Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
  • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
  • A61M5/142—Pressure infusion, e.g. using pumps
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
  • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
  • G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
  • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
  • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
  • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
  • G16H50/70—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for mining of medical data, e.g. analysing previous cases of other patients
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M2205/00—General characteristics of the apparatus
  • A61M2205/33—Controlling, regulating or measuring
  • A61M2205/3331—Pressure; Flow

Definitions

• the invention relates to a method and means for monitoring, controlling and predicting blood glucose levels, in particular for postprandial blood glucose level prediction.
• T1DM type 1 diabetes mellitus
• BG blood glucose
• too much insulin leads to hypoglycemia which is a potentially life threating situation.
• Managing BG levels by injecting a suitable amount of insulin is a difficult task and a considerable burden for patients with diabetes, especially since there is a large day-to-day variability of BG dynamics and a myriad of factors that influence BG levels. Therefore, the design of smart control algorithms that help patients with managing their BG levels has kept control engineers busy for many years already.
• models for the prediction of future BG levels such as physiological models or patient-data-based models, have been found to be able to provide reliable and accurate results for the prediction of future BG levels only under very specially limited and well-controlled circumstances, such as, for example in clinical settings with a strict regimen of well-defined meal intakes at well-defined times and with well-defined insulin administration dosages at well-defined insulin injection times.
• said objectives are achieved by a computer-implemented method, a computer system, a computer-storage media and a medical device according to the independent claims.
• a method for predicting future blood glucose levels in particular for postprandial blood glucose level prediction, can be a computer-implemented method and may comprise one, some or all of the following exemplary possible steps:
• a blood glucose level prediction model may in particular be understood as being a patient- data-based blood glucose level prediction model or as a physiological prediction model.
• Said exemplary glucose data of the first medical data set may originate from a glucose monitoring system that is measuring/recording blood or interstitial fluid glucose values of a patient at regular intervals or at scheduled times.
• glucose data may be understood as comprising glucose data measured in the interstitial fluid of a patient and/or glucose data measured in the blood of a patient, i.e. blood glucose data.
• glucose level may also be understood as comprising glucose levels of glucose in interstitial fluids and/or glucose levels in blood, i.e. blood glucose levels.
• the exemplary step of providing the extracted second medical data set as input to a blood glucose level prediction model may inter alia comprise providing the extracted second medical data set as a training data set to a blood glucose level prediction model algorithm, e.g. a neural network algorithm, and training the blood glucose level prediction model algorithm with the extracted second medical data set.
• a blood glucose level prediction model algorithm e.g. a neural network algorithm
• the blood glucose level prediction model algorithm may be trained to identify the best blood glucose level prediction model and/or to identify the best parameters and/or best parameter values of a/the blood glucose level prediction model.
• further other medical data may be understood as referring to data on meal intakes, e.g. amount of carbohydrates of/from meal intake(s), data on medication, such as, for example, data on insulin injections or measured or recorded insulin levels, e.g. recorded number/amount of bolus insulin injections or current insulin levels, heart rate, blood pressure, hormonal state / level of a hormone, psychological state, oxygen saturation, other analyte data (i.e. further physiological data other than glucose data / BG, for example, other blood analyte data such as hemoglobin levels) or any other data of medical interest.
• data on meal intakes e.g. amount of carbohydrates of/from meal intake(s)
• data on medication such as, for example, data on insulin injections or measured or recorded insulin levels, e.g. recorded number/amount of bolus insulin injections or current insulin levels, heart rate, blood pressure, hormonal state / level of a hormone, psychological state, oxygen saturation, other analyte data (i.e. further physiological data
• medical data set covering a time range can inter alia be understood as a data set that can be ordered in time such that each data entity or each data type, e.g. blood glucose level or glucose level, can be associated to a point in time, e.g. can be marked with a time stamp.
