WO2024254501A1 - Systems and methods for diabetes prediction - Google Patents
Systems and methods for diabetes prediction Download PDFInfo
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- WO2024254501A1 WO2024254501A1 PCT/US2024/033077 US2024033077W WO2024254501A1 WO 2024254501 A1 WO2024254501 A1 WO 2024254501A1 US 2024033077 W US2024033077 W US 2024033077W WO 2024254501 A1 WO2024254501 A1 WO 2024254501A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
- A61B5/0015—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network characterised by features of the telemetry system
- A61B5/0022—Monitoring a patient using a global network, e.g. telephone networks, internet
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration or pH-value ; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid or cerebral tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration or pH-value ; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid or cerebral tissue
- A61B5/14532—Measuring characteristics of blood in vivo, e.g. gas concentration or pH-value ; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid or cerebral tissue for measuring glucose, e.g. by tissue impedance measurement
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7203—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7246—Details of waveform analysis using correlation, e.g. template matching or determination of similarity
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
- A61B5/7267—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems involving training the classification device
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7271—Specific aspects of physiological measurement analysis
- A61B5/7275—Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
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- G—PHYSICS
- G06—COMPUTING OR CALCULATING; COUNTING
- G06N—COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
- G06N20/00—Machine learning
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- G—PHYSICS
- G06—COMPUTING OR CALCULATING; COUNTING
- G06N—COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
- G06N3/00—Computing arrangements based on biological models
- G06N3/02—Neural networks
- G06N3/08—Learning methods
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- 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
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- 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
Definitions
- Insulin reduces blood glucose levels by allowing cells in the muscles, liver and adipose tissue to absorb glucose and use it (or store it) as a source of energy. When observed continuously and over time, a patient’s glucose levels may provide an indication of diabetes, such as prediabetes, Type 1 or Type 2 diabetes, gestational diabetes mellitus (GDM), etc.
- GDM is a medical condition that prevents the body from using insulin effectively, which causes glucose to build up in the blood rather than being used by the cells. The “cause” of GDM is unknown. All pregnant women experience insulin resistance during pregnancy due to the hormone changes that occur, but pregnant women with GDM do not produce enough insulin to overcome the insulin resistance and prevent hyperglycemia indicative of GDM.
- FIG.1 illustrates aspects of an example health management system, in accordance with embodiments of the present disclosure.
- FIG. 2A depicts a diagram of an example CAM system and display devices, in accordance with embodiments of the present disclosure.
- FIGS.2B, 2C depict top and side views of the example CAM system, respectively, in accordance with embodiments of the present disclosure.
- FIG.3 presents a data diagram illustrating example input data and metric data for use by the health management system, in accordance with embodiments of the present disclosure.
- FIG. 4 depicts a block diagram of an example computing device, in accordance with embodiments of the present disclosure.
- FIG. 5 depicts a process flow diagram for evaluating and selecting a model and a combination of analyte features for predicting a disease, in accordance with embodiments of the present disclosure.
- FIG. 6A depicts a graph presenting example measured glucose data for a number of CAM wear sessions for a prototypical pregnant patient, in accordance with embodiments of the present disclosure.
- FIG. 6B presents an example combination of features for predicting GDM, in accordance with embodiments of the present disclosure.
- FIG.6C depicts a graph presenting example measured glucose data and an associated autocorrelation function for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- FIG.6D depicts a graph presenting example measured glucose data and an associated autocorrelation function for a person not clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- FIG.6E depicts a graph presenting example measured glucose data and associated peak widths for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- FIG. 6I depicts a graph presenting example measured glucose data and associated durations near the EGV set point for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- FIG. 6J depicts a graph presenting example measured glucose data and associated durations near the EGV set point for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- FIG. 7A depicts an example artificial neural network (ANN), in accordance with embodiments of the present disclosure.
- FIG. 7B depicts an example logistic regression (LR) model, in accordance with embodiments of the present disclosure.
- FIG. 7C depicts another example logistic regression (LR) model, in accordance with embodiments of the present disclosure.
- Output data 144 may be stored in user database 110, provided to the user 102 through GUI 160 presented on display device 150, provided to the user’s caretaker (such as a parent, a relative, a guardian, a teacher, a nurse, etc.), provided to the user’s physician, or any other individual that has an interest in the wellbeing of the user for purposes of improving the user’s health, such as, in some cases by effectuating the recommended treatment.
- output data 144 may be stored in user profile 118.
- output data 144 may include a disease prediction, one or more treatment recommendations based on the disease prediction, treatment efficacy, identification of one or more disease indicators, etc.
- CAS 210 may include a multi-analyte sensor configured #8512806_1 - 21 - 0890-PCT01 PATENT to measure glucose concentration levels, lactate concentration levels, potassium concentration levels, troponin concentration levels, creatinine concentration levels, etc. [0102] Accordingly, CAS 210 is configured to generate at least one analog sensor signal that is proportional to the concentration level of particular analyte, and SEM 220 is configured to sample the analog sensor signal, generate measured analyte data, and transmit the measured analyte data to display device 150 via wireless connection 170.
- Display devices 150 may be mobile computing devices that are connected network 180.
- display devices 150 may include CAM data receiver 152, smartphone 154, tablet computer 156, smartwatch 158, laptop computer (not shown), etc.
- display devices 150 may be non-mobile computing devices (such as a desktop computer, etc.) that are connected to network 180.
- display devices 150 are configured for displaying data, including measured analyte data, which may be transmitted by SEM 220.
- Display devices 150 may include a touchscreen display for displaying data to a user and receiving inputs from the user. For example, GUI 160 may be presented to the user for such purposes.
- CAM data receiver 152 may be a custom display device specially designed for displaying certain types of data associated with measured analyte data received from SEM 220.
- smartphone 154 may use a commercially available operating system (OS), and may be configured to display a graphical representation of the continuous measured analyte data (such as including current and historic data) using GUI 160.
- OS operating system
- GUI 160 GUI 160
- the content of the data packages (such as amount, format, and/or type of data to be displayed, alarms, etc.) may be customized (such as programmed differently by the manufacture and/or by an end user) for each particular display device 150.
- a number of different display devices 150 may be in direct wireless communication with a SEM 220 of a CAM system 200 worn by a user 102 during a wear session to enable a number of different types and/or levels of display and/or functionality associated with the displayable data.
- the type of alarms customized for each particular display device 150, the number of alarms customized for each particular display device 150, the timing of alarms customized for each particular display device 150, and/or the threshold levels configured for each of the alarms (such as for triggering) are based on output data 144.
- NAS 230 may include a temperature sensor, an altimeter sensor, an accelerometer sensor, a respiration rate sensor, a sweat sensor, a heart rate sensor, an electrocardiogram (ECG) sensor, a blood pressure sensor, a respiratory sensor, an oxygenated hemoglobin sensor (spO2), etc.
- ECG electrocardiogram
- Other devices may be coupled to SEM 220, such as an insulin pump, a peritoneal dialysis machine, a hemodialysis machine, etc.
- FIGS. 2B, 2C depict top and side views of CAM system 200, respectively, in accordance with embodiments of the present disclosure.
- CAM system 200 includes housing 202 enclosing SEM 220, and adhesive pad 204 disposed on the bottom surface of housing 202. CAS 210 protrudes from the bottom surface of housing 202 and adhesive pad 204. CAM system 200 is configured to be worn on epidermis 104 of user 102 at a convenient location, such as the back of the upper arm, the abdomen, etc. [0112] CAM system 200 may be battery powered, and, in certain embodiments, the battery may be replaced or recharged if necessary.
- SEM 220 is coupled to CAS 210, and includes electronic circuitry configured to acquire, process, store and transmit measured analyte data, as well as other information, to display devices 150 for presentation to user 102.
- CAS 210 may be a single-analyte sensor that includes a percutaneous wire that has a proximal portion coupled to SEM 220 and a distal portion with several electrodes.
- a measurement (or working) electrode may be coated, covered, treated, embedded, etc., with one or more chemical molecules that react with a particular analyte, and a reference electrode may provide a reference electrical voltage.
- the measurement electrode may generate the analog sensor signal, which is conveyed along a conductor that extends from the measurement electrode to the proximal portion of the percutaneous wire that is coupled to SEM 220.
- CAS 210 penetrates epidermis 104, and the distal portion extends into the dermis and/or subcutaneous tissue 106 under epidermis 104 (as depicted in FIG.2B).
- Other configurations of CAS 210 may also be used, such as a multi-analyte sensor that includes multiple measurement electrodes, each generating an analog sensor signal that represents the concentration levels of a particular analyte.
- CAS 210 may incorporate a thermocouple within, or alongside, the percutaneous wire to provide an analog temperature signal to SEM 220, which may be used to correct the analog sensor signal or the measured analyte data for temperature.
- the thermocouple may be incorporated into SEM 220 above adhesive pad 204, or, alternatively, the thermocouple may contact epidermis 104 of user 102 through openings in adhesive pad 204.
- SEM 220 includes, inter alia, processor (P) 222, memory (M) 224, transceiver or transmitter/receiver (T/R) 226, one or more antennae (A) 228 coupled to transceiver 226, analog signal processing circuitry, analog-to-digital (A/D) signal processing circuitry, digital signal processing circuitry, a power source for CAS 210 (such as a potentiostat), etc.
- Processor 222 may be a general-purpose or application-specific microprocessor, an application-specific integrated circuit (ASIC), a field-programmable gate array (FPGA), etc., that executes instructions to perform control, computation, input/output, etc. functions for CAM system 200.
