2,841 research outputs found

    Continuous glucose monitoring sensors: Past, present and future algorithmic challenges

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    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

    Artificial neural network algorithm for online glucose prediction from continuous glucose monitoring.

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    Background and Aims: Continuous glucose monitoring (CGM) devices could be useful for real-time management of diabetes therapy. In particular, CGM information could be used in real time to predict future glucose levels in order to prevent hypo-/hyperglycemic events. This article proposes a new online method for predicting future glucose concentration levels from CGM data. Methods: The predictor is implemented with an artificial neural network model (NNM). The inputs of the NNM are the values provided by the CGM sensor during the preceding 20 min, while the output is the prediction of glucose concentration at the chosen prediction horizon (PH) time. The method performance is assessed using datasets from two different CGM systems (nine subjects using the Medtronic [Northridge, CA] Guardian® and six subjects using the Abbott [Abbott Park, IL] Navigator®). Three different PHs are used: 15, 30, and 45 min. The NNM accuracy has been estimated by using the root mean square error (RMSE) and prediction delay. Results: The RMSE is around 10, 18, and 27 mg/dL for 15, 30, and 45 min of PH, respectively. The prediction delay is around 4, 9, and 14 min for upward trends and 5, 15, and 26 min for downward trends, respectively. A comparison with a previously published technique, based on an autoregressive model (ARM), has been performed. The comparison shows that the proposed NNM is more accurate than the ARM, with no significant deterioration in the prediction delay

    Deep learning methods for improving diabetes management tools

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    Diabetes is a chronic disease that is characterised by a lack of regulation of blood glucose concentration in the body, and thus elevated blood glucose levels. Consequently, affected individuals can experience extreme variations in their blood glucose levels with exogenous insulin treatment. This has associated debilitating short-term and long-term complications that affect quality of life and can result in death in the worst instance. The development of technologies such as glucose meters and, more recently, continuous glucose monitors have offered the opportunity to develop systems towards improving clinical outcomes for individuals with diabetes through better glucose control. Data-driven methods can enable the development of the next generation of diabetes management tools focused on i) informativeness ii) safety and iii) easing the burden of management. This thesis aims to propose deep learning methods for improving the functionality of the variety of diabetes technology tools available for self-management. In the pursuit of the aforementioned goals, a number of deep learning methods are developed and geared towards improving the functionality of the existing diabetes technology tools, generally classified as i) self-monitoring of blood glucose ii) decision support systems and iii) artificial pancreas. These frameworks are primarily based on the prediction of glucose concentration levels. The first deep learning framework we propose is geared towards improving the artificial pancreas and decision support systems that rely on continuous glucose monitors. We first propose a convolutional recurrent neural network (CRNN) in order to forecast the glucose concentration levels over both short-term and long-term horizons. The predictive accuracy of this model outperforms those of traditional data-driven approaches. The feasibility of this proposed approach for ambulatory use is then demonstrated with the implementation of a decision support system on a smartphone application. We further extend CRNNs to the multitask setting to explore the effectiveness of leveraging population data for developing personalised models with limited individual data. We show that this enables earlier deployment of applications without significantly compromising performance and safety. The next challenge focuses on easing the burden of management by proposing a deep learning framework for automatic meal detection and estimation. The deep learning framework presented employs multitask learning and quantile regression to safely detect and estimate the size of unannounced meals with high precision. We also demonstrate that this facilitates automated insulin delivery for the artificial pancreas system, improving glycaemic control without significantly increasing the risk or incidence of hypoglycaemia. Finally, the focus shifts to improving self-monitoring of blood glucose (SMBG) with glucose meters. We propose an uncertainty-aware deep learning model based on a joint Gaussian Process and deep learning framework to provide end users with more dynamic and continuous information similar to continuous glucose sensors. Consequently, we show significant improvement in hyperglycaemia detection compared to the standard SMBG. We hope that through these methods, we can achieve a more equitable improvement in usability and clinical outcomes for individuals with diabetes.Open Acces

