Repository logo
 

Modelling endogenous insulin concentration in type 2 diabetes during closed-loop insulin delivery.


Change log

Authors

Ruan, Yue 
Thabit, Hood 
Wilinska, Malgorzata E 

Abstract

BACKGROUND: Closed-loop insulin delivery is an emerging treatment for type 1 diabetes (T1D) evaluated clinically and using computer simulations during pre-clinical testing. Efforts to make closed-loop systems available to people with type 2 diabetes (T2D) calls for the development of a new type of simulators to accommodate differences between T1D and T2D. Presented here is the development of a model of posthepatic endogenous insulin concentration, a component omitted in T1D simulators but key for simulating T2D physiology. METHODS: We evaluated six competing models to describe the time course of endogenous insulin concentration as a function of the plasma glucose concentration and time. The models were fitted to data collected in insulin-naive subjects with T2D who underwent two 24-h visits and were treated, in a random order, by either closed-loop insulin delivery or glucose-lowering oral agents. The model parameters were estimated using a Bayesian approach, as implemented in the WinBUGS software. Model selection criteria were used to identify the best model describing our clinical data. RESULTS: The selected model successfully described endogenous insulin concentration over 24 h in both study periods and provided plausible parameter estimates. Model-derived results were in concordance with a clinical finding which revealed increased posthepatic endogenous insulin concentration during the control study period (P < 0.05). The modelling results indicated that the excess amount of insulin can be attributed to the glucose-independent effect as the glucose-dependent effect was similar between visits (P > 0.05). CONCLUSIONS: A model to describe endogenous insulin concentration in T2D including components of posthepatic glucose-dependent and glucose-independent insulin secretion was identified and validated. The model is suitable to be incorporated in a simulation environment for evaluating closed-loop insulin delivery in T2D.

Description

Keywords

Administration, Oral, Bayes Theorem, Blood Glucose, Computer Simulation, Diabetes Mellitus, Type 2, Dietary Carbohydrates, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Insulin Lispro, Insulin Secretion, Markov Chains, Models, Theoretical, Pancreas, Artificial, Postprandial Period

Journal Title

Biomed Eng Online

Conference Name

Journal ISSN

1520-9156
1475-925X

Volume Title

14

Publisher

BioMed Central
Sponsorship
Wellcome Trust (100574/Z/12/Z)
Diabetes UK (None)
This work was funded in part by a National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre Grant, Diabetes UK (BDA07/0003549), and Wellcome Strategic Award (100574/Z/12/Z). The research was conducted with support from Addenbrooke’s Clinical Research Facility (Cambridge, UK).