Data-Driven Disturbance Estimation and Control with Application to Blood Glucose Regulation

A data-driven control approach for nonlinear systems is proposed, called data-driven estimation and control (D2EC), which combines a disturbance estimator and a nonlinear control algorithm. The estimator provides a signal representing the unknown disturbances affecting the plant to control. This signal is used by the control algorithm to improve its performance. A real-data study is presented, concerned with the regulation of blood glucose concentration in type 1 diabetic patients. Preliminary tests of the D2EC approach are also carried out using a diabetic patient simulator, obtained from a revised version of the well-known University of Virginia/Padova model. Both the real-data and the simulator-based studies indicate that the proposed approach has the potential to become an effective tool in the context of diabetes treatment and, more in general, in the biomedical field, where accurate first-principle models can seldom be found and relevant disturbances are present

Sparse Reconstruction of Glucose Fluxes Using Continuous Glucose Monitors

A new technique for estimating postprandial glucose flux profiles without the use of glucose tracers is proposed. A sparse vector space representation is first found for the space of plausible glucose flux profiles using sparse encoding. A Lasso formulation is then used to estimate the glucose fluxes that combines (1) known patient model parameters; (2) the vector space of plausible glucose flux profiles; (3) continuous glucose monitor measurements taken during the meal; (4) amount of insulin injected; (5) amount of meal carbohydrates; and (6) an estimate of the initial conditions. Three glucose fluxes are then estimated, namely; glucose rate of appearance from the intestine; endogenous glucose production from the liver; insulin dependent glucose utilization; and other important state variables. The simulation results show that the technique is capable of estimating the glucose fluxes with high accuracy, even for complex meal scenarios. The experimental results indicate that the technique is capable of reproducing the triple tracer measurements for three T1DM undergoing the triple tracer protocol while estimating the missing measurements for a certain model parameter selection

Parental evaluation of a telemonitoring service for children with Type 1 Diabetes

Introduction In the past years, we developed a telemonitoring service for young patients affected by Type 1 Diabetes. That service provides data to the clinical staff and offers an important tool to the parents, that are able to oversee in real time their children. The aim of this work was to analyze the parents' perceived usefulness of the service. Methods The service was tested by the parents of 31 children enrolled in a seven-day clinical trial during a summer camp. To study the parents' perception we proposed and analyzed two questionnaires. A baseline questionnaire focused on the daily management and implications of their children's diabetes, while a post-study one measured the perceived benefits of telemonitoring. Questionnaires also included free text comment spaces. Results Analysis of the baseline questionnaires underlined the parents' suffering and fatigue: 51% of total responses showed a negative tendency and the mean value of the perceived quality of life was 64.13 in a 0-100 scale. In the post-study questionnaires about half of the parents believed in a possible improvement adopting telemonitoring. Moreover, the foreseen improvement in quality of life was significant, increasing from 64.13 to 78.39 ( p-value\u2009=\u20090.0001). The analysis of free text comments highlighted an improvement in mood, and parents' commitment was also proved by their willingness to pay for the service (median\u2009=\u2009200\u2009euro/year). Discussion A high number of parents appreciated the telemonitoring service and were confident that it could improve communication with physicians as well as the family's own peace of mind

Has covid-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?

OBJECTIVE To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy. RESEARCH DESIGN AND METHODS This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020. RESULTS Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patients who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P 5 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2. CONCLUSIONS The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any “second wave” requires strategies to educate and reassure parents about timely emergency department attendance for non–COVID-19 symptoms

Adherence to the Mediterranean Diet Is Associated with Better Metabolic Features in Youths with Type 1 Diabetes