    Diabetes Mellitus Glucose Prediction by Linear and Bayesian Ensemble Modeling

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    Diabetes Mellitus is a chronic disease of impaired blood glucose control due to degraded or absent bodily-specific insulin production, or utilization. To the affected, this in many cases implies relying on insulin injections and blood glucose measurements, in order to keep the blood glucose level within acceptable limits. Risks of developing short- and long-term complications, due to both too high and too low blood glucose concentrations are severalfold, and, generally, the glucose dynamics are not easy too fully comprehend for the affected individual—resulting in poor glucose control. To reduce the burden this implies to the patient and society, in terms of physiological and monetary costs, different technical solutions, based on closed or semi-closed loop blood glucose control, have been suggested. To this end, this thesis investigates simplified linear and merged models of glucose dynamics for the purpose of short-term prediction, developed within the EU FP7 DIAdvisor project. These models could, e.g., be used, in a decision support system, to alert the user of future low and high glucose levels, and, when implemented in a control framework, to suggest proactive actions. The simplified models were evaluated on 47 patient data records from the first DIAdvisor trial. Qualitatively physiological correct responses were imposed, and model-based prediction, up to two hours ahead, and specifically for low blood glucose detection, was evaluated. The glucose raising, and lowering effect of meals and insulin were estimated, together with the clinically relevant carbohydrate-to-insulin ratio. The model was further expanded to include the blood-to-interstitial lag, and tested for one patient data set. Finally, a novel algorithm for merging of multiple prediction models was developed and validated on both artificial data and 12 datasets from the second DIAdvisor trial

    Artificial Pancreas System With Unannounced Meals Based on a Disturbance Observer and Feedforward Compensation

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    © 2021 IEEE. Personal use of this material is permitted. Permissíon from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertisíng or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.[EN] This brief is focused on the closed-loop control of postprandial glucose levels of patients with type 1 diabetes mellitus after unannounced meals, which is still a major challenge toward a fully autonomous artificial pancreas. The main limitations are the delays introduced by the subcutaneous insulin pharmacokinetics and the glucose sensor, which typically leads to insulin overdelivery. Current solutions reported in the literature typically resort to meal announcement, which requires patient intervention. In this brief, a disturbance observer (DOB) is used to estimate the effect of unannounced meals, and the insulin pharmacokinetics is taken into account by means of a feedforward compensator. The proposed strategy is validated in silico with the UVa/Padova metabolic simulator. It is demonstrated how the DOB successfully estimates and counteracts not only the effect of meals but also the sudden drops in the glucose levels that may lead to hypoglycemia. For unannounced meals, results show a median time-in-range of 80% in a 30-day scenario with high carbohydrate content and large intrasubject variability. Optionally, users may decide to announce meals. In this case, considering severe bolus mismatch due to carbohydrate counting errors, the median time-in-range is increased up to 88%. In every case, hypoglycemia is avoided.This work was supported in part by the Ministerio de Economia y Competitividad under Grant DPI2016-78831-C2-1-R and in part by the European Union through FEDER Funds.Sanz Diaz, R.; García Gil, PJ.; Diez, J.; Bondía Company, J. (2021). Artificial Pancreas System With Unannounced Meals Based on a Disturbance Observer and Feedforward Compensation. IEEE Transactions on Control Systems Technology. 29(1):454-460. https://doi.org/10.1109/TCST.2020.2975147S45446029

