Improving the insulin therapy for diabetic patients using optimal impulsive disturbance rejection: Continuous time approach

IF 5.3 2区 医学 Q1 ENGINEERING, BIOMEDICAL Biocybernetics and Biomedical Engineering Pub Date : 2024-04-01 DOI:10.1016/j.bbe.2024.05.003
Martin Dodek, Eva Miklovičová, Miroslav Halás
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Abstract

The paper proposes a new model-based optimization approach to improve the clinical efficiency of compensatory insulin bolus treatment in diabetic patients, aiming to mitigate the consequences of diabetes. The most important contribution of this paper is a novel methodology for determining the optimal parameters of insulin treatment, namely the size and timing of insulin boluses, to effectively compensate for carbohydrate intake. This concept can be seen as the so-called optimal model-based bolus calculator. The presented theoretical framework deals with the problem of optimal disturbance rejection in impulsive systems by minimizing an integral quadratic cost function. The methodology considers a personalized empirical transfer function model with static gains and time constants as the only parameters assumed to be known, making the bolus calculator more straightforward to implement in clinical practice. Contrary to other techniques, the proposed methodology considers impulsive insulin administration in the form of boluses, which is more feasible than continuous infusion. In contrast to the conventional bolus calculator, the proposed algorithm allows for maximizing therapy performance by optimizing the relative time of insulin bolus administration with respect to carbohydrate intake. Another feature to highlight is that the solution of the optimization problem can be obtained analytically, hence no numerical iterative solvers are required. Additionally, the continuous-time domain approach allows for a much finer adjustments of the insulin administration timing compared to discrete-time models. The proposed approach was validated in an in-silico study, which demonstrated the importance of systematically determined insulin–carbohydrate ratio and the relative delay between disturbance and its compensation. The results showed that the proposed optimal bolus calculator outperforms the traditional suboptimal formula.

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利用最佳脉冲干扰抑制改善糖尿病患者的胰岛素治疗:连续时间方法
本文提出了一种新的基于模型的优化方法,以提高糖尿病患者胰岛素栓剂补偿治疗的临床效率,从而减轻糖尿病的后果。本文最重要的贡献是提出了一种新方法,用于确定胰岛素治疗的最佳参数,即胰岛素注射量和时间,以有效补偿碳水化合物的摄入。这一概念可视为所谓的基于模型的最佳栓剂计算器。所提出的理论框架通过最小化积分二次成本函数来解决脉冲系统中的最佳干扰抑制问题。该方法考虑了个性化的经验传递函数模型,将静态增益和时间常数作为唯一的已知参数,从而使栓塞计算器在临床实践中更易于实施。与其他技术不同的是,所提出的方法考虑到了胰岛素的脉冲式给药,这比连续输注更加可行。与传统的胰岛素注射计算器相比,所提出的算法通过优化胰岛素注射与碳水化合物摄入的相对时间,最大限度地提高了治疗效果。另一个值得强调的特点是,优化问题的解决方案可以通过分析获得,因此不需要数字迭代求解器。此外,与离散时间模型相比,连续时间域方法允许对胰岛素给药时间进行更精细的调整。在一项室内研究中对所提出的方法进行了验证,证明了系统确定的胰岛素-碳水化合物比率以及干扰和干扰补偿之间的相对延迟的重要性。结果表明,所提出的最佳栓剂计算器优于传统的次优公式。
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来源期刊
CiteScore
16.50
自引率
6.20%
发文量
77
审稿时长
38 days
期刊介绍: Biocybernetics and Biomedical Engineering is a quarterly journal, founded in 1981, devoted to publishing the results of original, innovative and creative research investigations in the field of Biocybernetics and biomedical engineering, which bridges mathematical, physical, chemical and engineering methods and technology to analyse physiological processes in living organisms as well as to develop methods, devices and systems used in biology and medicine, mainly in medical diagnosis, monitoring systems and therapy. The Journal''s mission is to advance scientific discovery into new or improved standards of care, and promotion a wide-ranging exchange between science and its application to humans.
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