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J Korean Med Sci. 2016 Feb;31(2):231-9. doi: 10.3346/jkms.2016.31.2.231. Epub 2016 Jan 26.

In-Silico Trials for Glucose Control in Hospitalized Patients with Type 2 Diabetes.

Author information

1
Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, Korea.
2
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
3
Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.; Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Korea.
4
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract

Although various basal-bolus insulin therapy (BBIT) protocols have been used in the clinical environment, safer and more effective BBIT protocols are required for glucose control in hospitalized patients with type 2 diabetes (T2D). Modeling approaches could provide an evaluation environment for developing the optimal BBIT protocol prior to clinical trials at low cost and without risk of danger. In this study, an in-silico model was proposed to evaluate subcutaneous BBIT protocols in hospitalized patients with T2D. The proposed model was validated by comparing the BBIT protocol and sliding-scale insulin therapy (SSIT) protocol. The model was utilized for in-silico trials to compare the protocols of adjusting basal-insulin dose (BBIT1) versus adjusting total-daily-insulin dose (BBIT2). The model was also used to evaluate two different initial total-daily-insulin doses for various levels of renal function. The BBIT outcomes were superior to those of SSIT, which is consistent with earlier studies. BBIT2 also outperformed BBIT1, producing a decreased daily mean glucose level and longer time-in-target-range. Moreover, with a standard dose, the overall daily mean glucose levels reached the target range faster than with a reduced-dose for all degrees of renal function. The in-silico studies demonstrated several significant findings, including that the adjustment of total-daily-insulin dose is more effective than changes to basal-insulin dose alone. This research represents a first step toward the eventual development of an advanced model for evaluating various BBIT protocols.

KEYWORDS:

Biomedical Engineering; Blood Glucose; Computer Simulation; Diabetes Mellitus, Type 2; Insulin; Models, Theoretical

PMID:
26839477
PMCID:
PMC4729503
DOI:
10.3346/jkms.2016.31.2.231
[Indexed for MEDLINE]
Free PMC Article

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