- Processor 222 may include a single integrated circuit, such as a micro- processing device, or multiple integrated circuit devices and/or circuit boards working in cooperation to accomplish the appropriate functionality.
- processor 222, memory 224, transmitter/receiver 226, the A/D signal processing circuitry, and the digital signal processing circuitry may be combined into a system-on-chip (SoC).
- SoC system-on-chip
- CAS 210 and adhesive pad 204 may be assembled to form an application assembly, where the application assembly is configured to be applied to the user’s epidermis 104 so that CAS 210 is subcutaneously inserted as depicted.
- SEM 220 may be attached to the assembly after application to the user’s epidermis 104 via an attachment mechanism (not shown).
- SEM 220 may be incorporated as part of the application assembly, such that CAS 210, adhesive pad 204 and SEM 220 can all be applied at once to the user’s epidermis 104.
- this application assembly is applied to the user’s epidermis 104 using a separate sensor applicator (not shown).
- CAM system 200 may be removed by peeling adhesive pad 204 from the user’s epidermis 104. It is to be appreciated that CAM system 200 and its various components are illustrated as one example form factor, and CAM system 200 and its components may have different form factors without departing from the spirit or scope of the described techniques.
- processor 222 is configured to sample the analog sensor signal using the A/D signal processing circuitry at regular intervals (such as the sampling period), generate measured analyte data from the sampled analog sensor signal, and generate sensor data packages that include, inter alia, the measured analyte data.
- Processor 222 may store the measured analyte data in memory 224, and generate the sensor data packages at regular intervals (such as the transmission period) for transmission by T/R 226 to display device 150.
- Processor 222 may also add additional data to the sensor data packages, such as supplemental #8512806_1 - 25 - 0890-PCT01 PATENT sensor information that includes a sensor identifier, a sensor status, temperatures that correspond to the measured analyte data, etc.
- the sensor identifier represents information that uniquely identifies CAS 210 from other sensors, such as other sensors of other analyte monitoring devices, other sensors implanted previously or subsequently in the user’s epidermis 104, and so on.
- the sensor identifier may also be used to identify other aspects about CAS 210, such as a manufacturing lot of CAS 210, packaging details of CAS 210, shipping details of CAS 210, and so on. In this way, various issues detected for sensors manufactured, packaged, and/or shipped in a similar manner as CAS 210 may be identified and used in different ways in order to calibrate the measured analyte data, to notify users of defective sensors, to notify manufacturing facilities of machining issues, and so forth.
- the sensor status of the supplemental sensor information represents a state of CAS 210 at a given time, such as a state of the sensor at a same time one of the measured analyte data is produced.
- the sensor status may include an entry for each of the measured analyte data, such that there is a one-to-one relationship between the measured analyte data and statuses captured in the supplemental sensor information.
- the sensor status may describe an operational state of CAS 210.
- processor 222 may identify one of a number of predetermined operational states for a given measurement. The identified operational state may be based on the communications from CAS 210 and/or characteristics of those communications. [0123]
- a lookup table, stored in memory 224 may include the predetermined number of operational states and bases for selecting one state from another.
- the predetermined states may include a “normal” operation state where the bases for selecting this state may include an analog sensor signal from CAS 210 that falls within thresholds indicative of normal operation, an analog temperature signal that is within a threshold of suitable temperatures to continue operation as expected, etc.
- the predetermined states may also include operational states that indicate that one or more characteristics of the analog sensor signal from CAS 210 are outside of normal activity and may result in potential errors in the measured analyte data, such as an analog sensor signal from CAS 210 that is outside a threshold of expected signal strength, an environmental temperature that is outside suitable temperatures to continue operation as expected, detecting that the user 102 has physically rolled onto CAM system 200, etc.
- FIG.3 presents data diagram 300 illustrating input data 128 and metric data 130 for use by health management system 100, in accordance with embodiments of the present disclosure.
- FIG.3 illustrates input data 128 on the left, display device 150 and network computing device 142 in the middle, and metric data 130 on the right.
- display device 150 stores and executes one or more related applications and presents GUI 160 to the user, while network computing device 142 stores and executes DSE 114 (including DAM 116), as well as other applications.
- DSE 114 including DAM 116
- metric data 130 includes various types of data, such as discrete numerical values, ranges, qualitative values (high/medium/low, stable/unstable, rate of change, points of inflection, etc.), etc.
- Display device 150 obtains input data 128 through one or more channels such as manual user input, sensors/monitors, other applications executing on display device 150, EMR systems, etc.).
- DSE 114 may process input data 128 to generate metric data 130, and generate a disease prediction based on certain elements of metric data 130.
- DSE 114 may process continuous analyte sensor data 129, such as measured glucose data provided by CAM system 200, to determine glucose features 131, and then generate a GDM prediction as output data 144, such as GDM or not GDM, based on a combination of glucose features 131.
- training system 140 has evaluated, selected and trained a model to predict GDM based on a combination of glucose features that have been extracted from historical glucose data, and DSE 114 executes the model to generate the GDM prediction.
- food consumption information may include information about one or more of meals, snacks, and/or beverages, such as one or more of the size, content (milligrams (mg) of sodium, potassium, carbohydrate, fat, protein, etc.), sequence of consumption, and time of consumption.
- food consumption may be provided by a user through manual entry, by providing a photograph through an application that is configured to recognize food types and quantities, by scanning a #8512806_1 - 27 - 0890-PCT01 PATENT bar code or menu, and/or interrogating an NFC / RFID tag.
- meal size may be manually entered as one or more of calories, quantity (such as “three cookies”), menu items (such as “Royale with Cheese”), and/or food exchanges (such as 1 fruit, 1 dairy).
- meal information may be received by the related application(s) executing on display device 150.
- meal information may be provided via one or more other applications synchronized with the related application(s), such as one or more other mobile health applications executed by display device 150.
- the synchronized applications may include, such as an electronic food diary application, photograph application, etc.
- food consumption information entered by a user may relate to nutrients consumed by the user. Consumption may include any natural or designed food or beverage.
- Food consumption information entered by a user may also be related to analytes, including any of the other analytes described herein.
- exercise information may also be provided.
- Exercise information may be any information surrounding activities, such as activities requiring physical exertion by the user.
- exercise information may range from information related to low intensity (such as walking a few steps) and high intensity (such as five mile run) physical exertion.
- exercise information may be provided, for example, by an accelerometer sensor or a heart rate monitor on a wearable device such as a watch, fitness tracker, and/or patch.
- exercise information may also be provided through manual user input and/or through a surrogate sensor and prediction algorithm measuring changes to heart rate (or other cardiac metrics).
- user statistics such as one or more of age, height, weight, BMI, body composition (such as % body fat), stature, build, or other information may also be provided as an input.
- user statistics may be provided through GUI 160, by interfacing with an electronic source such as an electronic medical record, from measurement devices, etc.
- the measurement devices include one or #8512806_1 - 28 - 0890-PCT01 PATENT more of a wireless, such as a Bluetooth-enabled, weight scale or camera, which may, for example, communicate with display device 150 to provide user data.
- treatment information may also be provided as an input. Treatment information may include information about the type, dosage, and/or timing of when one or more medications (such as SGLT2, insulin) are to be taken by the user.
- the treatment information may include information about one or more inhibitors, one or more drugs known to reduce blood glucose levels, one or more drugs known to affect glucose, and/or one or more medications for treating one or more symptoms of acute or chronic conditions and diseases the user may have.
- the treatment information may include information regarding different lifestyle habits, surgical procedures, and/or other non-invasive procedures recommended by the user’s physician.
- the user’s physician may recommend a user increase/decrease their carbohydrate intake, exercise for a minimum of thirty minutes a day, or increase an insulin dosage or other medication to maintain, improve, and/or reduce hyper- and/or hypoglycemic episodes, etc.
- a healthcare professional may recommend that a user engage in at-home treatment and/or treatment at a clinic.
- the treatment information may also indicate a patient’s adherence to the prescribed type, dosage, and/or timing of medications.
- the treatment/medication information may indicate whether and when exactly and with what dosage/type the medication was taken.
- measured analyte data may include glucose concentration levels measured by at least a glucose sensor (or multi-analyte sensor configured to measure at least glucose) that is a part of CAM system 200.
- Glucose baselines, glucose level rates of change, glucose trends, glucose variability, glucose clearance, glucose time in-range, glucose features 131, etc. may also be determined from the measured glucose data acquired by CAM system 200. Additionally, fasting blood glucose and HbA1c levels may be provided as metric data 130.
- data may also be received from one or more non-analyte sensors 230.
- Data from non-analyte sensors 230 may include information related to a heart rate, heart rate variability (such as the variance in time between the beats of the heart), ECG data, a respiration rate, oxygen saturation, a blood pressure, or a body temperature (such as to detect illness, physical activity, etc.) of a user.
- electromagnetic sensors may also detect low-power radio frequency (RF) fields emitted from objects or tools touching or near the object, which may provide information about user activity or location.
- RF radio frequency
- non-analyte sensors 230 may include a scanner/reader to detect medication related information (such as type, brand, dosage, frequency).
- a scanner may include a reader configured to detect near-field communication (NFC) and/or radio frequency identification (RFID) information provided by a corresponding active or passive tag provided with packaging or otherwise accompanying the medication.
