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Insulin algorithm

Martin de Bock, Sybil A McAuley, Mary Binsu Abraham, Grant Smith, Jennifer Nicholas, Geoff R Ambler, Fergus J Cameron, Jan M Fairchild, Bruce R King, Elizabeth A Geelhoed, Elizabeth A Davis, David Norman O'Neal, Timothy W Jones
INTRODUCTION: Automated insulin delivery (also known as closed loop, or artificial pancreas) has shown potential to improve glycaemic control and quality of life in people with type 1 diabetes (T1D). Automated insulin delivery devices incorporate an insulin pump with continuous glucose monitoring(CGM) and an algorithm, and adjust insulin in real time. This study aims to establish the safety and efficacy of a hybrid closed-loop (HCL) system in a long-term outpatient trial in people with T1D aged 12 -<25 years of age, and compare outcomes with standard therapy for T1D as used in the contemporary community...
August 13, 2018: BMJ Open
Alexandra Migdal, Martin Abrahamson, Anne Peters, Nan Vint
Type 2 Diabetes Mellitus (T2DM) is a growing problem in the United States, affecting 30.3 million Americans, or 9.4% of the US population. Given that T2DM is a progressive disease, intensification of rapid acting insulin (RAI) to address hyperglycemia is often required. The American Diabetes Association and the European Association for the Study of Diabetes recommend individualizing the treatment approach to glucose control, considering factors such as age, health behaviors, comorbidities, and life expectancy...
August 14, 2018: Annals of Medicine
Gregory P Forlenza, Zoey Li, Bruce A Buckingham, Jordan E Pinsker, Eda Cengiz, R Paul Wadwa, Laya Ekhlaspour, Mei Mei Church, Stuart A Weinzimer, Emily Jost, Tatiana Marcal, Camille Andre, Lori Carria, Vance Swanson, John W Lum, Craig Kollman, William Woodall, Roy W Beck
OBJECTIVE: This study evaluated a new insulin delivery system designed to reduce insulin delivery when trends in continuous glucose monitoring (CGM) glucose concentrations predict future hypoglycemia. RESEARCH DESIGN AND METHODS: Individuals with type 1 diabetes ( n = 103, age 6-72 years, mean HbA1c 7.3% [56 mmol/mol]) participated in a 6-week randomized crossover trial to evaluate the efficacy and safety of a Tandem t:slim X2 pump with Basal-IQ integrated with a Dexcom G5 sensor and a predictive low-glucose suspend algorithm (PLGS) compared with sensor-augmented pump (SAP) therapy...
August 8, 2018: Diabetes Care
Lawrence Blonde, Vivian Fonseca
A growing body of data, guideline recommendations, algorithms, and position papers supports the use of glucagon-like peptide-1 (GLP-1) receptor agonists in type 2 diabetes (T2D), given their beneficial effects on glycemic control, weight, lipid parameters, and blood pressure, and low risk for hypoglycemia when used in patients who have not achieved glycemic goals with metformin and lifestyle interventions. Exciting new evidence continues to emerge, showing the utility of certain GLP-1 receptor agonists to decrease incident cardiovascular (CV) outcomes, and to bolster glycemic control when combined with other antihyperglycemic therapies, including basal insulin...
August 7, 2018: Endocrine Practice
Iman Hajizadeh, Mudassir Rashid, Kamuran Turksoy, Sediqeh Samadi, Jianyuan Feng, Mert Sevil, Nicole Hobbs, Caterina Lazaro, Zacharie Maloney, Elizabeth Littlejohn, Ali Cinar
BACKGROUND: Despite the recent advancements in the modeling of glycemic dynamics for type 1 diabetes mellitus, automatically considering unannounced meals and exercise without manual user inputs remains challenging. METHOD: An adaptive model identification technique that incorporates exercise information and estimates of the effects of unannounced meals obtained automatically without user input is proposed in this work. The effects of the unknown consumed carbohydrates are estimated using an individualized unscented Kalman filtering algorithm employing an augmented glucose-insulin dynamic model, and exercise information is acquired from noninvasive physiological measurements...
July 31, 2018: Journal of Diabetes Science and Technology
Kota Imai, Hiroki Murayama, Takahisa Hirose
INTRODUCTION: The Japanese guidelines emphasize treatment individualization and intensification with oral anti-diabetes drugs and glucagon-like peptide-1 receptor agonists (OADGs) as add-on therapy to insulin in the management of type 2 diabetes mellitus (T2DM). However, a step-wise treatment algorithm is not clearly defined in the Japanese guidelines. This study explores the treatment factors and patient characteristics for selecting the OADGs as add-on therapy to insulin from physicians' perspectives in a real-world setting in Japan...