• each data entity or each data type e.g. blood glucose level or glucose level
• A/the medical data set(s) can be in an exemplary electronic format, for example, the first and second medical data set can be structured in a row-based table format, wherein each row or each row index corresponds to a point in time and wherein each row comprises at least one entry for the value of a particular medical data entity or type, e.g. glucose level value or blood glucose level value and wherein each column represents a different or separate data entity or data type, e.g. glucose level or blood glucose level, time, type of meal, amount of carbohydrates of a/the meal intake, amount of a bolus insulin injection, level of a hormone or other data entities or data types of medical interest.
• a particular medical data entity or type e.g. glucose level value or blood glucose level value
• each column represents a different or separate data entity or data type, e.g. glucose level or blood glucose level, time, type of meal, amount of carbohydrates of a/the meal intake, amount of a bolus insulin injection, level of a hormone or other data entities or data types
• the medical data set can also be structured in a column- based format, wherein each column or each column index corresponds to a point in time.
• data or medical data may inter alia be understood as comprising data entities and/or data types and/or data values and/or data points.
• the exemplary first medical data set may be a hybrid data set with data automatically retrieved from medical sensors and with data manually inputted by a patient/user.
• removing data may inter alia be understood as removing data from a/said first medical data set including removing the data including any associated data values.
• the data format of said possible data entities or data types or data values can inter alia comprise numeric types, e.g. floating point types or fixed point types or integer types, string or text types, e.g. character or string, Boolean types, or other types, such as composite types, e.g. arrays, vectors.
• extracting may also be understood as referring to selecting or generating or filtering and the term identifying may also be understood as referring to checking for or looking for or scanning for.
• the exemplary step of identifying duplicates in the first medical data set and removing any identified duplicates may be understood as comprising the removal of all occurrences of the identified duplicates, i.e. all data related to or associated with the identified duplicates may be removed.
• one unique occurrence / one unique entry of data of identified duplicates is kept.
• one entry / one row is removed from the data set and one entry / one row associated to the identified duplicate(s) is kept.
• said exemplary first medical data set contains valid multiple identical entries / valid duplicates, e.g. entries having the same data and with the same / identical data values at different times, i.e. at/with different time indices, since for example the patient may eat exactly the same meal at different times, suspicious or anomalous double-entries or duplicates may be identified by checking whether such identical entries are recorded as having occurred within a short time interval or even at the same time, e.g. having the same time stamp.
• said entries may be marked as suspicious or anomalous during an exemplary step of identifying duplicates in the first medical data set and may subsequently be removed from the said exemplary first medical data set.
• the exemplary step of identifying data values that lie above a predefined maximum threshold data value can be based on a predefined maximum threshold data value derived from statistical analysis of previously recorded medical data sets of the patient. For example, some data / data values of the first medical data set may indicate unrealistic high amounts of carbohydrate intake(s) and/or unrealistic high amounts insulin inputs.
• carbohydrate and bolus insulin intakes with a value bigger/higher than a specific threshold can be marked as suspicious in the data and can be removed from the first medical data.
• An exemplary maximum threshold data value for example, can be calculated/defined as 1.5 times the interquartile range above the 75% quartile (third quartile) of all carbohydrate and/or insulin values of the specific patient, wherein the values may be retrieved from historic patient records.
• This specific maximum threshold data value is exemplary only and other ranges/limits and/or other data, e.g. heart rate or other analyte data, can be used to derive maximum threshold data values on which basis data can be removed from the first medical data set.
• a predefined maximum threshold data value can be based on determining the interquartile range above the 75% quartile of all available data values of a specific data type including any previously / historically recorded data values for a patient.
• the exemplary step of identifying data values that lie below a predefined minimum threshold data value can also be based on a predefined minimum threshold data value derived from statistical analysis of previously recorded medical data sets of the patient.
• a predefined minimum threshold data value can be calculated/defined as 1.5 times the interquartile range below the 25% quartile (first quartile) of all carbohydrate and/or insulin values of the specific patient and demanding that said exemplary minimum threshold data value is not negative, i.e. not less than zero.
