A modular safety system for an insulin dose recommender: a feasibility study.
File(s)LIU-manuscript _Revised_v2.docx (5.08 MB)
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2020-01-01
Date Acceptance
2019-05-01
Citation
Journal of Diabetes Science and Technology, 2020, 14 (1), pp.87-96
ISSN
1932-2968
Publisher
SAGE Publications
Start Page
87
End Page
96
Journal / Book Title
Journal of Diabetes Science and Technology
Volume
14
Issue
1
Copyright Statement
© 2019 Diabetes Technology Society. The final, definitive version of this paper has been published in Liu, C., Avari, P., Leal, Y., Wos, M., Sivasithamparam, K., Georgiou, P., … Herrero, P. (2020). A Modular Safety System for an Insulin Dose Recommender: A Feasibility Study. Journal of Diabetes Science and Technology, 14(1), 87–96
by Sage Publications Ltd. All rights reserved. It is available at: https://doi.org/10.1177/1932296819851135
by Sage Publications Ltd. All rights reserved. It is available at: https://doi.org/10.1177/1932296819851135
Sponsor
Commission of the European Communities
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31117804
Grant Number
689810
Subjects
decision support
insulin delivery
run-to-run control
safety
type 1 diabetes
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-05-22