July 30, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Monica Girotra, Aaron Hansen, Azeez Farooki, David J Byun, Le Min, Ben C Creelan, Margaret K Callahan, Michael B Atkins, Elad Sharon, Scott J Antonia, Pamela West, Amy E Gravell
Clinical trials in the past decade have established the antitumor effects of immune checkpoint inhibition as a revolutionary treatment for cancer. Namely, blocking antibodies to cytotoxic T-lymphocyte antigen 4 and programmed death 1 or its ligand have reached routine clinical use. Manipulation of the immune system is not without side effects, and autoimmune toxicities often known as immune-related adverse events (IRAEs) are observed. Endocrine IRAEs, such as hypophysitis, thyroid dysfunction, and insulin-dependent diabetes mellitus, can present with unique profiles that are not seen with the use of traditional chemotherapeutics...
July 2018: JNCI cancer spectrum
Tong Zhang, Yunjuan Zhao, Tao Du, Xiaodan Zhang, Xiaowei Li, Ruike Liu, Yunlin Wang, Bo Chen, Ling He, Wangen Li
Background: Patient-centered care is respectful to a patient's preference. All prior clinical trials on patient self-titration algorithms for basal insulin were decided by physicians. We hypothesized that patients and physicians have different preferences. Patients and methods: Physicians and diabetes patients were asked to choose their preferred insulin glargine self-titration algorithm among 5 algorithms. Algorithm 1, 1 U increase once daily; algorithm 2, 2 U increase every 3 days; algorithm 3, 3 U increase every 3 days; algorithm 4, titration every 3 days according to fasting blood glucose, and algorithm 5, weekly titration 2-8 U based on 3-day mean fasting blood glucose levels...
2018: Patient Preference and Adherence
Eric Renard, Nadia Tubiana-Rufi, Elisabeth Bonnemaison-Gilbert, Régis Coutant, Fabienne Dalla-Vale, Anne Farret, Amélie Poidvin, Natacha Bouhours-Nouet, Charlotte Abettan, Caroline Storey-London, Aurelie Donzeau, Jerome Place, Marc D Breton
AIMS: We investigated glucose control with closed-loop (CL) versus threshold-low-glucose-suspend (TLGS) insulin pump delivery in pre-pubertal children with type 1 diabetes (T1D) in supervised hotel conditions. MATERIALS AND METHODS: The patients (n=24, age range: 7-12, HbA1c: 7.5±0.5% (58±5 mmol/mol)) and their parents were admitted twice at 3-week interval. CL control to range (CTR) or TLGS set at 3.9mmol/l were assessed for 48 hours in randomized order. Admissions included 3 meals and 1 snack, and physical exercise...
July 25, 2018: Diabetes, Obesity & Metabolism
Yuanjia Wang, Haoda Fu, Donglin Zeng
Individualized medical decision making is often complex due to patient treatment response heterogeneity. Pharmacotherapy may exhibit distinct efficacy and safety profiles for different patient populations. An "optimal" treatment that maximizes clinical benefit for a patient may also lead to concern of safety due to a high risk of adverse events. Thus, to guide individualized clinical decision making and deliver optimal tailored treatments, maximizing clinical benefit should be considered in the context of controlling for potential risk...
2018: Journal of the American Statistical Association
Naim Alkhouri, Fred Poordad, Eric Lawitz
Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of insulin resistance, which is the hallmark of type 2 diabetes (T2D). NAFLD is a known risk factor for developing T2D and has a very high prevalence in those with existing T2D. The diabetes spectrum includes several conditions from prediabetes to T2D to insulin-dependent diabetes leading to macrovascular and microvascular complications. Similarly, NAFLD has a histologic spectrum that ranges from the relatively benign nonalcoholic fatty liver to the aggressive form of nonalcoholic steatohepatitis with or without liver fibrosis to nonalcoholic steatohepatitis-cirrhosis leading to end-stage liver disease...
July 2018: Hepatology communications
Lena S Kiefer, Jana Fabian, Susanne Rospleszcz, Roberto Lorbeer, Jürgen Machann, Corinna Storz, Mareen S Kraus, Christopher L Schlett, Frank Roemer, Elke Wintermeyer, Wolfgang Rathmann, Konstantin Nikolaou, Annette Peters, Fabian Bamberg
OBJECTIVES: Intra- and intermyocellular lipid deposition and adipose tissue are part of glucose homeostasis and insulin resistance; however, their role in type 2 diabetes mellitus (T2DM) remains unclear. We assessed differences in the degree of abdominal myosteatosis among subjects with T2DM and prediabetes. MATERIALS AND METHODS: Asymptomatic subjects from the general population were classified as subjects with T2DM, prediabetes or healthy controls and underwent multi-echo Dixon magnetic resonance imaging (MRI) (TR 8...
August 2018: European Journal of Radiology
Ricardo Sánchez-Peña, Patricio Colmegna, Fabricio Garelli, Hernán De Battista, Demián García-Violini, Marcela Moscoso-Vásquez, Nicolás Rosales, Emilia Fushimi, Enrique Campos-Náñez, Marc Breton, Valeria Beruto, Paula Scibona, Cintia Rodriguez, Javier Giunta, Ventura Simonovich, Waldo H Belloso, Daniel Cherñavvsky, Luis Grosembacher
BACKGROUND: Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial...
