machine-learning methods (support vector regression, SVR; regression random forest; feed-forward neural network, fNN; and long short-term memory neural network). For each method, the prediction accuracy and hypoglycemia detection capabilities were assessed using either population or individualized model parameters. As far as prediction accuracy is concerned, the results show that the best linear algorithm (individualized ARIMA) provides accuracy comparable to that of the best nonlinear algorithm (individualized fNN), with root mean square errors of 22.15 and 21.52 mg/dL, respectively. As far as hypoglycemia detection is concerned, the best linear algorithm (individualized ARIMA) provided precision = 64%, recall = 82%, and one false alarm/day, comparable to the best nonlinear technique (population SVR): precision = 63%, recall = 69%, and 0.5 false alarms/day. In general, the head-to-head comparison of the thirty algorithms fed by CGM data only made using a wide dataset shows that individualized linear models are more effective than population ones, while no significant advantages seem to emerge when employing nonlinear methodologies.
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Mohebbi A, Johansen AR, Hansen N, Christensen PE, Tarp JM, Jensen ML, Bengtsson H, Morup M. Short Term Blood Glucose Prediction based on Continuous Glucose Monitoring Data. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5140-5145. [PMID: 33019143 DOI: 10.1109/embc44109.2020.9176695] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Continuous Glucose Monitoring (CGM) has enabled important opportunities for diabetes management. This study explores the use of CGM data as input for digital decision support tools. We investigate how Recurrent Neural Networks (RNNs) can be used for Short Term Blood Glucose (STBG) prediction and compare the RNNs to conventional time-series forecasting using Autoregressive Integrated Moving Average (ARIMA). A prediction horizon up to 90 min into the future is considered. In this context, we evaluate both population-based and patient-specific RNNs and contrast them to patient-specific ARIMA models and a simple baseline predicting future observations as the last observed. We find that the population-based RNN model is the best performing model across the considered prediction horizons without the need of patient-specific data. This demonstrates the potential of RNNs for STBG prediction in diabetes patients towards detecting/mitigating severe events in the STBG, in particular hypoglycemic events. However, further studies are needed in regards to the robustness and practical use of the investigated STBG prediction models.
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After-meal blood glucose level prediction using an absorption model for neural network training. Comput Biol Med 2020; 125:103956. [DOI: 10.1016/j.compbiomed.2020.103956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022]
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Advanced Diabetes Management Using Artificial Intelligence and Continuous Glucose Monitoring Sensors. SENSORS 2020; 20:s20143870. [PMID: 32664432 PMCID: PMC7412387 DOI: 10.3390/s20143870] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
Wearable continuous glucose monitoring (CGM) sensors are revolutionizing the treatment of type 1 diabetes (T1D). These sensors provide in real-time, every 1-5 min, the current blood glucose concentration and its rate-of-change, two key pieces of information for improving the determination of exogenous insulin administration and the prediction of forthcoming adverse events, such as hypo-/hyper-glycemia. The current research in diabetes technology is putting considerable effort into developing decision support systems for patient use, which automatically analyze the patient's data collected by CGM sensors and other portable devices, as well as providing personalized recommendations about therapy adjustments to patients. Due to the large amount of data collected by patients with T1D and their variety, artificial intelligence (AI) techniques are increasingly being adopted in these decision support systems. In this paper, we review the state-of-the-art methodologies using AI and CGM sensors for decision support in advanced T1D management, including techniques for personalized insulin bolus calculation, adaptive tuning of bolus calculator parameters and glucose prediction.