- NFC near-field communication
- RFID radio frequency identification
- Another example of a scanner may be a barcode, QR, or other optical scanner capable of accessing information associated with a visual pattern provided on the packaging or otherwise associated with the medication.
- data received from non-analyte sensors 230 may include data relating to a user’s insulin delivery.
- data related to the user’s insulin delivery may be received, via a wireless connection on a smart pen, via user input, and/or from an insulin pump.
- Insulin delivery information may include one or more of insulin manufacturer, insulin dosage, insulin formulation, insulin volume, basal vs bolus dose, intended pharmacokinetic profile (such as short-acting, long-acting), number of units of insulin delivered, time of delivery, etc. Other metrics, such as insulin action time or duration of insulin action, may also be received.
- time may also be provided, such as time of day, UTC time or time from a real-time clock.
- Said real-time clock may be provided externally (synchronized to a server via a WiFi wireless connection) or may be embedded as an integrated circuit (RTC) within the wearable / sensor electronics.
- measured analyte data may be timestamped to indicate a date and time when the analyte measurement was acquired by CAM system 200.
- at least a portion of input data 128 may be acquired through GUI 160 of display device 150.
- DAM 116 may determine, based on the measured analyte data and other data (such as GPS data), whether the user is engaging in an activity over a period of time that might affect the measured analyte data, such as engaging in exercise, consuming nutrients, etc.
- DAM 116 may first identify which measured analyte data are not to be used for calculating an analyte baseline by identifying which measured analyte data have been affected by an activity, such as consumption of food, exercise, medication, or other perturbation that would disrupt determination of the analyte baseline. DAM 116 may then exclude such measured analyte data when calculating the analyte baseline #8512806_1 - 30 - 0890-PCT01 PATENT of a user. In other examples, DAM 116 may calculate the analyte baseline by first determining a percentage of the measured analyte data values during this time period that represent the lowest analyte values measured.
- an absolute maximum analyte concentration level may be determined from measured analyte data, health/sickness metrics, and/or other condition metrics.
- the absolute maximum analyte concentration level represents a user’s maximum analyte concentration level determined to be safe over a period of time (such as hourly, weekly, daily, etc.).
- the absolute maximum analyte concentration level may be consistent across all users.
- each patient may have a different absolute maximum analyte concentration level.
- absolute maximum analyte concentration level per patient may change over time.
- a user may be initially assigned an absolute maximum analyte concentration level based on clinical data. This assigned absolute maximum analyte concentration level may be adjusted over time based on other sensor data, comorbidities, etc. for patient.
- the minimum analyte concentration level may be determined in a similar manner.
- analyte thresholds other than an absolute maximum and/or minimum analyte concentration level of a user may be determined from measured analyte data, health/sickness metrics, other condition metrics, etc.
- Such analyte thresholds may represent maximum or minimum analyte concentration levels determined to be safe during certain activities, which may vary across different activities.
- analyte concentration level rates of change may be determined from measured analyte data.
- an analyte concentration level rate of change refers to a rate that indicates how one or more time-stamped measured analyte data values change in relation to one or more other time-stamped measured analyte data values.
- Analyte concentration level rates of change may be determined over one or more seconds, minutes, hours, days, etc.
- determined analyte concentration level rates of change may be marked as “increasing rapidly” or “decreasing rapidly”.
- “rapidly” may describe #8512806_1 - 31 - 0890-PCT01 PATENT analyte concentration level rates of change that are clinically significant and pointing towards a trend of analyte concentration levels likely breaching absolute maximum analyte concentration level or absolute minimum analyte concentration level within a defined period of time.
- a predictive trend may, in some cases, indicate that a patient is likely to hit, for example, absolute maximum analyte concentration level within a specified time period (such as one or two hours) based on determined analyte concentration level rate of change. Accordingly, such an analyte concentration level rate of change may be marked as “increasing rapidly”.
- a predictive trend may, in some cases, indicate that a patient is likely to hit absolute minimum analyte concentration level within a specified time period (such as one or two hours) based on analyte concentration level rate of change determined. Accordingly, such an analyte concentration level rate of change may be marked as “decreasing rapidly”.
- analyte baseline rates of change may be determined from analyte baselines determined for a user over time.
- an analyte clearance rate may be determined from measured analyte data following consumption of a known, or estimated, amount of analyte.
- the analyte clearance rates analyzed over time may be indicative of medication efficacy or onset of a condition.
- slope of a curve of analyte clearance during a first time period (such as after administration of an inhibitor) compared to slope of a curve of an analyte clearance during a second time period (such as after consuming same inhibitor) may be indicative of an effectiveness of a treatment.
- analyte clearance rate may be determined by calculating a slope between a first value at t 0 (such as during a period of increased analyte concentration levels) and the user’s analyte baseline reached at t1.
- an analyte clearance rate may be calculated over time until increased analyte concentration levels of the user reach some value relative to user’s analyte baseline (such as a percentage of a user’s analyte baseline).
- Analyte clearance rates calculated over time may be time-stamped and stored in user’s profile 118.
- a standard deviation of analyte concentration levels may be determined from measure analyte data.
- a standard deviation of one or more analyte concentration levels may be determined based on variability of one or more analyte concentration levels as compared to an average analyte concentration level over one or more #8512806_1 - 32 - 0890-PCT01 PATENT time periods.
- a time-in-range metric (not shown) may be determined from measured analyte data. For example, with an established upper limit and lower limit, time period during which measured analyte data was between upper and lower limits can be determined.
- time-in-range may be determined for individual instances of measured analyte data being in-range or may be determined over a predetermined length of time (one day) for which each individual in-range periods are summed.
- analyte trends may be determined based on analyte concentration levels over certain periods of time.
- analyte trends may be determined based on analyte baselines over certain periods of time.
- analyte trends may be determined based on absolute analyte concentration level minimums over certain periods of time.
- analyte trends may be determined based on absolute maximum analyte concentration levels over certain periods of time.
- analyte trends may be determined based on analyte concentration level rates of change over certain periods of time. In certain embodiments, analyte trends may be determined based on analyte baseline rates of change over certain periods of time. In certain embodiments, analyte trends may be determined based on calculated analyte clearance rates over certain periods of time.
- CAM system 200 may be configured to measure interstitial glucose levels, generate glucose measurement data, and transmit the sensor data packages to display device 150, and then DSE 114 and DAM 116 may determine various glucose-related data. DSE 114 and DAM 116 may be hosted by network computing device 142 or display device 150.
- glucose concentration level rates of change may be determined from glucose measurement data.
- a glucose concentration level rate of change refers to a rate that indicates how time-stamped glucose measurement data values change in relation to one or more other time-stamped glucose measurement data values.
- Glucose concentration level rates of change may be determined over one or more seconds, minutes, hours, days, etc.
- a glucose trend may be determined based on glucose measurement data over a certain period of time.
- glucose trends may be determined based on glucose concentration level rates of change over certain periods of time.
- glycemic variability may be determined from glucose measurement data.
- glycemic variability refers to a standard deviation of glucose concentration levels over a period of time. Glycemic variability may be determined over one or more minutes, hours, days, etc.
- a glucose clearance rate may be determined from glucose measurement data following consumption of a known, or estimated, amount of glucose or known nutrient resulting in production of glucose. Glucose clearance rates analyzed over time may be indicative of glucose homeostasis. The glucose clearance rate may be indicative of an effectiveness of a medication type, dosage, and/or frequency.
- the glucose clearance rate may be determined by calculating a slope between an initial high glucose concentration level (such as a highest glucose concentration level during a period of 20-30 minutes after consumption of glucose) at t 0 and a subsequent low glucose concentration level at t 1 .
- the low glucose concentration level (G L ) may be determined based on a user’s initial high glucose concentration level (GH) and a baseline glucose concentration level (GB) before consumption of glucose.
- the glucose clearance rate may be determined over one or more periods of time after consumption of glucose, such as following an oral glucose tolerance test (OGTT).
- OGTT oral glucose tolerance test
- the glucose clearance rate may be calculated for each time period to represent dynamics of glucose clearance rate after consumption of glucose.
- These glucose clearance rates calculated over time may be time-stamped and stored in user’s profile 118. Certain metrics may be derived from time-stamped glucose clearance rates, such as mean, median, standard deviation, percentile, etc.
- health and sickness metrics may be determined, for example, based on one or more of user input (such as pregnancy information, known sickness or disease information, etc.), from physiologic sensors (such as temperature, etc.), activity sensors, etc.
- a user’s state may be defined as being one or more of healthy, ill, rested, or exhausted.
- meal state metric may indicate state user is in with respect to food consumption. For example, meal state may indicate whether user is in one of a fasting state, pre-meal state, eating state, post-meal response state, or stable state.
- meal state may also indicate nourishment on board, such as meals, snacks, or beverages consumed, and may be determined, for example from food consumption information, time of meal information, and/or digestive rate information, which may be correlated to food type, quantity, and/or sequence (such as which food/beverage was eaten first).
- meal habits metrics are based on content and timing of a user’s meals. For example, if a meal habit metric is on a scale of 0 to 1, better/healthier meals user eats higher meal habit metric of user will be to 1, in an example. Also, more user’s food consumption adheres to a certain time schedule or a recommended diet, closer their meal habit metric will be to 1, in an example.
- an activity level metric may indicate user’s level of activity.
- the activity level metric may be determined based on input from an activity sensor or other physiologic sensors, such as non-analyte sensors 230.
- activity level metric may be calculated by DAM 116 based on input data 128, such as one or more of exercise information, non-analyte sensor data (such as accelerometer data, etc.), time, user input, etc.