• said minimum threshold data value is exemplary only and other ranges/limits and/or other data, e.g. heart rate or other analyte data, can be used to derive minimum threshold data values on which basis data can be removed from the first medical data set.
• a predefined minimum threshold data value can be based on determining the interquartile range below the 25% quartile of all available data values of a specific data type including any previously / historically recorded data values for a patient. It is inter alia also possible to set an exemplary predefined minimum threshold data value to be zero, to exclude any negative data / negative data values that may indicate an error in the first medical data set.
• the exemplary step of identifying data values that differ from predetermined expected data values by more than a predetermined amount and removing data associated to said identified data values may, for example, comprise checking for unrealistic/suspicious carbohydrate to insulin ratios.
• a base for such a check for unrealistic/suspicious carbohydrate to insulin ratios can be an estimate for the expected injected bolus insulin amount, BI exp ected , which can be computed according to the following formula:
• CHO ⁇ s the carbohydrate content of a meal or amount of carbohydrates of a meal intake, AG is the deviation of the glucose value or blood glucose value, BGCGM, measured/recorded by a glucose monitoring system, e.g. by a continuous glucose monitoring system (CGM), from a nominal target glucose value or blood glucose value, BG target , e.g. BG target set to 110 mg/dl, i.e.
• identifying data values that differ from predetermined expected data values by more than a predetermined amount may comprise checking whether a recorded bolus insulin amount differs from an expected bolus insulin amount by more than a predetermined amount, e.g. by more than 10, 20 or 40%.
• continuous glucose monitoring system can be understood as referring to a glucose monitoring system that is measuring/recording glucose values, e.g. blood glucose values and/or interstitial glucose values, of a patient at regular intervals or at scheduled times, wherein the frequency with which glucose levels of a patient can be measured/recorded can be up to 12 measurements per hour, i.e. with a sampling time T s of 5 minutes, or the frequency can be higher, e.g. every minute or even with sampling times of less than a minute.
• glucose values e.g. blood glucose values and/or interstitial glucose values
• CIR is a/the patient specific carbohydrate-to-insulin-ratio value or factor that, for example, has been set by the patient himself or with the assistance of a medical doctor
• ISF is a/the patient specific insulin sensitivity factor that also may, for example, have been set by the patient himself or with the assistance of a medical doctor.
• a patient may rely on said CIR and ISF values to compute their specific bolus insulin injection needs.
• the above exemplary defined expected bolus insulin amount BI expected depends on the two ratios CHO/ CIR and AG /ISF. Anomalous deviations in either one of said ratios can be reflected in a measured/recorded injected bolus insulin amount, BI, value.
• data or data points or data subsets or data segments of the first medical data set can be identified / marked as suspicious/anomalous when the measured/recorded 57-value differs from a predetermined expected injected bolus insulin amount or value by more than a predetermined amount or value.
• I may be set to 0.6 and u may be set to 1.4 when demanding that data with a measured/recorded 57-value that differ by more than 40% from the expected value BI expectedS Y ⁇ ou ⁇ be removed from the first medical data set.
• the step of identifying incomplete data for which data values are missing and removing identified incomplete data from the first medical data set may inter alia comprise checking for a missing time / missing time stamp of data and/or checking for a wrong data format, e.g. the occurrence of a string of characters instead of an expected float or integer value and/or may comprise checking for a missing data value for an expected data entity or data type.
• the step of identifying at least one predetermined time-dependent data pattern and removing data associated to said identified time-dependent data pattern may for example comprise checking for any unexplainable or invalid rises or falls in certain data values over time.
• unexpected or unexplainable or invalid rises or falls in certain data values over time may be considered as predetermined time-dependent data patterns or as anomalous temporal signatures in a subset of the first medical data set.