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Xie J, Wang Q. Benchmarking Machine Learning Algorithms on Blood Glucose Prediction for Type I Diabetes in Comparison With Classical Time-Series Models. IEEE Trans Biomed Eng 2020; 67:3101-3124. [PMID: 32091990 DOI: 10.1109/tbme.2020.2975959] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This paper aims to compare the performance of several commonly known machine-learning (ML) models versus a classic Autoregression with Exogenous inputs (ARX) model in the prediction of blood glucose (BG) levels using time-series data of patients with Type 1 diabetes (T1D). METHODS The ML algorithms include ML-based regression models and deep learning models such as a vanilla Long-Short-Term-Memory (LSTM) Network and a Temporal Convolution Network (TCN). Evaluations have been conducted with respect to different input features, regression model orders, as well as using the recursive method or direct method for multi-step prediction of BG levels. Prediction performance metrics include the average Root Mean Square Error (RMSE), temporal gain (TG) for early prediction, and the normalized energy of the second-order differences (ESOD) of the predicted time series to reflect risk of false alerts on hypo/hyper glycemia events. RESULTS The ARX model achieved the lowest average RMSE for both recursive and direct methods, the second highest average TG under the direct method, but with a higher average normalized ESOD than some other models. CONCLUSION There was no significant advantage observed from the ML models compared to the classic ARX model in predicting BG levels for T1D, except that TCN's performance was more robust with respect to BG trajectories with spurious oscillations, for which ARX tended to over-predict peak BG values and under-predict valley BG values. SIGNIFICANCE Insight learned from this study could help researchers and clinical practitioners to select appropriate models for BG prediction.
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Seo W, Lee YB, Lee S, Jin SM, Park SM. A machine-learning approach to predict postprandial hypoglycemia. BMC Med Inform Decis Mak 2019; 19:210. [PMID: 31694629 PMCID: PMC6833234 DOI: 10.1186/s12911-019-0943-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For an effective artificial pancreas (AP) system and an improved therapeutic intervention with continuous glucose monitoring (CGM), predicting the occurrence of hypoglycemia accurately is very important. While there have been many studies reporting successful algorithms for predicting nocturnal hypoglycemia, predicting postprandial hypoglycemia still remains a challenge due to extreme glucose fluctuations that occur around mealtimes. The goal of this study is to evaluate the feasibility of easy-to-use, computationally efficient machine-learning algorithm to predict postprandial hypoglycemia with a unique feature set. METHODS We use retrospective CGM datasets of 104 people who had experienced at least one hypoglycemia alert value during a three-day CGM session. The algorithms were developed based on four machine learning models with a unique data-driven feature set: a random forest (RF), a support vector machine using a linear function or a radial basis function, a K-nearest neighbor, and a logistic regression. With 5-fold cross-subject validation, the average performance of each model was calculated to compare and contrast their individual performance. The area under a receiver operating characteristic curve (AUC) and the F1 score were used as the main criterion for evaluating the performance. RESULTS In predicting a hypoglycemia alert value with a 30-min prediction horizon, the RF model showed the best performance with the average AUC of 0.966, the average sensitivity of 89.6%, the average specificity of 91.3%, and the average F1 score of 0.543. In addition, the RF showed the better predictive performance for postprandial hypoglycemic events than other models. CONCLUSION In conclusion, we showed that machine-learning algorithms have potential in predicting postprandial hypoglycemia, and the RF model could be a better candidate for the further development of postprandial hypoglycemia prediction algorithm to advance the CGM technology and the AP technology further.
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Affiliation(s)
- Wonju Seo
- Department of Creative IT engineering, POSTECH, 77, Cheongam-Ro, Nam-Gu, Pohang, 37673, Republic of Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Seoul, 06351, Republic of Korea
| | - Seunghyun Lee
- Department of Creative IT engineering, POSTECH, 77, Cheongam-Ro, Nam-Gu, Pohang, 37673, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Seoul, 06351, Republic of Korea.
| | - Sung-Min Park
- Department of Creative IT engineering, POSTECH, 77, Cheongam-Ro, Nam-Gu, Pohang, 37673, Republic of Korea.
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Vettoretti M, Facchinetti A. Combining continuous glucose monitoring and insulin pumps to automatically tune the basal insulin infusion in diabetes therapy: a review. Biomed Eng Online 2019; 18:37. [PMID: 30922295 PMCID: PMC6440103 DOI: 10.1186/s12938-019-0658-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/20/2019] [Indexed: 12/19/2022] Open
Abstract
For individuals affected by Type 1 diabetes (T1D), a chronic disease in which the pancreas does not produce any insulin, maintaining the blood glucose (BG) concentration as much as possible within the safety range (70–180 mg/dl) allows avoiding short- and long-term complications. The tuning of exogenous insulin infusion can be difficult, especially because of the inter- and intra-day variability of physiological and behavioral factors. Continuous glucose monitoring (CGM) sensors, which monitor glucose concentration in the subcutaneous tissue almost continuously, allowed improving the detection of critical hypo- and hyper-glycemic episodes. Moreover, their integration with insulin pumps for continuous subcutaneous insulin infusion allowed developing algorithms that automatically tune insulin dosing based on CGM measurements in order to mitigate the incidence of critical episodes. In this work, we aim at reviewing the literature on methods for CGM-based automatic attenuation or suspension of basal insulin with a focus on algorithms, their implementation in commercial devices and clinical evidence of their effectiveness and safety.
