J Diabetes Sci Technol. 2009 Jul 1;3(4):895-902.

Computing the risk of postprandial hypo- and hyperglycemia in type 1 diabetes mellitus considering intrapatient variability and other sources of uncertainty.

García-Jaramillo M, Calm R, Bondia J, Tarín C, Vehí J.

Source

Institut d'Informàtica i Aplicacions, Universitat de Girona, Campus de Montilivi, Girona, Spain. magarcia@eia.udg.edu

Abstract

OBJECTIVE:

The objective of this article was to develop a methodology to quantify the risk of suffering different grades of hypo- and hyperglycemia episodes in the postprandial state.

METHODS:

Interval predictions of patient postprandial glucose were performed during a 5-hour period after a meal for a set of 3315 scenarios. Uncertainty in the patient's insulin sensitivities and carbohydrate (CHO) contents of the planned meal was considered. A normalized area under the curve of the worst-case predicted glucose excursion for severe and mild hypo- and hyperglycemia glucose ranges was obtained and weighted accordingly to their importance. As a result, a comprehensive risk measure was obtained. A reference model of preprandial glucose values representing the behavior in different ranges was chosen by a xi(2) test. The relationship between the computed risk index and the probability of occurrence of events was analyzed for these reference models through 19,500 Monte Carlo simulations.

RESULTS:

The obtained reference models for each preprandial glucose range were 100, 160, and 220 mg/dl. A relationship between the risk index ranges <10, 10-60, 60-120, and >120 and the probability of occurrence of mild and severe postprandial hyper- and hypoglycemia can be derived.

CONCLUSIONS:

When intrapatient variability and uncertainty in the CHO content of the meal are considered, a safer prediction of possible hyper- and hypoglycemia episodes induced by the tested insulin therapy can be calculated.