- the activity level metric may be expressed as a step rate of user.
- Activity level metrics may be time-stamped so that they may be correlated with one or more of the user’s analyte levels at the same time.
- body temperature metrics may be calculated by DAM 116 based on input data 128, and more specifically, non-analyte sensor data from a temperature sensor.
- heart rate metrics (such as heart rate and heart rate variability) may be calculated by DAM 116 based on input data 128, such as non-analyte sensor data from a heart rate sensor, etc.
- respiratory metrics (not shown) may be calculated by DAM 116 based on input data 128, such as non-analyte sensor data from a respiratory rate sensor, etc.
- blood pressure metrics may be calculated by DAM 116 based on input data 128, such as non-analyte sensor data from blood pressure sensor, etc. #8512806_1 - 35 - 0890-PCT01 PATENT
- physiological metrics such as analyte concentration levels, analyte concentration level rates of change, heart rate, blood pressure, etc.
- physiological metrics may be stored as metric data 130 when a state or condition of user is confirmed.
- physiological metrics may be analyzed over time to provide an indication of changes in state or condition of user.
- computing device 400 may be configured as display device 150.
- computing device 400 may be coupled to network 180 via a wireless connection.
- Certain display devices 150 such as laptop computers, may include one or more I/O devices 435, such as a keyboard, a mouse, display 436, touch screen 437, etc.
- Other display devices 150 such as handheld health monitors, smartphones, smartwatches, tablet computers, etc., may include touch screen 437, which is a combination of an I/O device and a display.
- Display devices 150 may include one or more I/O devices 435 (such as buttons, a touchpad, etc.), and display 436 or touch screen 437.
- I/O devices 435 such as buttons, a touchpad, etc.
- display devices 150 may be battery-powered, and the battery may be periodically recharged or replaced as needed.
- computing device 400 may be configured as network computing device 142, as well as the network computing device(s) of training system 140.
- computing device 400 may be coupled to network 180 via a wired or wireless connection, and may include one or more optional I/O devices 435, such as a keyboard, a mouse, display 436, etc.
- Computing device 400 includes interconnect (bus) 430 coupled to one or more processors 405, storage element or memory 410, one or more network interfaces 425, and one or more I/O interfaces 420, which may include a display interface (such as HDMI, etc.), a keyboard interface (such as USB, etc.), a local wireless communications interface (such as Bluetooth, BLE, RFID, NFC, etc.), a touch screen interface, etc.
- processor 405 may be a central processing unit (CPU), and computing device 400 may include one or more specialized processors, such as a graphics processing unit (GPU), a neural processing unit (NPU), etc.
- Bus 430 is a communication system that transfers data between processor 405, memory 410, network interfaces 425, and I/O interfaces 420. In certain embodiments, bus 430 transfers data between these components and one or more specialized processors, such as GPUs, NPUs, etc.
- Processor 405 includes one or more general-purpose or application-specific microprocessors with one or more processing cores that execute instructions to perform various functions for computing device 400, such as control, computation, input/output, etc.
- Processor 405 may include a single integrated circuit, such as a micro-processing device, or multiple integrated circuit devices and/or circuit boards working in cooperation to accomplish the appropriate functionality. Additionally, processor 405 may execute software applications and software modules stored within memory 410, such as an operating system, DSE 114, etc.
- DSE 114 may include rule-based models, machine learning models including LR models, ANNs, recurrent neural networks (RNNs), long short-term memory (LSTM) networks, convolutional neural networks (CNNs), etc., DAM 116, as well as other software modules.
- memory 410 stores instructions for execution by processor 405 as well as data.
- Memory 410 may include a variety of non-transitory computer-readable medium that may be accessed by processor 405 as well as other components.
- memory 410 may include volatile and nonvolatile medium, non-removable medium and/or removable medium.
- memory 410 may include combinations of random access memory (RAM), dynamic RAM (DRAM), static RAM (SRAM), read only memory (ROM), flash memory, cache memory, and/or any other type of non-transitory computer-readable medium.
- RAM random access memory
- DRAM dynamic RAM
- SRAM static RAM
- ROM read only memory
- flash memory cache memory, and/or any other type of non-transitory computer-readable medium.
- Memory 410 contains various components for retrieving, presenting, modifying, and storing user profile 118 as well as other data 412.
- memory 410 stores software applications and modules that provide functionality when executed by processor 405, such as DSE 114, DAM 116, etc.
- the operating system provides operating system functionality for computing device 400.
- Data 412 may include data associated with the operating system, the software applications and modules, DSE 114, DAM 116, etc.
- Network interfaces 425 are configured to transmit data to and from network 180 using one or more wired and/or wireless connections.
- network 180 may include one or more LANs, WLANs, LPWANs, WANs, cellular networks (such as 3G, 4G, LTE, 5G, 6G, etc.), the Internet, etc., employing various network topologies and protocols.
- network 180 may also include various combinations of wired and/or wireless physical layers, #8512806_1 - 37 - 0890-PCT01 PATENT such as, for example, copper wire or coaxial cable networks, fiber optic networks, WiFi networks, Bluetooth mesh networks, CDMA, FDMA and TDMA cellular networks, etc.
- I/O interfaces 420 are configured to transmit and/or receive data from I/O devices 435.
- I/O interfaces 420 enable connectivity between processor 405, memory 410 and I/O device(s) 435 by encoding data to be sent from processor 405 or memory 410 to I/O devices 435, and decoding data received from I/O devices 435 for processor 405 or memory 410.
- data may be sent over wired and/or wireless connections.
- I/O interfaces 420 may include one or more wired communications interfaces, such as USB, Ethernet, etc., and/or one or more wireless communications interfaces, coupled to one or more antennas, such as WiFi, Bluetooth, cellular, etc.
- I/O devices 435 provide data to and from computing device 400. As discussed above, I/O devices 435 are operably connected to computing device 400 using a wired and/or wireless connection. I/O devices 435 may include a local processor coupled to a communication interface that is configured to communicate with computing device 400 using the wired and/or wireless connection. For example, I/O devices 435 may include display 436, touch screen 437, a keyboard, a mouse, a touch pad, etc.
- FIG.5 depicts a process flow diagram 500 for evaluating and selecting a model and a combination of analyte features for predicting a disease, in accordance with embodiments of the present disclosure.
- training system 140 is configured to execute, inter alia, the operations represented by process flow diagram 500. These operations may be expressed within one or more software applications and supporting modules that are stored and executed by the network computing device(s) of training system 140.
- the software applications may include a prediction system application (the “prediction system”) and a model manager application (the “model manager”), while the supporting modules may include a preprocessing manager module, a variability simulator module, a feature constructor module, a predictor module, an evaluator module, etc.
- training system 140 receives historical analyte data and historical outcome data from historical records database 112. #8512806_1 - 38 - 0890-PCT01 PATENT [0176]
- the historical analyte data may include measured analyte concentration levels for a user population (such as historical glucose level measurements for pregnant users), and the historical outcome data may include clinical disease diagnoses that indicate whether each user of the population has been clinically diagnosed with the particular disease based on one or more independent sources, such as GDM diagnoses associated with the historical glucose level measurements.
- the model manager may be configured to, inter alia, evaluate and select features of the historical analyte data that are robust for accurately predicting a particular disease in presence of variabilities that are caused by manufacturing-related variability of CAS 210, as discussed below.
- the model manager may include, or be assisted by, the preprocessing manager module, the variability simulator module, the feature constructor module, the predictor module, the evaluator module, as well as other modules or functionality. One or more of these modules may also be incorporated into other process flows, such as process flow diagram 800 for predicting GDM (as discussed below).
- training system 140 preprocesses the historical analyte data.
- the preprocessing manager module may be configured to, inter alia, preprocess the historical analyte data to generate a time-ordered sequence of historical analyte data according to respective timestamps. Due to corruption and communication errors, the historical analyte data stored in historical records database 112 may not only be out of time order but may also be missing one or more analyte concentration level measurements. For example, there may be gaps in the time-ordered sequence where one or more analyte concentration level measurements are expected. In these situations, the preprocessing manager module may be further configured to interpolate missing analyte concentration level measurements and incorporate them into time-ordered historical analyte data sequence.
- the preprocessing manager module may also be configured to filter out portions of the analyte concentration level measurements according to particular criteria, such as to remove corrupted or poor signal quality data.
- particular criteria such as to remove corrupted or poor signal quality data.
- the historical analyte data may already be in time order, such that ordering and interpolating analyte concentration level measurements are not needed.
- the time-ordered sequence of historical analyte data includes analyte concentration level measurements in sequential time series format, i.e., time series analyte measurement data also known as analyte traces.
- training system 140 simulates the analyte sensor variance to generate biased analyte measurement data.
- the variability simulator module may be configured to, inter alia, introduce manufacturing-related analyte sensor variability (bias) into the time series analyte measurement data to generate biased analyte measurement data.
- the variability simulator module may perform multiple variability simulations over a number of simulation rounds, each with a different percent of simulated manufacturing-related analyte sensor variability added to the time series analyte measurement data before the data is passed to the feature constructor module.
- the variability simulator module may apply different analyte sensor performance variabilities and characteristics to the time series analyte measurement data during each simulation round.
- the variability simulator module may simulate analyte sensor bias with a fixed variability (such as standard deviation), which is applied to each analyte trace of the time series analyte measurement data. In one example, fixed variability is 8.