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Affiliation(s)
- Martina Vettoretti
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131, Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131, Padova, Italy.
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Short-term prediction of glucose in type 1 diabetes using kernel adaptive filters. Med Biol Eng Comput 2018; 57:27-46. [PMID: 29967934 DOI: 10.1007/s11517-018-1859-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
This study aims at presenting a nonlinear, recursive, multivariate prediction model of the subcutaneous glucose concentration in type 1 diabetes. Nonlinear regression is performed in a reproducing kernel Hilbert space, by either the fixed budget quantized kernel least mean square (QKLMS-FB) or the approximate linear dependency kernel recursive least-squares (KRLS-ALD) algorithm, such that a sparse model structure is accomplished. A multivariate feature set (i.e., subcutaneous glucose, food carbohydrates, insulin regime and physical activity) is used and its influence on short-term glucose prediction is investigated. The method is evaluated using data from 15 patients with type 1 diabetes in free-living conditions. In the case when all the input variables are considered: (i) the average root mean squared error (RMSE) of QKLMS-FB increases from 13.1 mg dL-1 (mean absolute percentage error (MAPE) 6.6%) for a 15-min prediction horizon (PH) to 37.7 mg dL-1 (MAPE 20.8%) for a 60-min PH and (ii) the RMSE of KRLS-ALD, being predictably lower, increases from 10.5 mg dL-1 (MAPE 5.2%) for a 15-min PH to 31.8 mg dL-1 (MAPE 18.0%) for a 60-min PH. Multivariate data improve systematically both the regularity and the time lag of the predictions, reducing the errors in critical glucose value regions for a PH ≥ 30 min. Graphical abstract ᅟ.
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Yang J, Li L, Shi Y, Xie X. An ARIMA Model With Adaptive Orders for Predicting Blood Glucose Concentrations and Hypoglycemia. IEEE J Biomed Health Inform 2018; 23:1251-1260. [PMID: 29993728 DOI: 10.1109/jbhi.2018.2840690] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The continuous glucose monitoring system is an effective tool, which enables the users to monitor their blood glucose (BG) levels. Based on the continuous glucose monitoring (CGM) data, we aim at predicting future BG levels so that appropriate actions can be taken in advance to prevent hyperglycemia or hypoglycemia. Due to the time-varying nonstationarity of CGM data, verified by Augmented Dickey-Fuller test and analysis of variance, an autoregressive integrated moving average (ARIMA) model with an adaptive identification algorithm of model orders is proposed in the prediction framework. Such identification algorithm adaptively determines the model orders and simultaneously estimates the corresponding parameters using Akaike Information Criterion and least square estimation. A case study is conducted with the CGM data of diabetics under daily living conditions to analyze the prediction performance of the proposed model together with the early hypoglycemic alarms. Results show that the proposed model outperforms the adaptive univariate model and ARIMA model.
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Gadaleta M, Facchinetti A, Grisan E, Rossi M. Prediction of Adverse Glycemic Events From Continuous Glucose Monitoring Signal. IEEE J Biomed Health Inform 2018; 23:650-659. [PMID: 29993992 DOI: 10.1109/jbhi.2018.2823763] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The most important objective of any diabetes therapy is to maintain the blood glucose concentration within the euglycemic range, avoiding or at least mitigating critical hypo/hyperglycemic episodes. Modern continuous glucose monitoring (CGM) devices bear the promise of providing the patients with an increased and timely awareness of glycemic conditions as these get dangerously near to hypo/hyperglycemia. The challenge is to detect, with reasonable advance, the patterns leading to risky situations, allowing the patient to make therapeutic decisions on the basis of future (predicted) glucose concentration levels. We underline that a technically sound performance comparison of the approaches proposed in recent years has yet to be done, thus it is unclear which one is preferred. The aim of this study is to fill this gap by carrying out a comparative analysis among the most common methods for glucose event prediction. Both regression and classification algorithms have been implemented and analyzed, including static and dynamic training approaches. The dataset consists of 89 CGM time series measured in diabetic subjects for 7 subsequent days. Performance metrics, specifically defined to assess and compare the event-prediction capabilities of the methods, have been introduced and analyzed. Our numerical results show that a static training approach exhibits better performance, in particular when regression methods are considered. However, classifiers show some improvement when trained for a specific event category, such as hyperglycemia, achieving performance comparable to the regressors, with the advantage of predicting the events sooner.
