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Prandial insulin dosing using run-to-run control: application of clinical data and medical expertise to define a suitable performance metric.
Diabetes Care. 2007 May; 30(5):1131-6.DC

Abstract

OBJECTIVE

We propose a novel algorithm to adjust prandial insulin dose using sparse blood glucose measurements. The dose is adjusted on the basis of a performance measure for the same meal on the previous day. We determine the best performance measure and tune the algorithm to match the recommendations of experienced physicians.

RESEARCH DESIGN AND METHODS

Eleven subjects with type 1 diabetes, using continuous subcutaneous insulin infusion, were recruited (seven women and four men, aged 21-65 years with A1C of 7.1 +/- 1.3%). Basal insulin infusion rates were optimized. Target carbohydrate content for the lunch meal was calculated on the basis of a weight-maintenance diet. Over a period of 2-4 days, subjects were asked to measure their blood glucose according to the algorithm's protocol. Starting with their usual insulin-to-carbohydrate ratio, the insulin bolus dose was titrated downward until postprandial glucose levels were high (180-250 mg/dl [10-14 mmol/l]). Subsequently, physicians made insulin bolus recommendations to normalize postprandial glucose concentrations. Graphical methods were then used to determine the most appropriate performance measure for the algorithm to match the physician's decisions. For the best performance measure, the gain of the controller was determined to be the best match to the dose recommendations of the physicians.

RESULTS

The correlation between the clinically determined dose adjustments and those of the algorithm is R2 = 0.95, P < 1e - 18.

CONCLUSIONS

We have shown how engineering methods can be melded with medical expertise to develop and refine a dosing algorithm. This algorithm has the potential of drastically simplifying the determination of correct insulin-to-carbohydrate ratios.

Links

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Authors+Show Affiliations

Palerm CC
Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA 93106-5080, USA.
Zisser H
No affiliation info available
Bevier WC
No affiliation info available
Jovanovic L
No affiliation info available
Doyle FJ
No affiliation info available

MeSH

AlgorithmsBlood GlucoseDiabetes Mellitus, Type 1Dose-Response Relationship, DrugDrug Administration ScheduleEatingHumansInsulin Infusion SystemsPostprandial PeriodTime Factors

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17303792

Clinical Trial Links

Controlled Insulin Delivery: Combining Technology With Treatment

Citation

Palerm, Cesar C., et al. "Prandial Insulin Dosing Using Run-to-run Control: Application of Clinical Data and Medical Expertise to Define a Suitable Performance Metric." Diabetes Care, vol. 30, no. 5, 2007, pp. 1131-6.
Palerm CC, Zisser H, Bevier WC, et al. Prandial insulin dosing using run-to-run control: application of clinical data and medical expertise to define a suitable performance metric. Diabetes Care. 2007;30(5):1131-6.
Palerm, C. C., Zisser, H., Bevier, W. C., Jovanovic, L., & Doyle, F. J. (2007). Prandial insulin dosing using run-to-run control: application of clinical data and medical expertise to define a suitable performance metric. Diabetes Care, 30(5), 1131-6.
Palerm CC, et al. Prandial Insulin Dosing Using Run-to-run Control: Application of Clinical Data and Medical Expertise to Define a Suitable Performance Metric. Diabetes Care. 2007;30(5):1131-6. PubMed PMID: 17303792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prandial insulin dosing using run-to-run control: application of clinical data and medical expertise to define a suitable performance metric. AU - Palerm,Cesar C, AU - Zisser,Howard, AU - Bevier,Wendy C, AU - Jovanovic,Lois, AU - Doyle,Francis J,3rd Y1 - 2007/02/15/ PY - 2007/2/17/pubmed PY - 2007/6/15/medline PY - 2007/2/17/entrez SP - 1131 EP - 6 JF - Diabetes care JO - Diabetes Care VL - 30 IS - 5 N2 - OBJECTIVE: We propose a novel algorithm to adjust prandial insulin dose using sparse blood glucose measurements. The dose is adjusted on the basis of a performance measure for the same meal on the previous day. We determine the best performance measure and tune the algorithm to match the recommendations of experienced physicians. RESEARCH DESIGN AND METHODS: Eleven subjects with type 1 diabetes, using continuous subcutaneous insulin infusion, were recruited (seven women and four men, aged 21-65 years with A1C of 7.1 +/- 1.3%). Basal insulin infusion rates were optimized. Target carbohydrate content for the lunch meal was calculated on the basis of a weight-maintenance diet. Over a period of 2-4 days, subjects were asked to measure their blood glucose according to the algorithm's protocol. Starting with their usual insulin-to-carbohydrate ratio, the insulin bolus dose was titrated downward until postprandial glucose levels were high (180-250 mg/dl [10-14 mmol/l]). Subsequently, physicians made insulin bolus recommendations to normalize postprandial glucose concentrations. Graphical methods were then used to determine the most appropriate performance measure for the algorithm to match the physician's decisions. For the best performance measure, the gain of the controller was determined to be the best match to the dose recommendations of the physicians. RESULTS: The correlation between the clinically determined dose adjustments and those of the algorithm is R2 = 0.95, P < 1e - 18. CONCLUSIONS: We have shown how engineering methods can be melded with medical expertise to develop and refine a dosing algorithm. This algorithm has the potential of drastically simplifying the determination of correct insulin-to-carbohydrate ratios. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/17303792/Prandial_insulin_dosing_using_run_to_run_control:_application_of_clinical_data_and_medical_expertise_to_define_a_suitable_performance_metric_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=17303792 DB - PRIME DP - Unbound Medicine ER -