- the variability simulator module also associates the biased analyte data with the respective historical outcome data.
- training system 140 extracts analyte features from the biased analyte measurement data.
- the feature constructor module may be configured to, inter alia, extract one or more features or feature vectors from the biased analyte measurement data for evaluation in connection with predicting a particular disease.
- the feature constructor module applies one or more processes or functions to the biased analyte measurement data to extract the analyte features.
- each process or function extracts a different feature from the biased analyte measurement data.
- each analyte concentration level measurement within the biased analyte measurement data is associated with a point in time and sequenced with respect to time.
- a first measured analyte concentration level obtained at an earlier time is #8512806_1 - 40 - 0890-PCT01 PATENT arranged before a second measured analyte concentration level obtained at a later time in time series data.
- Autocorrelation is another trend-related feature that describes the degree of similarity between a given analyte trace and a lagged (time delayed) version of itself over successive time intervals, and may provide a measure of how rapidly analyte concentration levels fluctuate as a result of body response.
- autocorrelation skew is another trend-related feature that represents the skew of the autocorrelation distribution (i.e., the measure of the symmetry of the distribution) of different autocorrelation values taken with lags up to 16 samples from 5-minute analyte trace data.
- ACS may be presented as a single value between 0 and 1.
- ACS may be insensitive (i.e., not sensitive) to glucose sensor bias.
- Glucose traces for persons clinically diagnosed with GDM may have higher ACSs, which indicates that the glucose concentration level is not fluctuating rapidly due, at least in part, to a slow pancreatic response time.
- a person clinically diagnosed with GDM may have a glucose trace autocorrelation that begins at 1.0 for lag 0 (i.e., 0 time periods apart) and decreases to about 0.7 at lag 10 (i.e., 10 time periods apart).
- the glucose trace has a degree of similarity with itself that remains high within first 10 time periods.
- a person not clinically diagnosed with GDM may have a glucose trace autocorrelation that begins at 1.0 for lag 0 (i.e., 0 time periods apart) and decreases to about 0.1 at lag 10 (i.e., 10 time periods apart).
- the glucose trace has a degree of similarity with itself that decreases significantly within first 5, 8, 10, 12, 15, etc. time periods.
- the time-related and day-related features may include features that describe the dynamics of the analyte traces during the day and day-to-day, such as mean analyte concentration levels on a particular day, mean analyte concentration levels at a particular time #8512806_1 - 41 - 0890-PCT01 PATENT of day, rates-of-change in analyte concentration level on a particular day, rates-of-change in analyte concentration level between particular times of day, etc.
- Time-related and day-related features may also include statistics-by-day and statistics by time-of-day, differences between various statistical means for different days (such as a mean of daily difference), differences between means of analyte traces for different times of day (such as waking hours and sleeping hours), differences between standard deviations of analyte traces for different times of day, etc.
- the variability and stability features may include features that describe the degree of variability and stability of the analyte traces. For example, magnitude peak measures peak width and/or height relative to a set point analyte concentration level, mean peak width determines the mean of the peak widths, etc.
- set point frequency is a variability and stability feature that provides a measure of how frequently the analyte concentration level is within a range of an analyte set point value, such as the range with respect to the highest analyte concentration level for a particular analyte trace.
- average duration of time within 5% of set point (A5%SP) feature provides another measure of how frequently the analyte concentration level is within a range of an analyte set point value.
- SPF may be less sensitive to glucose sensor bias. Glucose traces for persons clinically diagnosed with GDM typically have lower set point frequencies.
- the frequency-related features may include features that describe the dominant frequencies of analyte variability within the analyte traces, which are extracted from the analyte traces after transforming the analyte traces from the time domain to the frequency domain. This transformation enables additional information to be extracted from the analyte traces, such as frequencies into which the time-domain data may be decomposed.
- the value-based features may include features that describe various statistical measures of the analyte traces, such as mean, median, standard deviation, skew, kurtosis, coefficient of variation, statistical distributions, etc., interquartile range differences, time-based threshold measures, etc.
- the value-based features may include a time-within-range measure, which corresponds to an amount of time that each analyte trace is between a first analyte concentration level and a second analyte concentration level that is less than first analyte #8512806_1 - 42 - 0890-PCT01 PATENT concentration level, corresponding to the upper and lower limits of a range, respectively.
- the value-based features may include a time outside range measure, which corresponds to an amount of time that an analyte trace is outside such a range.
- the value-based features may include event occurrence-based features, which may indicate occurrences of each analyte trace increasing above the first analyte concentration level (such as a hyperglycemia event) and/or decreasing below the second analyte concentration level (such as a hypoglycemia event).
- FIG.6A depicts graph 600 presenting measured glucose data 610 for a number of CAM wear sessions for a prototypical pregnant patient, in accordance with embodiments of the present disclosure.
- Measured glucose data 610 is presented as estimated glucose value (EGV) in mg/dL vs. time. These data were acquired during a study of about 1,000 participants with over 10,000 total CAM wear sessions.
- the participants of the study were healthy pregnant women with HbA1c levels less than 6.5%, who were enrolled between a gestational age between 12 to 16 weeks and participated until just before delivery at 40 weeks (or thereabouts).
- the study not only acquired historical glucose measurement levels, but also historical outcome data that included patient demographics, maternal and fetal delivery outcomes, and OGTT data indicating the presence or absence of GDM. OGTT testing was performed per standard of care.
- Measured glucose data 610 for the prototypical patient includes EGVs for thirteen CAM wear sessions, i.e., measured glucose data 610.1, 610.2, 610.3, 610.4, 610.5, 610.6, 610.7, 610.8, 610.9, 610.10, 610.11, 610.12, and 610.13.
- Each CAM wear session includes about 5 days of data, which may be processed to remove data points acquired during OGTT session, outliers, etc., for training and testing purposes. Additionally, measured glucose data 610 for patients with unclear GDM diagnoses may be excluded from the training and testing data.
- Measured glucose data segment 612 was acquired over 4 weeks, from about August 4 th to September 4 th , and is presented below graph 600.
- Measured glucose data segment 612 represents the standard of care window for traditional OGTT testing for pregnant patients, i.e., #8512806_1 - 43 - 0890-PCT01 PATENT 22 weeks to 26 weeks. In certain embodiments, measured glucose data segments and related OGTT testing results may be used to develop training and testing data for the ML models. [0198] Measured glucose data segment 612 includes EGVs from CAM wear sessions 610.4, 610.5, 610.6, and 610.7. Average EGV level 614, upper EGV threshold 616 (140 mg/dL), and lower EGV threshold 618 (64 mg/dL) are also depicted.
- measured glucose data 610 has a level of granularity that supports the determination of screening and diagnostic thresholds that are based on gestational week. More particularly, the diagnostic threshold that determines whether the patient does not have diabetes or has GDM may be lower in the earlier stages of pregnancy than in the later stages of pregnancy. In other words, the diagnostic threshold increases as the gestational week increases.
- the same model with the same glucose features and weights may be used during the earlier and the later stages of pregnancy to predict GDM.
- the diagnostic threshold during the standard-of-care window was determined to be 0.709 (an example of a later stage of pregnancy), while the diagnostic threshold before the standard-of- care window was determined to be 0.404 (an example of an earlier stage of pregnancy).
- the determination of the diagnostic threshold balances sensitivity and specificity, which ensures that there are reasonable numbers of False Negatives and False Positives (i.e., a subject who is incorrectly diagnosed as having GDM), so that the model is neither over-predicting nor under- predicting GDM.
- FIG. 6B presents a combination of features for predicting GDM, in accordance with embodiments of the present disclosure.
- the combination of features may include autocorrelation skew (ACS) feature 620, mean peak width (MPW) feature 630 (MPW), 10 th to 90 th percentile range (1090PR) feature 640, and average duration of time within 5% of set point feature (A5%SP) 650.
- ACS feature 620 exhibits a high autocorrelation and a low skew (symmetry) for EGV trace 621 which indicates a slow response to changes in glucose concentration levels and the presence of GDM.
- ACS feature 620 exhibits a low autocorrelation and a high skew #8512806_1 - 44 - 0890-PCT01 PATENT (asymmetry) for EGV trace 622 which indicates a faster response to changes in glucose concentration levels and the absence of GDM.
- MPW feature 630 exhibits large mean peak widths for EGV trace 631 which indicates broad peaks and the presence of GDM. Conversely, MPW feature 630 exhibits small mean peak widths for EGV trace 632 which indicates narrow peaks and the absence of GDM.
- 1090PR feature 640 exhibits a high range of EGV values between the 10 th and 90 th percentile for EGV trace 641 which indicates a wide (large) glucose range and the presence of GDM. Conversely, 1090PR feature 640 exhibits a low range of EGV values between the 10 th and 90 th percentile for EGV trace 642 which indicates a narrow glucose range and the absence of GDM.
- A5%SP feature 650 exhibits a low average time duration near the EGV set point for EGV trace 651 which indicates low glycemic stability and the presence of GDM.
- FIG. 6C depicts graph 623 presenting measured glucose data 624 and an associated autocorrelation function (ACF) 625 for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- ACF 625 has a high autocorrelation with a low skew (i.e., the ACS feature value is equal to 0.02), which indicates the presence of GDM.
- FIG. 6D depicts graph 626 presenting measured glucose data 627 and an associated ACF 628 for a person not clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- ACF 628 has a low autocorrelation with a high skew (i.e., the ACS feature value is equal to 0.98), which indicates the absence of GDM.
