Development and Evaluation of Personalized Explainable Machine Learning Models to Predict and Prevent Nocturnal Hypoglycemia in Type 1 Diabetes

用于预测和评估个性化可解释机器学习模型的开发和评估 预防1型糖尿病患者夜间低血糖 项目摘要 低血糖(葡萄糖70 mg/dL)仍然是实现1型糖尿病最佳血糖控制的限制因素 糖尿病(T1D)，夜间低血糖尤其危险。夜间低血糖可能导致 在身体损伤、睡眠质量差、害怕低血糖、无意识低血糖的情况下。严重发作 可导致癫痫发作和需要紧急护理的昏迷，甚至死亡(卧床死亡综合症)。 虽然自动胰岛素输送(AID)系统在夜间血糖控制方面显示出了好处， 夜间仍会出现低血糖。此外，许多患有T1D的人通过持续的血糖管理 皮下输液泵(CSII)治疗或每日多次胰岛素注射(MDI)治疗。数据已更新 2013至2014年间，16,061名患有T1D的患者参加了T1D交换诊所登记 结果显示，大约40%的参与者使用MDI管理他们的血糖。在这个项目中，我们建议 开发和评估收集和分析血糖测量的个性化决策支持工具， 胰岛素、膳食和体力活动数据可在睡前预测夜间低血糖和 建议采取积极的碳水化合物干预措施，大幅降低夜间低血糖。在 在项目的工程开发阶段，我们将使用独特的时间匹配血糖数据集 来自Pump的管理数据(即连续血糖测量、胰岛素、膳食和锻炼)，闭合- LOOP和MDI用户提取夜间低血糖风险的主要影响因素的信息并进行培训 基于人口的预测模型将随着时间的推移进行个性化，以更好地捕捉主体之间的关系 可变性。我们将设计一种睡前干预，包括一种具有可变营养的睡前智能零食 可以预防夜间低血糖的内容。零食将因常量营养素含量和大小而有所不同 优化餐后血糖达到峰值的时间，使其与预测的低血糖发作的时间相匹配。 我们将进行一项随机交叉研究，以评估我们基于智能手机的决策支持工具 20名患有T1D的患者是MDI使用者，他们经历低血糖的风险更高。 参与者将被随机分配到第一次使用CGM(控制期)，然后使用智能手机- 基于决策支持工具+夜间低血糖干预(干预期)，反之亦然。这个 控制期和干预期各为期三周。我们将衡量 通过比较控制期与非控制期夜间低血糖发生的百分比时间进行干预 干预期。我们还将回顾衡量预测模型在预测中的准确性 使用来自控制期的数据进行夜间低血糖。我们预计拟议的睡前干预措施 将导致一夜低血糖所花费的时间显著减少至少50%。 基线。

Development and Evaluation of Personalized Explainable Machine Learning Models to Predict and Prevent Nocturnal Hypoglycemia in Type 1 Diabetes Project Summary Hypoglycemia (glucose < 70 mg/dL) remains the limiting factor for achieving optimal glycemic control in type 1 diabetes (T1D), with nocturnal hypoglycemia being particularly dangerous. Nocturnal hypoglycemia may result in physical injury, poor sleep quality, fear of hypoglycemia, and hypoglycemia unawareness. Severe episodes can cause seizures and unconsciousness requiring emergency care, and even death (dead in bed syndrome). While automated insulin delivery (AID) systems have shown benefits in glucose control during the night, nighttime hypoglycemia still occurs. Moreover, many people with T1D manage their glucose with continuous subcutaneous infusion pump (CSII) therapy or multiple daily insulin injections (MDI) therapy. Data updated between 2013 and 2014 from 16,061 individuals with T1D participating in the T1D Exchange clinic registry showed that approximately 40% participants managed their glucose with MDI. In this project, we propose to develop and evaluate a personalized decision support tool that collects and analyzes glucose measurements, insulin, meals, and physical activity data to predict at bedtime the likelihood of overnight hypoglycemia and recommend a proactive carbohydrate intervention to substantially reduce nocturnal hypoglycemia. In the engineering development phase of the project, we will use unique datasets of time-matched glucose management data (i.e., continuous glucose measurements, insulin, meals, and exercise) from pump, closed- loop and MDI users to extract information about the major contributors to nocturnal hypoglycemia risk and train a population-based prediction model that will be personalized over time to better capture inter-subject variability. We will design a bedtime intervention consisting of a bedtime smart snack with variable nutrient content that can prevent nighttime hypoglycemia. Snacks will vary by macronutrient content and size to optimize time to peak post-prandial glycemia that will match the timing to predicted episode of hypoglycemia. We will conduct a randomized cross-over study to evaluate our smartphone-based decision support tool on a cohort of 20 people with T1D who are MDI users and are at higher risk of experiencing hypoglycemia. Participants will be randomly assigned to either first use CGM only (control period) followed by a smartphone- based decision support tool + nocturnal hypoglycemia intervention (intervention period), or vice-versa. The control and intervention periods will have a duration of three weeks each. We will measure the effect of the intervention by comparing the percent time in nocturnal hypoglycemia during the control period vs. the intervention period. We will also retrospectively measure the accuracy of the prediction model in predicting nocturnal hypoglycemia using data from the control period. We expect that the proposed bedtime intervention will lead to a significant reduction in time spent in hypoglycemia overnight of at least 50% reduction relative to baseline.