    Modeling and Prediction in Diabetes Physiology

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    Diabetes is a group of metabolic diseases characterized by the inability of the organism to autonomously regulate the blood glucose levels. It requires continuing medical care to prevent acute complications and to reduce the risk of long-term complications. Inadequate glucose control is associated with damage, dysfunction and failure of various organs. The management of the disease is non trivial and demanding. With today’s standards of current diabetes care, good glucose regulation needs constant attention and decision-making by the individuals with diabetes. Empowering the patients with a decision support system would, therefore, improve their quality of life without additional burdens nor replacing human expertise. This thesis investigates the use of data-driven techniques to the purpose of glucose metabolism modeling and short-term blood-glucose predictions in Type I Diabetes Mellitus (T1DM). The goal was to use models and predictors in an advisory tool able to produce personalized short-term blood glucose predictions and on-the-spot decision making concerning the most adequate choice of insulin delivery, meal intake and exercise, to help diabetic subjects maintaining glycemia as close to normal as possible. The approaches taken to describe the glucose metabolism were discrete-time and continuous-time models on input-output form and statespace form, while the blood glucose short-term predictors, i.e., up to 120 minutes ahead, used ARX-, ARMAX- and subspace-based prediction

    Stochastic Seasonal Models for Glucose Prediction in the Artificial Pancreas

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    [EN] Background: Linear empirical dynamic models have been widely used for glucose prediction. The extension of the concept of seasonality, characteristic of other domains, is explored here for the improvement of prediction accuracy. Methods: Twenty time series of 8-hour postprandial periods (PP) for a same 60g-carbohydrate meal were collected from a closed-loop controller validation study. A single concatenated time series was produced representing a collection of data from similar scenarios, resulting in seasonality. Variability in the resulting time series was representative of worstcase intrasubject variability. Following a leave-one-out cross-validation, seasonal and nonseasonal autoregressive integrated moving average models (SARIMA and ARIMA) were built to analyze the effect of seasonality in the model prediction accuracy. Further improvement achieved from the inclusion of insulin infusion rate as exogenous variable was also analyzed. Prediction horizons (PHs) from 30 to 300 min were considered. Results: SARIMA outperformed ARIMA revealing a significant role of seasonality. For a 5-h PH, average MAPE was reduced in 26.62%. Considering individual runs, the improvement ranged from 6.3% to 54.52%. In the best-performing case this reduction amounted to 29.45%. The benefit of seasonality was consistent among different PHs, although lower PHs benefited more, with MAPE reduction over 50% for PHs of 60 and 120 minutes, and over 40% for 180 min. Consideration of insulin infusion rate into the seasonal model further improved performance, with a 61.89% reduction in MAPE for 30-min PH and reductions over 20% for PHs over 180 min. Conclusions: Seasonality improved model accuracy allowing for the extension of the PH significantly.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the Spanish Ministry of Economy and Competitiveness, grants DPI2013-46982-C2-1-R and DPI2016-78831-C2-1-R, and the European Union through FEDER funds.Montaser Roushdi Ali, E.; Diez, J.; BondĂ­a Company, J. (2017). Stochastic Seasonal Models for Glucose Prediction in the Artificial Pancreas. Journal of Diabetes Science and Technology. 11(6):1124-1131. https://doi.org/10.1177/1932296817736074S1124113111

    DiaTrend: A dataset from advanced diabetes technology to enable development of novel analytic solutions

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    Objective digital data is scarce yet needed in many domains to enable research that can transform the standard of healthcare. While data from consumer-grade wearables and smartphones is more accessible, there is critical need for similar data from clinical-grade devices used by patients with a diagnosed condition. The prevalence of wearable medical devices in the diabetes domain sets the stage for unique research and development within this field and beyond. However, the scarcity of open-source datasets presents a major barrier to progress. To facilitate broader research on diabetes-relevant problems and accelerate development of robust computational solutions, we provide the DiaTrend dataset. The DiaTrend dataset is composed of intensive longitudinal data from wearable medical devices, including a total of 27,561 days of continuous glucose monitor data and 8,220 days of insulin pump data from 54 patients with diabetes. This dataset is useful for developing novel analytic solutions that can reduce the disease burden for people living with diabetes and increase knowledge on chronic condition management in outpatient settings.Comment: 11 pages, 5 figures, 2 table
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