- FIG.6E depicts graph 633 presenting measured glucose data 634 and associated peak widths 635 for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure. Peak widths 635 are broad and yield a large mean peak width (i.e., the MPW feature value is 25.57) which indicates the presence of GDM. For example, the first four peak widths are 21, 15, 18 and 15.
- FIG.6F depicts graph 636 presenting measured glucose data 637 and associated peak widths 638 for a person not clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- Peak widths 638 are narrow and yield a small mean peak width (i.e., the MPW feature value is 8.65) which indicates the absence of GDM.
- the first four peak widths are 3, 6, 7, and 6.
- FIG.6G depicts graph 643 presenting measured glucose data 644 and associated 10 th and 90 th percentile ranges 645 for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.10 th and 90 th percentile ranges 645 encompass a large range of EGV values (i.e., the 1090PR feature value is 70.0) which indicates the presence of GDM. [0212] FIG.
- FIG. 6H depicts graph 646 presenting measured glucose data 647 and associated 10 th and 90 th percentile ranges 648 for a person not clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- 10 th and 90 th percentile ranges 648 encompass a small range of EGV values (i.e., the 1090PR feature value is 32.0) which indicates the absence of GDM.
- FIG. 6I depicts graph 653 presenting measured glucose data 654 and associated durations 655 near the EGV set point for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- FIG. 6J depicts graph 656 presenting measured glucose data 657 and associated durations 658 near the EGV set point for a person clinically diagnosed with GDM, in accordance with embodiments of the present disclosure.
- the set point is 107.0 mg/dL, and durations 658 are high (i.e., the A5%SP feature value is 0.106) which indicates the presence of GDM.
- training system 140 generates disease predictions using one or more models and different combinations of the extracted analyte features.
- the predictor module may be configured to, inter alia, generate disease predictions for a particular disease using one or more models based on different combinations of extracted analyte features from the biased analyte measurement data sets.
- the disease predictions may include binary disease screening predictions (such as normal or predisposed), as well as binary disease diagnosis predictions (such as normal/predisposed or disease).
- the predictor module may use bivariate models that combine two features of the extracted analyte features, as well as multivariate models that combine three (or more) features of extracted analyte features.
- Each disease prediction may be associated with the historical outcome data for a member of the user population, which includes clinical diagnoses such as #8512806_1 - 46 - 0890-PCT01 PATENT normal, predisposed, disease, etc.
- the models may include rule-based models, machine learning (ML) models, etc.
- ML model such as an ANN
- An ANN models relationships between input data or signals and output data or signals using a network of interconnected nodes that is trained through a learning process. The nodes are arranged into various layers, including, for example, an input layer, one or more hidden layers, and an output layer.
- the input layer receives input data, such as, for example, image data, sensor time series data, etc.
- output layer generates output data, such as, for example, a probability that image data contains a known object, a medical condition, etc.
- Each hidden layer provides at least a partial transformation of input data to output data.
- a deep ANN (DNN) has multiple hidden layers in order to model complex, nonlinear relationships between input data and output data. [0218] In a fully-connected, feedforward ANN, each node is connected to all of nodes in preceding layer, as well as to all of nodes in subsequent layer.
- each input layer node is connected to each hidden layer node
- each hidden layer node is connected to each input layer node and each output layer node
- each output layer node is connected to each hidden layer node.
- Additional hidden layers are similarly interconnected.
- Each connection has a weight value
- each node has an activation function, such as, for example, a linear function, a step function, a sigmoid function, a hyperbolic or tanh operation, a rectified linear unit (ReLu) function, etc., that determines output of node based on weighted sum of inputs to node.
- the input data propagates from input layer nodes, through respective connection weights to hidden layer nodes, and then through respective connection weights to output layer nodes.
- the sigmoid and ReLu functions output a number between 0 and 1, while tanh operation outputs a number between ⁇ 1 and 1, for any given input.
- input data is provided to activation function for that node, and output of activation function is then provided as an input data value to each hidden layer node.
- input data value received from each input layer node is multiplied by a respective connection weight, and resulting products are summed or accumulated into an activation signal value that is provided to activation function for that node.
- the output of activation function is then provided as an input data value to each output layer node.
- FIG.7A depicts ANN 700, in accordance with embodiments of the present disclosure.
- ANN 700 includes input layer 710, one or more hidden layers, such as hidden layers 7101, 7202,..., 720N, and output layer 730.
- Input layer 710 includes one or more input nodes, such as Node I,1 , Node I,2 ,..., Node I,i .
- Hidden layer 720 1 includes one or more hidden nodes, such as Node1,1, Node1,2,..., Node1,j.
- Hidden layer 7202 includes one or more hidden nodes, such as Node2,1, Node2,2,..., Node2,k.
- Hidden layer 720N includes one or more hidden nodes, such as Node N,1 , Node N,2 ,..., Node N,n .
- Output layer 730 includes one or more output nodes, such as Node O,1 , Node O,2 ,..., Node O,o .
- N there are N hidden layers; input layer 710 includes “i” nodes, hidden layer 7301 includes “j” nodes, hidden layer 7202 includes “k” nodes, hidden layer 730 N includes “n” nodes, and output layer 730 includes “o” nodes.
- N 3
- i equals 3
- j k
- n 5
- o equals 3.
- Input NodeI,1, NodeI,2 and NodeI,3 are each coupled to hidden Node1,1, Node1,2, Node1,3, Node1,4 and Node1,5.
- Hidden Node1,1, Node1,2, Node1,3, Node1,4 and Node1,5 are each coupled to hidden Node 2,1 , Node 2,2 , Node 2,3 , Node 2,4 and Node 2,5 .
- Hidden Node 2,1 , Node 2,2 , Node2,3, Node2,4 and Node2,5 are each coupled to hidden Node3,1, Node3,2, Node3,3, Node3,4 and Node3,5.
- Hidden Node3,1, Node3,2, Node3,3,4 and Node3,5 are each coupled to output Node O,1 , Node O,2 , Node O,3 .
- Training an ANN includes optimizing connection weights between nodes by minimizing prediction error of output data until ANN achieves a particular level of accuracy.
- One method is backpropagation, or backward propagation of errors, which iteratively and recursively determines a gradient (i.e., a partial derivative of error function) with respect to each weight, and then adjusts each weight to improve performance of network.
- FIG. 7B depicts LR model 702, in accordance with embodiments of the present disclosure.
- LR model 702 may be described as including input layer 710, hidden layer 720, classification layer 722 and output layer 732.
- Input layer 710 receives a set of input features ⁇ 1 , ... , ⁇ ⁇ .
- LR model 702 is a univariate LR model when set of input features includes a single input feature, a bivariate LR model when set of input features includes two input #8512806_1 - 48 - 0890-PCT01 PATENT features, and a multivariate LR model when set of input features includes three or more input features.
- Hidden layer 720 includes a decision function ( ⁇ D) and a sigmoid function ( ⁇ ), classification layer 722 includes a threshold function ( ⁇ T), and output layer 732 generates and outputs predicted class label 750, such as “normal” or “GDM,” etc.
- Predicted class label 750 is the disease prediction, such as the GDM prediction.
- Hidden layer 720 calculates the probability of disease ⁇ ( ⁇ ) for a set of input features b ased on a sigmoid function ( ⁇ ) that operates on the output ( ⁇ ) of the decision function ( ⁇ D).
- Classification layer 722 applies a threshold function ( ⁇ T) to the probability of disease ⁇ ( ⁇ ) .
- the threshold function ( ⁇ T) may include a probability threshold against which the probability of disease ⁇ ( ⁇ ) is compared.
- the threshold function ( ⁇ T) may output a value of 0 when the probability of disease ⁇ ( ⁇ ) is less than the probability threshold, and output a value of 1 when the probability of disease ⁇ ( ⁇ ) is equal to or greater than the probability threshold.
- Output layer 732 generates the predicted class label based on the output of the threshold function ( ⁇ T).
- the decision function ( ⁇ D) generates output ( ⁇ ) based on set of input features weights ( ⁇ ⁇ ), and a bias, and is given by Equation 1: [0229]
- the sigmoid function ( ⁇ ) generates the probability of the disease ⁇ ( ⁇ ) and is given by Equation 2: [0230]
- the threshold function ( ⁇ T) may be used to diagnose whether the user has the disease or does not have the disease, such as GDM.
- the threshold function ( ⁇ T) may also be used to screen whether the user has a predisposition for the disease or does not have a predisposition for the disease, such as GDM.
- a GDM screening model may include a screening threshold function ( ⁇ TS ) that determines whether the user has a predisposition for GDM (“pre-GDM”), while a GDM diagnosis model may include a diagnostic threshold function ( ⁇ TD ) that determines whether the user has GDM.
- the probability threshold for the screening threshold function ( ⁇ TS ) is less than the probability threshold for the diagnostic threshold function ( ⁇ TD ).
- FIG. 7C depicts LR model 704, in accordance with embodiments of the present disclosure.
- LR model 704 may be described as including input layer 710, hidden layer 720, classification layer 724 and output layer 734.
- Input layer 710 receives a set of input features ⁇ 1 , ... , ⁇ ⁇ .
- LR model 704 is a univariate LR model when the set of input features includes a single input feature, a bivariate LR model when the set of input features includes two input features, and a multivariate LR model when the set of input features includes three or more input features, such as a multivariate LR model with a set of four input features (as described below), etc.