July 1, 2018: Journal of Diabetes Science and Technology
Sultan Imangaliyev, Andrei Prodan, Max Nieuwdorp, Albert K Groen, Natal A W van Riel, Evgeni Levin
Mining biological information from rich "-omics" datasets is facilitated by organizing features into groups that are related to a biological phenomenon or clinical outcome. For example, microorganisms can be grouped based on a phylogenetic tree that depicts their similarities regarding genetic or physical characteristics. Here, we describe algorithms that incorporate auxiliary information in terms of groups of predictors and the relationships between them into the metagenome learning task to build intelligible models...
July 4, 2018: Methods: a Companion to Methods in Enzymology
Eleni I Georga, José C Príncipe, Dimitrios I Fotiadis
This study aims at presenting a nonlinear, recursive, multivariate prediction model of the subcutaneous glucose concentration in type 1 diabetes. Nonlinear regression is performed in a reproducing kernel Hilbert space, by either the fixed budget quantized kernel least mean square (QKLMS-FB) or the approximate linear dependency kernel recursive least-squares (KRLS-ALD) algorithm, such that a sparse model structure is accomplished. A multivariate feature set (i.e., subcutaneous glucose, food carbohydrates, insulin regime and physical activity) is used and its influence on short-term glucose prediction is investigated...
July 2, 2018: Medical & Biological Engineering & Computing
Susanna Esposito, Elisa Santi, Giulia Mancini, Francesco Rogari, Giorgia Tascini, Giada Toni, Alberto Argentiero, Maria Giulia Berioli
BACKGROUND: Type 1 diabetes (DM1) is one of the most common chronic diseases in childhood and requires life-long insulin therapy and continuous health care support. An artificial pancreas (AP) or closed-loop system (CLS) have been developed with the aim of improving metabolic control without increasing the risk of hypoglycaemia in patients with DM1. As the impact of APs have been studied mainly in adults, the aim of this review is to evaluate the efficacy and safety of the AP in the paediatric population with DM1...
June 28, 2018: Journal of Translational Medicine
Lucia Carboni, Luca Marchetti, Mario Lauria, Peter Gass, Barbara Vollmayr, Amanda Redfern, Lesley Jones, Maria Razzoli, Karim Malki, Veronica Begni, Marco A Riva, Enrico Domenici, Laura Caberlotto, Aleksander A Mathé
An enhanced understanding of the pathophysiology of depression would facilitate the discovery of new efficacious medications. To this end, we examined hippocampal transcriptional changes in rat models of disease and in humans to identify common disease signatures by using a new algorithm for signature-based clustering of expression profiles. The tool identified a transcriptomic signature comprising 70 probesets able to discriminate depression models from controls in both Flinders Sensitive Line and Learned Helplessness animals...
June 12, 2018: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Jerzy Sitkowski, Wojciech Bocian, Elżbieta Bednarek, Mateusz Urbańczyk, Wiktor Koźmiński, Piotr Borowicz, Grażyna Płucienniczak, Natalia Łukasiewicz, Iwona Sokołowska, Lech Kozerski
The NMR derived translational diffusion coefficients were performed on unlabeled and uniformly labeled 13 C,15 N human insulin in water, both in neat, with zinc ions only, and in pharmaceutical formulation, containing only m-cresol as phenolic ligand, glycerol and zinc ions. The results show the dominant role of the pH parameter and the concentration on aggregation. The diffusion coefficient Dav was used for monitoring the overall average state of oligomeric ensemble in solution. The analysis of the experimental data of diffusion measurements, using the direct exponential curve resolution algorithm (DECRA) allows suggesting the two main components of the oligomeric ensemble...
June 2018: Journal of Biomolecular NMR
Paolo Pozzilli, Silvia Pieralice
Autoimmune diabetes is a heterogeneous disease which can arise at any age. Subjects with adult-onset autoimmune diabetes who do not necessitate insulin-therapy for at least 6 months after diagnosis are demarcated as having latent autoimmune diabetes in adults (LADA). This condition is more heterogeneous than young-onset autoimmune diabetes and shares clinical and metabolic characteristics with both type 2 and type 1 diabetes. Patients with LADA are considered by having highly variable β-cell destruction, different degrees of insulin resistance and heterogeneous titre and pattern of islet autoantibody, suggesting different pathophysiological pathways partially explaining the heterogeneous phenotypes of LADA...
June 2018: Endocrinology and Metabolism
Jing Li, Ziqiang Fu, Hua Jiang, Liping Chen, Xian Wu, Hongjuan Ding, Yankai Xia, Xinru Wang, Qiuqin Tang, Wei Wu
STUDY QUESTION: What is the role of insulin-like growth factor 2 (IGF2)-derived miR-483-3p in macrosomia? SUMMARY ANSWER: IGF2-derived intronic miR-483-3p is overexpressed in macrosomia placentas, and miR-483-3p prompts HTR-8/SVneo extravillous trophoblast cell line proliferation through down-regulation of its target RB1 inducible coiled-coil 1 (RB1CC1). WHAT IS KNOWN ALREADY: Macrosomia is a common pregnancy-associated disease and causes a number of adverse maternal and perinatal outcomes...
June 25, 2018: Molecular Human Reproduction
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