• identifying/detecting an invalid rise in glucose levels or blood glucose levels in data from a glucose monitoring system/device such as for example data recorded/measured by a/the continuous glucose monitoring system/device, CGM, that cannot be associated to a meal intake (which itself also can be an indication of an incomplete data set / incomplete data entry) can be detected/identified using the following exemplary computer-implementable method and criteria:
• the filter e.g. using a Savitzky-Golay-Filter (SGF) with filter parameters d and w, wherein the filter parameter d refers to a/the polynomial degree and wherein the filter parameter w refers to a/the window size of the Savitzky-Golay-Filter.
• SGF Savitzky-Golay-Filter
• Ay y(t max ) - y(t min ), the difference in glucose levels / blood glucose levels between the time of a local maximum and the time of a local minimum.
• c) Determining if the following condition is satisfied, wherein c(t) denotes the corresponding data values for the amount of carbohydrates from meal intakes at a given time, i.e. denotes a time-dependent carbohydrates input signal, Ay min denotes a threshold for a minimum rise in glucose levels / blood glucose levels and wherein y min denotes a rate-of-change threshold for the change in glucose levels / blood glucose levels.
• time interval [t min , t max ] can be considered an invalid rise in glucose levels or blood glucose (BG) levels and data or data segments associated with that invalid rise can be marked as suspicious and can be removed from the first medical data set.
• Exemplary parameters and exemplary parameter values for the above exemplary described possible steps of using a Savitzky-Golay-Filter (SGF) to identify a predetermined time-dependent data pattern such as an anomalous or suspicious or invalid rise in glucose levels / blood glucose (BG) levels are listed in the following table I.
• SGF Savitzky-Golay-Filter
• a check can be implemented to identify data or data points or data segments in the first medical data set or in the second medical data set that are particularly well suited as starting points or data segments to be inputted to a blood glucose level prediction model in order to facilitate identifying / determining the best blood glucose level prediction model parameters / parameter values.
• a suitable valid starting point in the first medical data set or in the second medical data set might be identified as a meal intake of a predetermined minimum amount of carbohydrates, e.g. of at least 20 g of carbohydrates, with a simultaneous injection of an appropriate amount of bolus insulin, e.g. an amount of bolus insulin that is not marked as invalid or suspicious and that is, for example, in agreement with expected injection amounts of bolus insulin, as described further above.
• a suitable valid starting point in the first medical data set or in the second medical data set might be identified as a meal intake of a predetermined minimum amount of carbohydrates, e.g. of at least 20 g of carbohydrates, with a simultaneous injection of an appropriate amount of bolus insulin, e.g. an amount of bolus insulin that is not marked as invalid or suspicious and that is, for example, in agreement with expected injection amounts of bolus insulin, as described further above.
• a suitable data segment on whose basis best-fit model parameter values of parameters of a blood glucose level prediction model can be derived from may be defined by commencing with a valid starting point and ending with a data point that is marked as suspicious or with a last data point before a hole or a gap in the first medical data set, for example a gap longer than a predetermined duration, e.g. longer than 30 minutes.
• a predetermined duration e.g. longer than 30 minutes.
• the end of a valid data segment may be defined by identifying a marker for a next valid starting point or the end of a valid data segment can be defined by the lapse of a predetermined time duration after the beginning of the data segment, e.g. 2 hours after the first point of the data segment, whichever may occur first.
• T o further facilitate the use of data segments of the first medical data set or of the second medical data set for identifying the best blood glucose level prediction model parameters / parameter values, a minimum length / a minimum duration can be set for the identification/selection of data segments of the first medical data.
• the step of providing the extracted second medical data set as input to a blood glucose level prediction model data may comprise identifying in the second medical data set at least one data segment, wherein a data segment is a subset of a plurality of data points of the extracted second medical data set that covers at least a minimum time range.
• the above-mentioned exemplary second medical data set may be derived from the first medical data set by removing data from the first medical data set according to any of the above exemplary described methods, criteria or rules.
