Using Iterative Learning for Insulin Dosage Optimization in Multiple-Daily-Injections Therapy for People With Type 1 Diabetes
Marzia Cescon, Sunil Deshpande, Revital Nimri, Francis J. Doyle, Eyal Dassau
Abstract
OBJECTIVE: In this work, we design iterative algorithms for the delivery of long-acting (basal) and rapid-acting (bolus) insulin, respectively, for people with type 1 diabetes (T1D) on multiple-daily-injections (MDIs) therapy using feedback from self-monitoring of blood glucose (SMBG) measurements. METHODS: Iterative learning control (ILC) updates basal therapy consisting of one long-acting insulin injection per day, while run-to-run (R2R) adapts meal bolus therapy via the update of the mealtime-specific insulin-to-carbohydrate ratio (CR). Updates are due weekly and are based upon sparse SMBG measurements. RESULTS: Upon termination of the 20 weeks long in-silico trial, in a scenario characterized by meal carbohydrate (CHO) normally distributed with mean μ = [50, 75, 75] grams and standard deviation σ = [5, 7, 7] grams, our strategy produced statistically significant improvements in time in range (70--180) [mg/dl], from 66.9(33.1) % to 93.6(6.7) %, p = 0.02. CONCLUSIONS: Iterative learning shows potential to improve glycemic regulation over time by driving blood glucose closer to the recommended glycemic targets. SIGNIFICANCE: Decision support systems (DSSs) and automated therapy advisors such as the one proposed here are expected to improve glycemic outcomes reducing the burden on patients on MDI therapy.