Our aim was to evaluate adherence to the Mediterranean diet (MedDiet) among children and adolescents with type 1 diabetes (T1D) in relation to metabolic control. Adherence to the MedDiet was assessed with the Mediterranean Diet Quality Index (KIDMED)questionnaire and physical activity by the International Physical Activity Questionnaire for Adolescent (IPAQ-A) on 65 subjects (32 males, 9–18 years) with T1D. Clinical and metabolic evaluation was performed (standardized body mass index(BMI-SDS), hemoglobin A1C (HbA1c), continuous glucose monitoring metrics when present, blood pressure, lipid profile). Parental characteristics (age, body mass index (BMI), socio-economic status) were reported. The adherence to the MedDiet was poor in 12.3%, average in 58.6%, and high in 29.1% of the subjects. Furthermore, 23.4% of patients were overweight/obese. The most impacting factors on BMI-SDS were skipping breakfast and their father’s BMI. HbA1c and time in range % were positively associated with sweets and fish intake, respectively. Additionally, the father’s socio-economic status (SES) and mother’s age were associated with glucose control. Blood pressure was associated with travelling to school in vehicles, extra-virgin olive oil intake and milk/dairy consumption at breakfast. The promotion of the MedDiet, mainly having a healthy breakfast, is a good strategy to include in the management of T1D to improve glucose and metabolic control. This research is valuable for parents to obtain the best results for their children with T1D

Diet management, lifestyle factors and education needs by target attainment in Italian youth with type 1 diabetes from the Global TEENs study

Background and aims: TEENs is an international, cross-sectional observational study, conducted in 20 countries in order to assess T1D management and psychosocial parameters in 8-25-year-olds (y/o). Data on diet management, lifestyle factors and education needs by target HbA1c attainment from the Italian cohort are reported. Materials and methods: Data were collected at 23 centres by participant interview, medical record review and participant/parent survey from 1,009 Italian youth (46% female) in three age groups: 8-12 y/o (n=330), 13-18 y/o (n=490), and 19-25 y/o (n=189). HbA1c was measured uniformly using A1cNow™ with target HbA1c defined as <7.5% (58 mmol/mol) for ≤18 y/o (ISPAD) and <7% (53 mmol/mol) for >18 y/o (ADA). Results: Overall, 40% of participants met HbA1c targets. Measuring food intake based on experience was the most common method used by all age groups, followed by carbohydrate counting (Table). Of the participants who used carbohydrate counting, a higher percentage met target HbA1c than did not in all age groups, with a significant effect on target attainment due to carbohydrate counting compared with other methods observed in 13-18 y/o (p=0.035). Avoiding sugars was the least common method used in all age groups. Across all age groups, participants who did not undertake any exercise were numerically less likely to reach HbA1c target; on the contrary, participants who exercised 1-2 days/week were numerically more likely to reach HbA1c target. Performing exercise had a significant effect on target HbA1c attainment in 8-12 y/o (p=0.012). The majority of participants were in the underweight/normal body mass index (BMI) category in all age groups, with no clear pattern between BMI class and the proportion of patients reaching HbA1c target. Participants of all ages commonly requested education on diet, carbohydrate counting, how to manage T1D during illness, and how to manage blood glucose levels with exercise. Conclusion: Carbohydrate counting and exercising at least twice per week help to attain HbA1c target across all age groups. Assessment of lifestyle factors suggests that efforts targeting carbohydrate counting and exercise could promote successful health outcomes and help more patients with T1D to reach the recommended HbA1c target. Supported by: Sanof

Rethinking carbohydrate intake and time in range in children and adolescents with type 1 diabetes