• the above-mentioned exemplary second medical data set may be derived from / generated from the first medical data set by extracting valid data segments from the first medical data set according to any of the above exemplary described methods, criteria or rules.
• the second medical data set can be split up according to a predefined schedule, such as for example, splitting the second medical data set into three different parts that are associated to meal times such as breakfast, lunch and dinner times.
• each part of the second medical data set can be provided as separate input to a blood glucose level prediction model to derive model parameters for each different part, thereby better reflecting the effect of the meal times on the prediction performance of the model to predict future blood glucose levels.
• separate model parameter sets can be identified for breakfast, lunch and dinner time.
• Breakfast models can, for example, be identified from data segments with a starting point between 5:30 a.m. and 10:30 a.m., lunch models from those with a starting time between 10:30 a.m. and 2:30 p.m., and dinner models from those with a starting time between 5:00 p.m. and 9:00 p.m.
• a possible exemplary blood glucose level prediction model is described below which can be used to predict future blood glucose levels of patient on the basis of the above-described second medical data set.
• a suitable patient-data-based blood glucose level prediction model is the Kirchsteiger model (denoted with PM1) that describes the blood glucose response to carbohydrate intakes, as well as to bolus insulin injections, and that can be expressed with the following formula:
• £GCGM( s ) > which also can be denoted with CGM(s), describes the glucose level(s) / blood glucose level(s) measured/recorded via a continuous glucose monitoring (CGM) system, D(s) the carbohydrates of meal intakes and t/(s) the bolus insulin injections, all in the Laplace domain parametrized by the complex frequency , wherein, the transformation from the time domain f into the Laplace domain - can be described by the following Laplace transformation
• Equation (4) has an easy to grasp physiological interpretation: Whereas describes the effect of 1 gram of carbohydrates on glucose levels, K 2 corresponds to the effect of 1 IU of bolus insulin (both for time t ® ⁇ ). Time constants T t and T 2 are proportional to the response time to carbohydrate and insulin inputs.
• the second medical data set can be inputted in said patient-data-based blood glucose level prediction model and the best-fit model parameters / parameter values can be determined by minimizing a cost function.
• a possible suitable exemplary cost function to optimize / minimize in order to determine the best- fit model parameters of a blood glucose level prediction model, such as the above described Kirchsteiger model, is the following exemplary cost function /(Q): with
• y k corresponds to the measured output of a glucose monitoring system such as a continuous glucose monitoring system, i.e. y k corresponds to the glucose data / blood glucose level data / blood glucose values BGCGM and y k denotes the output of the chosen blood glucose level prediction model, e.g. the Kirchsteiger model.
• d denotes a data segment, for example, a data segment from the second medical data set that was identified from a/the first medical data set as described above.
• a data segment can be understood as a subset of a/the first medical data set, wherein the data of the data segment have been extracted/selected/filtered from a/the first medical data set according to one or more criteria and/or rules described above.
• the total number of data segments is denoted with d tot , i.e. there are 1 ...d tot data segments.
• the index for the data segments has been intentionally omitted in the above-described definition of the cost function /(Q).
• Each data segment d can further be characterized by a starting index k 0 and an end index k N , i.e. the index Acan be used to index individual data points / individual data within a given data segment d.
• the vector Q describes the model parameters, i.e. in the exemplary case of the Kirchsteiger model, said model vector Q may depend on the parameters K t , K 2 , T t and T 2 .
• the model output y k can be computed using the model parameters Q and an estimate of the initial state x 0 .
• This initial state estimate may correspond to the state of the model at the start k 0 of a data segment and may correspond to the best estimate of the glucose level value at the start of a data segment. Said initial state estimate can be estimated/derived/determined for each data segment.
• said initial state estimate may, for example, be derived by using a Kalman filter and/or by using an autoregressive approach.
