Cescon M, Deshpande S, Nimri R, Doyle Iii FJ, Dassau E. Using Iterative Learning for Insulin Dosage Optimization in Multiple-Daily-Injections Therapy for People With Type 1 Diabetes.
IEEE Trans Biomed Eng 2021;
68:482-491. [PMID:
32746043 DOI:
10.1109/tbme.2020.3005622]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE
In this work, we design iterative algorithms for the delivery of long-acting (basal) and rapid-acting (bolus) insulin, respectively, for people with type 1 diabetes (T1D) on multiple-daily-injections (MDIs) therapy using feedback from self-monitoring of blood glucose (SMBG) measurements.
METHODS
Iterative learning control (ILC) updates basal therapy consisting of one long-acting insulin injection per day, while run-to-run (R2R) adapts meal bolus therapy via the update of the mealtime-specific insulin-to-carbohydrate ratio (CR). Updates are due weekly and are based upon sparse SMBG measurements.
RESULTS
Upon termination of the 20 weeks long in-silico trial, in a scenario characterized by meal carbohydrate (CHO) normally distributed with mean μ = [50, 75, 75] grams and standard deviation σ = [5, 7, 7] grams, our strategy produced statistically significant improvements in time in range (70--180) [mg/dl], from 66.9(33.1) % to 93.6(6.7) %, p = 0.02.
CONCLUSIONS
Iterative learning shows potential to improve glycemic regulation over time by driving blood glucose closer to the recommended glycemic targets.
SIGNIFICANCE
Decision support systems (DSSs) and automated therapy advisors such as the one proposed here are expected to improve glycemic outcomes reducing the burden on patients on MDI therapy.
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