none15The aim of this study was to evaluate the association between macronutrient intake and time in range (TIR) of 70–180 mg/dL in children and adolescents with type 1 diabetes (T1D). A multi-center study recruited patients with T1D using continuous glucose monitoring (CGM) between January 2019 and January 2020 from centers across Italy. Diet intake was recorded using three-day weighed food diaries. Nutrients were evaluated as percentages of total intake. TIR was considered at target if the percentage of readings was higher than 70%. Clinical and nutritional factors associated with TIR at target were analyzed using multiple correspondence analysis and multiple logistic regression. Data from 197 participants (53% male, median age 11.6 years, median HbA1c 55.2 mmol/mol, median TIR 60%) were analyzed. Macronutrient intake was 45.9% carbohydrates, 16.9% protein, 37.3% fat, and 13.1 g/day fiber (median values). TIR > 70% was observed in 28% of participants; their diet contained more protein (17.6%, p = 0.015) and fiber (14.4 g/day, p = 0.031) than those not at target. The probability of having a TIR > 70% was significantly higher with 40–44% consumption of carbohydrates compared with 45–50% consumption of carbohydrates and with the use of a carbohydrate counting system. Based on these results, a five percent reduction in the percentage of carbohydrate intake can help children and adolescents with T1D achieve the goal of a TIR > 70%. Both a lower and higher percentage of carbohydrate intake appears to reduce the probability of reaching the target TIR > 70%. These results require validation in other populations before being used in clinical practice.openCherubini V.; Marino M.; Marigliano M.; Maffeis C.; Zanfardino A.; Rabbone I.; Giorda S.; Schiaffini R.; Lorubbio A.; Rollato S.; Iannilli A.; Iafusco D.; Scaramuzza A.E.; Bowers R.; Gesuita R.Cherubini, V.; Marino, M.; Marigliano, M.; Maffeis, C.; Zanfardino, A.; Rabbone, I.; Giorda, S.; Schiaffini, R.; Lorubbio, A.; Rollato, S.; Iannilli, A.; Iafusco, D.; Scaramuzza, A. E.; Bowers, R.; Gesuita, R

Combined Therapy with Insulin and Growth Hormone in 17 Patients with Type-1 Diabetes and Growth Disorders.

Combined growth hormone (GH) and insulin therapy is rarely prescribed by pediatric endocrinologists. We investigated the attitude of Italian physicians to prescribing that therapy in the case of short stature and type-1 diabetes (T1DM). Methods: A questionnaire was sent and if a patient was identified, data on growth and diabetes management were collected. Results: Data from 42 centers (84%) were obtained. Of these, 29 centers reported that the use of combined therapy was usually avoided. A total of 17 patients were treated in 13 centers (GH was started before T1DM onset in 9 patients and after the onset of T1DM in 8). Height SDS patterns during GH therapy in the 11 patients affected by GH deficiency ranged from -0.3 to +3.1 SDS. In the 8 diabetic patients in whom GH was added subsequently, mean insulin dose increased during the first 6 months of therapy from 0.7 ± 0.2 to 1.0 ± 0.2 U/kg (p = 0.004). HbA1c was unchanged during the first 6 months of combined therapy. Conclusions: Most Italian physicians do not consider prescribing the combined GH-insulin therapy in diabetic children with growth problems. However, the results of the 17 patients identified would confirm that the combined therapy was feasible and only caused mild insulin resistance. GH therapy was effective in promoting growth in most patients and did not affect diabetes metabolic contro

Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study

AimsInsulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy.MethodsData were collected for all participants younger than 19 years, starting insulin pump therapy before 31 December 2013. For each child, age, disease duration, date of insulin pump therapy initiation, insulin pump model, failure/malfunction/replacement yes/no and reason were considered for the year 2013.ResultsData were returned by 40 of 43 paediatric centres belonging to the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. In total, 1574 of 11 311 (13.9%) children and adolescents with Type 1 diabetes were using an insulin pump: 29.2% Animas VIBE, 9.4% Medtronic MiniMed 715/515, 34.3% Medtronic MiniMed VEO, 24.3% Accu-Check Spirit Combo and 2.8% other models. In 2013, 0.165 insulin pump replacements per patient-year (11.8% due to pump failure/malfunction and 4.7% due to accidental damage) were recorded. Animas VIBE (22.1%) and Medtronic MiniMed VEO (17.7%) were the most replaced.ConclusionsIn a large cohort of Italian children and adolescents with Type 1 diabetes, insulin pump failure/malfunction and consequent replacement are aligned with rates previously reported and higher in more sophisticated pump models