• This exemplary cost function can be inter alia performed using either a brute- force search algorithm over a grid of model parameter vector Q values or can be performed by local gradient search algorithms, e.g. a simplex algorithm, or by global optimization algorithms, e.g. genetic algorithms, simulated annealing algorithms, Markov chain Monte Carlo algorithms or other techniques.
• local gradient search algorithms e.g. a simplex algorithm
• global optimization algorithms e.g. genetic algorithms, simulated annealing algorithms, Markov chain Monte Carlo algorithms or other techniques.
• the derived best-fit model parameters Q best may then be used to predict future blood glucose levels of a/the patient, in particular to predict postprandial blood glucose levels of a/the patient.
• the derived best-fit model parameters Q best may then, for example, be used together with further information from data from the second medical data set, such as meal size and/or injected bolus quantity to simulate the postprandial future glucose trajectory of a/the patient.
• a blood glucose level prediction model such as the one exemplary described above on a medical data set, i.e. on a/the second medical data set described above, that was extracted/selected/generated from a first medical data set as described above, yields unprecedented robust, reliable and accurate predictions of future blood glucose levels of a/the patient that are superior to any current known prediction techniques.
• the application of the above described blood glucose level prediction model may be further refined by using a Kalman filter to estimate an initial state of the model.
• a Kalman filter can be used to estimate the state of the model before the starting point of a (first) data segment, e.g. 6 hours before the starting point of a (first) data segment, and to compute estimates for the state for each of those time points up to the start of a first data segment d.
• the last estimate of x (just at the start of the identification data segment) may then correspond to the initial state x 0 of the blood glucose level prediction model.
• the model inside the Kalman filter (derived from the model with parameters Q) can be updated in every iteration step of the optimization using the latest estimate of the model parameters Q, i.e. the model used for the prediction and the (same) model used inside the Kalman filter can be optimized simultaneously.
• G b can be an estimate of the patient's basal glucose level
• u is the input in the time domain.
• a prediction for time t ko + kT s (with T s being the sampling time) can thus, for example, be calculated as:
• KF-PM1 The combination of the exemplary Kirchsteiger model (PM1) and the exemplary Kalman filter (KF) may also be referred to as KF-PM1.
• said equation (8) may also be used for a prediction of future glucose levels by setting the estimated state x(t fco ) at time t ko to zero.
• the initial state x 0 may be assumed to be zero for the model (i.e. no impact of the initial state on the model output), but the effect of the initial state may be captured by an autoregressive (AR) model instead.
• AR autoregressive
• the predicted glucose output of this exemplary hybrid model approach may correspond to the sum of the chosen blood glucose level prediction model prediction(s) and the prediction(s) by the AR model.
• a population mean AR model with parameter values identified from data during the night period may be used for this purpose.
• y AR be the prediction of time t ko + kT s given information from up to time t ko .
• the combination of the exemplary Kirchsteiger model (PM1) and the exemplary autoregressive model (AR) may also be referred to as the AR-PM1 approach.
• the second medical data set may be provided as input also to other blood glucose level prediction models, not only to the exemplary models PM1 or its variants, KF- PM1 or AR-PM1.
• Ay AR (t + kT s ) a k Ay(t) + b k Ay(t - T s ) (11)
• Ayit ) y(t) - G b (12) can be used (where G b is again the patient-specific estimate of the basal glucose level).
• the parameters ( a k , b k ) are optimized using least squares (LS) optimization for each prediction horizon k. It should be noted that even though the structure of the global AR model used for this purpose can be identical to that inside the hybrid AR-PM1 approach described above, the model parameters may differ.
• the global AR model used as a baseline can be based on data from the entire 24-hour period of each day.
• PM2 may be referred to as PM2 and may be also implemented using a Kalman filter or with using an autoregressive (AR) model in which case said variants may be referred to as KF-PM2 or AR-PM2.
• AR autoregressive
• an obtained prediction of future blood glucose levels can be displayed to a patient, for example on a display of a glucose monitoring system or on the display of a computing device, e.g. a smartphone or personal computer.