- Hidden layer 720 includes a decision function ( ⁇ D) and a sigmoid function ( ⁇ ), and calculates the probability of GDM ⁇ ( ⁇ ) for a set of input features based on a sigmoid function ( ⁇ ) that operates on the output ( ⁇ ) of the decision function ( ⁇ D ).
- Classification layer 724 includes a GestScore function ( ⁇ GS ), and maps the output ( ⁇ ) of the decision function ( ⁇ D ) to a quantitative GDM risk value (GestScore 760), based on the GestScore function ( ⁇ GS ).
- Output layer 734 outputs GestScore 760, such as a number from 0 to 10, 0 to 100, 0 to 200, 0 to 1,000, etc., 1 to 10, 1 to 20, 1 to 100, 1 to 200, 1 to 1,000, etc.
- GestScore 760 advantageously provides a quantitative continuum-based GDM prediction that a person may (or may not) have not have GDM, may have pre-GDM, or may have GDM.
- Output layer 734 outputs GestScore 760.
- the GestScore function ( ⁇ GS) may normalize the output ( ⁇ ) of the decision function ( ⁇ D ), and then multiply the result by 100 to generate GestScore 760.
- the output ( ⁇ ) of the decision function ( ⁇ D ) may be input to a sigmoid or other similar function to generate GestScore 760.
- the GestScore function ( ⁇ GS) may scale the output ( ⁇ ) based on training data with a minimum- maximum scaling to generate GestScore 760 values between 0 and 100. Other scaling techniques may also be used, such as linear scaling, non-linear scaling, etc.
- the decision function ( ⁇ D ) generates output ( ⁇ ) based on set of input features weights and a bias, and is given by Equation 1 (above).
- the sigmoid generates the probability of GDM ⁇ ( ⁇ ) and is given by Equation 2 (above).
- the evaluator module may be configured to, inter alia, categorize each different combination of features extracted from the biased analyte #8512806_1 - 50 - 0890-PCT01 PATENT measurement data based on a performance metric and a robustness metric.
- the performance metric may indicate the classification or prediction accuracy of a feature based on the disease predictions and the historical outcome data.
- the robustness metric may indicate the insensitivity of a feature to the simulated manufacturing-related analyte sensor variability.
- the performance metric may include, inter alia, a true positive rate (TPR) and a true negative rate (TNR).
- TPR true positive rate
- TNR true negative rate
- the true positive rate provides the percentage of disease predictions that correctly predict a disease condition (i.e., sensitivity or probability of detection).
- the true negative rate provides the percentage of disease predictions that correctly predict a non-disease condition (i.e., specificity).
- the performance metric may also include a false positive rate (FPR) that provides the percentage of disease predictions that incorrectly predict a disease condition (i.e., probability of false alarm), and a false negative rate (FNR) that provides the percentage of disease predictions that incorrectly predict a non-disease condition (i.e., miss rate).
- FPR false positive rate
- FNR false negative rate
- PPV positive predictive value
- NPV negative predictive value
- the performance metric may also include a receiver operating characteristic (ROC) curve and an area under curve (AUC).
- the ROC curve plots the true positive rate (TPR) against the false positive rate (FPR), described above, at various threshold settings.
- the AUC is the area under the ROC curve, and is equal to the probability that a classifier will rank a randomly chosen positive prediction higher than a randomly chosen negative prediction. In other words, AUC is the probability that the classifier will be able to distinguish between a randomly selected positive prediction and a randomly selected negative prediction. [0241] The higher the performance metric, the higher that sensitivity and specificity for predicting the disease.
- the performance metric may rank features on a pre-defined scale, such as a scale from 0 to 1, where 0 refers to none (such as 0%) of the corresponding model predictions being accurate and 1 refers to all (such as 100%) of the corresponding model predictions being accurate.
- the robustness metric may indicate the degree to which the performance metric changes due to the amount of bias (such as the % variability) that is simulated and applied to the time series analyte measurement data (which may be averaged across repetitions for each member of the user population). For example, the robustness metric may combine bias #8512806_1 - 51 - 0890-PCT01 PATENT sensitivity for true positive rate and true negative rate.
- the robustness metric may rank the features on a pre-defined scale having a highest value and a lowest value.
- the highest value may indicate no change in the performance metric in response to the simulated bias, while the lowest value may indicate a maximum change in the performance metric in response to the simulated variability.
- the higher the robustness metric the more insensitive the feature may be to manufacturing variations of CAS 210.
- the evaluator module may determine a variability sensitivity metric, which may be an inverse of the robustness metric. For example, the higher the variability sensitivity metric, the more sensitive (and less robust) the feature may be to manufacturing variations in CAS 210.
- highly robust analyte features correspond to extracted analyte features that exhibit little change in the performance metric with various amounts of simulated variability (bias).
- trend-related features and variability and stability features may produce extracted analyte features that have relatively high robustness metrics (and relatively low variability sensitivity metrics).
- training system 140 selects the model and the combination of features.
- the evaluator module may be further configured to, inter alia, select a model and a combination of analyte features based on the robustness metric and the performance metric.
- the selected feature combination balances performance and robustness for a model that accurately predicts the disease with high sensitivity and specificity but is relatively unaffected by manufacturing-related variability that affects output and performance of CAS 210.
- a model built from a combination of two or more features provides a combination of robustness and performance that is greater than that provided by either feature alone. For example, when a first feature has a higher performance metric than a second feature, and a second feature has a higher robustness metric than first feature, the combination of the first and second features provides a higher overall performance than either feature alone.
- Certain value-based features may have relatively high performance metrics for certain diseases, while other value-based features may be relatively sensitive to manufacturing-related variability of CAS 210.
- increasing simulated positive sensor bias which raises the concentration levels of the analyte traces, may decrease true negative rate (and increase false positive rate) because the models may incorrectly predict that certain members of the user population without the disease actually have the disease due to the elevated concentration levels of the associated analyte traces.
- increasing simulated negative sensor bias which #8512806_1 - 52 - 0890-PCT01 PATENT lowers the concentration levels of the analyte traces, may decrease true positive rate (and increase false negative rate) because the models may incorrectly predict that certain members of the user population with the disease actually do not have the disease due to reduced concentration levels of the associated analyte traces.
- the value-based features may be combined with different features that have a high robustness metric, such as the trend-related features, in the robust analyte feature combination 434.
- the selected combination of analyte features may include any type of feature. For example, all of the features may be selected from the trend-related features, one feature may be selected from the trend-related features, such as autocorrelation mean, and one feature may be selected from the variability and stability features, such as set point frequency, etc.
- the evaluator module may filter the disease predictions to identify the model and feature combinations with robustness metrics that are greater than a robust threshold value, and then select the model and feature combination with the highest performance metric from the filtered model predictions.
- the evaluator module may filter the disease predictions to identify the model and feature combination with performance metrics that are greater than a performance threshold value, and then select the model and feature combination with the highest robustness metric from the filtered model predictions.
- training system 140 preprocesses different historical analyte data, such as different historical glucose level measurements.
- the preprocessing manager module may be configured to, inter alia, preprocess different historical analyte data to generate a different time-ordered sequence of historical analyte data. In other words, the time-ordered sequence of historical analyte data generated at 580 is different than the time-ordered sequence of historical analyte data generated at 520.
- training system 140 determines the selected combination of features from the time-ordered sequence of different historical analyte data.
- the feature constructor module may be configured to, inter alia, determine the selected combination of features from the historical analyte measurement data. As described above, the feature constructor module applies the relevant processes or functions to the historical analyte measurement data to determine the combination of analyte features. #8512806_1 - 53 - 0890-PCT01 PATENT [0252]
- training system 140 trains the selected model based on the selected combination of features from the time-ordered sequence of different historical analyte data, and the historical outcome data.
- the selected model may be an LR model, an ANN, etc., that is trained using supervised learning.
- the selected model may include an ensemble of models, such as an ensemble of LR models, each one trained to predict diabetes based on a particular feature the selected combination of features.
- the ensemble may include the same type of machine learning model, and each machine learning model may be trained using the same technique.
- the ensemble may include different types of machine learning models, and each type of machine learning model may be trained using the same technique or a different technique, such as supervised learning, unsupervised learning, reinforcement learning, etc.
- the model manager may build and train a multivariate LR model which includes a combination of four features, such as the ACS, MPW, 1090PR, and A5%SP features. Given the selected combination of features and the clinical disease diagnoses from the historical outcome data, the model manager may use one or more approaches for “fitting” these data to an equation for the multivariate LR model to produce the disease prediction within some tolerance.
- the logarithmic (“log”) loss cost function may be minimized to fit these data to an equation for a multivariate LR model.
- fitting approaches may include a least squares approach, a least absolute deviations regression, minimizing a penalized version of least squares cost function (such as ridge regression or lasso), etc.
- the first feature i.e., independent variable
- the second feature i.e., independent variable
- the MPW feature ⁇ ⁇ ⁇ ⁇
- the third feature i.e., independent variable
- the fourth feature i.e., independent variable
- the A5%SP feature ⁇ ⁇ 5% ⁇ ⁇
- the multivariate LR model parameters include the weights (i.e., ⁇ ⁇ ⁇ ⁇ , ⁇ ⁇ ⁇ ⁇ , ⁇ 1090 ⁇ ⁇ , and ⁇ ⁇ 5% ⁇ ⁇ in Eq.4) and a bias (i.e., bias in Eq.3).
