Abstract
The artificial pancreas is a closed-loop insulin delivery system that automatically regulates glucose levels in individuals with type 1 diabetes. In-silico testing using simulation environments accelerates the development of better artificial pancreas systems. Simulation environments need an accurate model that captures glucose dynamics during exercise to simulate real-life scenarios. We proposed six variations of the Bergman Minimal Model to capture the physiological effects of moderate exercise on glucose dynamics in individuals with type 1 diabetes. We estimated the parameters of each model with clinical data using a Bayesian approach and Markov chain Monte Carlo methods. The data consisted of measurements of plasma glucose, plasma insulin, and oxygen consumption collected from a study of 17 adults with type 1 diabetes undergoing aerobic exercise sessions. We compared the models based on the physiological plausibility of their parameters estimates and the deviance information criterion. The best model features (i) an increase in glucose effectiveness proportional to exercise intensity, and (ii) an increase in insulin action proportional to exercise intensity and duration. We validated the selected model by reproducing results from two previous clinical studies. The selected model accurately simulates the physiological effects of moderate exercise on glucose dynamics in individuals with type 1 diabetes. This work offers an important tool to develop strategies for exercise management with the artificial pancreas.
Highlights
Type 1 diabetes (T1D) is a chronic disease in which the immune system attacks and destroys the pancreatic beta cells resulting in the loss of insulin secretion [1]
We proposed six physiologically-motivated variations of the Bergman Minimal Model [16] to capture the effects of moderate exercise on glucose dynamics in individuals with T1D
Model 3 produced a better deviance information criterion (DIC) compared with Model 2 by neglecting the increase in insulin sensitivity (731 vs 705)
Summary
Type 1 diabetes (T1D) is a chronic disease in which the immune system attacks and destroys the pancreatic beta cells resulting in the loss of insulin secretion [1]. Individuals with T1D need life-long insulin therapy, which requires either multiple daily injections or the use of an insulin pump that infuses insulin subcutaneously, guided by glucose measurements. A glucose sensor is a wearable device that continuously monitors blood glucose levels [2]. Despite current technologies, individuals with T1D still spend significant amount of time outside the glucose target range, placing them at risk for devastating long-term complications such as heart attack, stroke, blindness, kidney disease, and amputation [3].
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