• a recommended dosage of insulin to be administered is displayed to a patient.
• a recommended dosage of insulin is automatically administered via automatic control of an insulin pump.
• the present invention facilitates the monitoring, predicting and controlling of blood glucose levels of a/the patient and also facilitates the control of administering appropriate dosages of insulin in a reliable and accurate manner.
• All of the herein described method steps for predicting blood glucose levels are computer- implementable, i.e. they can for example be executed by a computing system comprising a computer memory, one or more processors and optionally a display.
• a computing system can, for example, be one of the following types: a computer server, a personal computer or a mobile computing system, e.g. a smartphone, tablet or laptop.
• the present invention can be implemented as a glucose monitoring system comprising a sensor for obtaining glucose data / blood glucose data of patient, a computer memory, one or more processors and a display, wherein the computer memory of the glucose monitoring system may comprise computer-executable instructions which, when executed by the one or more processors of the glucose monitoring system, cause the one or more processors to perform one, some or all of the herein described steps for predicting blood glucose levels.
• Said exemplary glucose monitoring system may further comprise an insulin pump and the glucose monitoring system can further be configured to control the insulin pump, in particular for controlling the dosage of insulin that can be administered by the insulin pump.
• the exemplary glucose monitoring system may also be configured to determine a recommended dosage of insulin to be administered based on an obtained prediction of future blood glucose levels.
• the above and in the following described computer-implementable method steps may be stored on one or more computer-storage media, e.g. non-volatile computer-storage media, storing computer-executable instructions that, when executed by a computer system, can perform a method according to either one, some or all of the above and in the following exemplary described method steps for predicting blood glucose levels.
• computer-storage media e.g. non-volatile computer-storage media, storing computer-executable instructions that, when executed by a computer system, can perform a method according to either one, some or all of the above and in the following exemplary described method steps for predicting blood glucose levels.
• Fig. 1 Exemplary flow diagram for predicting blood glucose levels
• Fig. 2 Exemplary filtered blood glucose data / exemplary filtered glucose data
• Fig. 3 Exemplary prediction of postprandial blood glucose levels
• Fig. 1 schematically shows exemplary possible steps of a computer-implementable method, 100, for predicting blood glucose levels, in particular for postprandial blood glucose level prediction.
• a computer-implementable method 100, for predicting blood glucose levels, in particular for postprandial blood glucose level prediction.
• an exemplary first medical data set of a patient covering a time range can be retrieved or received, 101 , for processing.
• Said exemplary first medical data set comprising blood glucose data and further other medical data of said patient.
• the blood glucose data may originate from / may be received from / may be retrieved from a sensor of a glucose monitoring system and the other medical data may comprise at least one of the following: data on meal intakes, e.g. amount of carbohydrates from meal intakes, or data on medication, e.g. data on insulin injections or measured insulin levels, and/or other analyte data, wherein said exemplary other analyte data or insulin data may also originate from a medical sensor.
• data on meal intakes e.g. amount of carbohydrates from meal intakes
• data on medication e.g. data on insulin injections or measured insulin levels
• other analyte data e.g. data on insulin injections or measured insulin levels
• a patient can himself input data, e.g. data on meal intakes, e.g. amount of carbohydrates from meal intakes, or data on medication, blood glucose levels or insulin levels.
• data on meal intakes e.g. amount of carbohydrates from meal intakes, or data on medication, blood glucose levels or insulin levels.
• the first medical data set may be a hybrid data set with data automatically retrieved from medical sensors and with data manually inputted by a patient/user.
• said exemplary second medical data set may be extracted, 102, from the exemplary first medical data set on the basis of at least one of the following rules or criteria:
• the exemplary second medical data set generated / extracted from the first medical data set can then automatically be fed into / provided to / inputted, 109, to a blood glucose level prediction model.
• future blood glucose levels of the patient in particular, postprandial blood glucose levels of the patient, can be predicted, 110, with unprecedented accuracy and robustness.