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Ben Ali J, Hamdi T, Fnaiech N, Di Costanzo V, Fnaiech F, Ginoux JM. Continuous blood glucose level prediction of Type 1 Diabetes based on Artificial Neural Network. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2018.06.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Frandes M, Timar B, Timar R, Lungeanu D. Chaotic time series prediction for glucose dynamics in type 1 diabetes mellitus using regime-switching models. Sci Rep 2017; 7:6232. [PMID: 28740090 PMCID: PMC5524948 DOI: 10.1038/s41598-017-06478-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/13/2017] [Indexed: 11/09/2022] Open
Abstract
In patients with type 1 diabetes mellitus (T1DM), glucose dynamics are influenced by insulin reactions, diet, lifestyle, etc., and characterized by instability and nonlinearity. With the objective of a dependable decision support system for T1DM self-management, we aim to model glucose dynamics using their nonlinear chaotic properties. A group of patients was monitored via continuous glucose monitoring (CGM) sensors for several days under free-living conditions. We assessed the glycemic variability (GV) and chaotic properties of each time series. Time series were subsequently transformed into the phase-space and individual autoregressive (AR) models were applied to predict glucose values over 30-minute and 60-minute prediction horizons (PH). The logistic smooth transition AR (LSTAR) model provided the best prediction accuracy for patients with high GV. For a PH of 30 minutes, the average values of root mean squared error (RMSE) and mean absolute error (MAE) for the LSTAR model in the case of patients in the hypoglycemia range were 5.83 ( ± 1.95) mg/dL and 5.18 ( ± 1.64) mg/dL, respectively. For a PH of 60 minutes, the average values of RMSE and MAE were 7.43 ( ± 1.87) mg/dL and 6.54 ( ± 1.6) mg/dL, respectively. Without the burden of measuring exogenous information, nonlinear regime-switching AR models provided fast and accurate results for glucose prediction.
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Affiliation(s)
- Mirela Frandes
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Bogdan Timar
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. .,"Pius Brinzeu" Emergency Hospital, Timisoara, Romania.
| | - Romulus Timar
- Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,"Pius Brinzeu" Emergency Hospital, Timisoara, Romania
| | - Diana Lungeanu
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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Continuous Glucose Monitoring Sensors: Past, Present and Future Algorithmic Challenges. SENSORS 2016; 16:s16122093. [PMID: 27941663 PMCID: PMC5191073 DOI: 10.3390/s16122093] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/17/2016] [Accepted: 12/07/2016] [Indexed: 11/18/2022]
Abstract
Continuous glucose monitoring (CGM) sensors are portable devices that allow measuring and visualizing the glucose concentration in real time almost continuously for several days and are provided with hypo/hyperglycemic alerts and glucose trend information. CGM sensors have revolutionized Type 1 diabetes (T1D) management, improving glucose control when used adjunctively to self-monitoring blood glucose systems. Furthermore, CGM devices have stimulated the development of applications that were impossible to create without a continuous-time glucose signal, e.g., real-time predictive alerts of hypo/hyperglycemic episodes based on the prediction of future glucose concentration, automatic basal insulin attenuation methods for hypoglycemia prevention, and the artificial pancreas. However, CGM sensors’ lack of accuracy and reliability limited their usability in the clinical practice, calling upon the academic community for the development of suitable signal processing methods to improve CGM performance. The aim of this paper is to review the past and present algorithmic challenges of CGM sensors, to show how they have been tackled by our research group, and to identify the possible future ones.
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