• Fig. 2 schematically shows an exemplary filtered blood glucose data signal y(t), 200, that was obtained from filtering data 201 on (raw, unfiltered) blood glucose levels, e.g. time-dependent data BGCGM (t) from a glucose monitoring system, using a filter, e.g. using a Savitzky-Golay-Filter (SGF) as described above and with the exemplary parameters of table I.
• filtering data 201 on (raw, unfiltered) blood glucose levels e.g. time-dependent data BGCGM (t) from a glucose monitoring system
• SGF Savitzky-Golay-Filter
• the reference numeral 203 marks the ordinate axis of exemplary glucose values or blood glucose values, BG, and the reference numeral 202 marks the abscissa axis of exemplary time t.
• an exemplary identifying/detecting of an invalid rise in blood glucose levels in data from a glucose monitoring system such as for example data recorded/measured by a continuous glucose monitoring system, CGM, that cannot be associated to a meal intake (which itself also can be an indication of an incomplete data set / incomplete data entry) can be detected/identified using the following exemplary computer-implementable method and criteria:
• istart tmin T, wherein AT, 211, is a time shift
• Ay y(t max ) - y(t min ), the difference in glucose levels / blood glucose levels between the time of a local maximum and the time of a local minimum.
• c) Determining if the following condition is satisfied, wherein c(t) denotes the corresponding data values for the amount of carbohydrates from meal intakes at a given time, i.e. denotes a time-dependent carbohydrates input signal, Ay min denotes a threshold for a minimum rise in glucose levels / blood glucose levels and wherein y min denotes a rate-of-change threshold for the change in glucose levels / blood glucose levels.
• time interval [t min , t max ⁇ , 212 can be considered an invalid rise in glucose levels / blood glucose (BG) levels and data or data segments associated with that invalid rise can be marked as suspicious and can be removed from the first medical data set.
• BG blood glucose
• Identifying such an exemplary invalid rise in glucose levels / blood glucose (BG) levels is an example for identifying a predetermined time-dependent data pattern so that data associated to said identified time-dependent data pattern can be removed from first medical data set.
• Fig. 3 schematically exemplary shows glucose data / blood glucose data BG CG M (t), 304 of a patient, wherein the data may have been retrieved from a continuous glucose monitoring system.
• the shown glucose data / blood glucose data, 304 may be glucose data / blood glucose data from an exemplary second medical data set, i.e. glucose data / blood glucose data that was extracted from a first medical data set according to at least one of the steps, rules or criteria described above.
• the reference numeral 303 marks the ordinate axis of exemplary blood glucose values, BG, and the reference numeral 302 marks the abscissa axis of exemplary time t.
• the star symbol marks an event, 307, on the time line, such as a meal intake and/or an intake of medication, such as a bolus insulin intake.
• the event 307 may represent a breakfast meal event of the patient. Furthermore, there are shown two prediction trajectories for the prediction of postprandial blood glucose levels from two different blood glucose level prediction models based on said exemplary second medical data set.
• the reference numeral 305 denotes a prediction of postprandial blood glucose levels based on providing the second medical data set to a blood glucose level prediction model based on the Kirchsteiger model with applied Kalman filter, i.e. a KF-PM1 model
• the reference numeral 306 denotes a prediction of postprandial blood glucose levels based on providing the second medical data set to a blood glucose level prediction model based on the Kirchsteiger model in combination with an autoregressive model, i.e. an AR-PM1 model.
• the second medical data set can be fed to a blood glucose level prediction model, whose model parameters can be optimized, e.g. by minimizing a cost function, to derive the best-fit model parameters that best fit the data and that allow a prediction of future blood glucose levels of the patient.
• a blood glucose level prediction model whose model parameters can be optimized, e.g. by minimizing a cost function, to derive the best-fit model parameters that best fit the data and that allow a prediction of future blood glucose levels of the patient.

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