- the prediction system may input the feature combination values into the multivariate LR model, the decision function ( ⁇ D) may apply the weights and the bias to the feature combination values to generate the output ( ⁇ ) , and the GestScore function ( ⁇ GS) may scale the output ( ⁇ ) to generate the GestScore 760 value, which is provided as output data 144.
- the prediction system may scale each feature combination value using z-score normalization fitted using the training data set.
- the ACS feature ( ⁇ ⁇ ⁇ ⁇ ) has a value of 0.339636
- the MPW feature ( ⁇ ⁇ ⁇ ⁇ ) has a value of 13.290323
- the 1090PR feature ( ⁇ 1090 ⁇ ⁇ ) has a value of 42
- the A5%SP feature ( ⁇ ⁇ 5% ⁇ ⁇ ) has a value of 0.025623.
- the probability of GDM ⁇ ( ⁇ ) may be generated by applying the sigmoid function ( ⁇ ) to the output ( ⁇ ) , as given by Equation 7: 0.289305 Eq.7 #8512806_1 - 55 - 0890-PCT01 PATENT [0261]
- the GDM diagnosis threshold is 0.709, so the resulting GDM prediction is “no GDM” because the probability of diabetes ⁇ ( ⁇ ) is less than the diagnostic threshold (i.e., 0.289305 ⁇ 0.709).
- the GestScore function ( ⁇ GS) may apply a min-max scaler to the output ( ⁇ ) to scale the value between 0 and 1, and then multiply the scaled value by 100.
- the resulting GestScore 760 is 57.
- the ACS feature ( ⁇ ⁇ ⁇ ⁇ ) has a value of 0.252426
- the MPW feature ( ⁇ ⁇ ⁇ ⁇ ) has a value of 15.769231
- the 1090PR feature ( ⁇ 1090 ⁇ ⁇ ) has a value of 62
- the A5%SP feature ( ⁇ ⁇ 5% ⁇ ⁇ ) has a value of 0.010661.
- Equation 8 ⁇ ⁇ 1.69890085 + ( ⁇ 1.60847143) • ( ⁇ 1.306915254) + ( ⁇ 0.06612564) • (0.471708176) + (0.90834601) • (1.771051391) + ( ⁇ 0.56638379) • ( ⁇ 1.238024704)
- the probability of GDM ⁇ ( ⁇ ) may be generated by applying the sigmoid function ( ⁇ ) to the output ( ⁇ ), as given by Equation 9: 0.935953 Eq.9 [0265]
- the GDM diagnosis threshold is 0.709, so the resulting GDM prediction is “GDM” because the probability of diabetes ⁇ ( ⁇ ) is less than the diagnostic threshold (i.e., 0.935953 > 0.709).
- the GestScore function ( ⁇ GS) may apply a min-max scaler to the output ( ⁇ ) to scale the value between 0 and 1, and then multiply the scaled value by 100.
- the resulting GestScore 760 is 88.
- GestScore 760 may be used for screening pre-GDM.
- GestScore 760 may have a range of values from 0 to 100, and values between 0 and 68 (inclusive) may indicate the relative absence of prediabetes and GDM, values between 69 and 73 (inclusive) may indicate pre-GDM (i.e., a relative predisposition for GDM), and values between 74 and 100 may #8512806_1 - 56 - 0890-PCT01 PATENT indicate GDM.
- Agnostic GestScore screening threshold values and diagnostic threshold values may be determined from the historical analyte level measurements and historical outcome data of the pregnant user population, which may depend on the gestational week.
- GestScore screening threshold values and diagnostic threshold values may be established for each user.
- GestScore 760 may be compared to GestScore screening and diagnostic threshold values that are established for each user independently from the LR model.
- the additional data may include already- observed adverse effects data (such as data describing that any of a variety of adverse effects associated with GDM that have already been observed, etc.), demographic data (such as age, gender, ethnicity, etc.), medical history data, stress data, nutrition data, exercise data, prescription data, height and weight data, occupation data, etc.
- the model manager may build and train a multivariate LR model that includes a combination of three or more selected features.
- the model manager may build and train an ANN, etc.
- training the model includes providing a portion of the selected combination of historical features and the related historical outcome data to the model as a training data instance, receiving disease predictions from the model, comparing the disease predictions to the historical outcome data (such as the clinical disease diagnoses) using a loss function (such as mean squared error, etc.), adjusting the weights of the model based on the comparison, and then repeating the process for many training iterations.
- Each training iteration processes a different portion of the selected combination of historical features and the related historical outcome data, i.e., a different training data instance.
- the model manager may perform these iterations until the model generates disease predictions that consistently and substantially match the historical outcome data.
- the capability of a machine learning model, such as an LR model or an ANN, to consistently generate predictions that substantially match expected output portions may be referred to as “convergence.”
- model manager trains machine learning model until model “converges” on a solution in which weights of model have been sufficiently adjusted during training iterations so that final values of weights consistently generate predictions that substantially match expected output portions.
- the model may be configured to receive and process other data in addition to the selected combination of historical features and the related historical outcome data during training.
- the model manager may add additional data to the training data instances that describes other aspects of the user population, such as demographic information, medical history, exercise, stress, etc.
- the model may generate a disease prediction in a similar manner as discussed above, such that the disease prediction may be compared to the historical outcome data (such as the clinical disease diagnoses), and the weights of the model adjusted based on the comparison, etc.
- the historical analyte data may include inherent analyte sensor bias that sufficiently reflects manufacturing-related variability. Accordingly, the model may be developed directly from the historical analyte data without the introduction of additional analyte sensor bias.
- FIG. 8 depicts process flow diagram 800 representing operations for predicting a disease, in accordance with embodiments of the present disclosure.
- network computing device 142 may store and execute the relevant portions of the prediction system to provide a network-based, client-server disease prediction solution.
- one of display devices 150 such as smartphone 154, may store and execute the relevant portions of the prediction system to provide a local disease prediction solution rather than a network-based, client-server approach.
- CAM system 200 may store and execute the relevant portions of the prediction system to provide another local disease prediction solution.
- the prediction system receives measured analyte data for a user, such as measured glucose data.
- the measured analyte data may be received in sensor data packages transmitted by CAM system 200 worn by the user (or forwarded by a display device 150).
- the measured analyte data may be received, in aggregated form, from a display device 150 or from user database 110 for the user.
- the preprocessing manager module may preprocess the measured analyte data to generate a time-ordered sequence of measured analyte data according to respective timestamps, similar to process described above with respect to the historical analyte data (at blocks 520 and 580 of flow process diagram 500).
- the preprocessing manager #8512806_1 - 58 - 0890-PCT01 PATENT module may preprocess the measured glucose data to generate a time-ordered sequence of measured glucose data according to respective timestamps.
- the feature constructor module may determine the combination of features from the measured analyte data.
- the feature constructor module may apply the relevant processes or functions to the measured analyte data to determine the combination of analyte features, similar to process described above with respect to the historical analyte data (at block 590 of flow process diagram 500).
- the feature constructor module may apply the relevant processes or functions to the measured glucose data to determine the combination of glucose features.
- the prediction system may receive additional data, from a display device 150 or user database 110, that describe different aspects of the user.
- the additional data may include environmental data (such as temperature, etc.), already-observed adverse effects data (such as data describing that any of a variety of adverse effects associated with the disease (such as GDM) that have already been observed, etc.), demographic data (such as age, gender, ethnicity, etc.), medical history data, stress data, nutrition data, exercise data, prescription data, height and weight data, occupation data, etc.
- environmental data such as temperature, etc.
- already-observed adverse effects data such as data describing that any of a variety of adverse effects associated with the disease (such as GDM) that have already been observed, etc.
- demographic data such as age, gender, ethnicity, etc.
- medical history data such as age, gender, ethnicity, etc.
- stress data stress data
- nutrition data exercise data
- prescription data prescription data
- height and weight data occupation data
- the model may be a rule-base model, an ML such as an LR model, etc.
- the disease prediction may be a predicted class label (such as “GDM” or “no GDM”, etc.), a quantitative disease risk value (such as GestScore 760, etc.), etc.
- the prediction system outputs the disease prediction (as output data 144) to a display device 150 associated with the user, to the user database 110, etc.
- CAM system 200 may generate glucose concentration level measurements for a user over a predetermined time period, the prediction system may determine a glucose feature combination from the measured glucose concentration levels, and then generate a quantitative GDM risk value, such as GestScore 760, based on the glucose feature combination. The quantitative GDM risk value may then be presented, such as by displaying the quantitative GDM risk value to the user, doctor, health care provider, telemedicine service, etc., on a display device.
- FIGS. 9A, 9B depict graphical user interfaces (GUIs) 160 for displaying measured glucose data and a GDM prediction on a display device, in accordance with embodiments of the present disclosure.
- GUIs graphical user interfaces
- FIG.9C depicts GUI 160 for displaying measured glucose data and quantitative GDM risk information on a display device, in accordance with embodiments of the present disclosure.
- GUI 160 includes, inter alia, glucose measurement data graph 910, glucose measurement display widget 920, and GDM prediction display window 930.
- Example glucose concentration levels and example GDM predictions are illustrated.
- Glucose measurement data graph 910 displays glucose measurement data 915 acquired over a period of time. Most recent glucose measurement 914 may be displayed as a hollow circle or white dot, while the remaining glucose measurements 915 may be displayed as solid circles or black dots; other representations may also be used.
- Glucose measurement data graph 910 may also display user-customizable regions including above target range region 911, target range region 912 and below target range region 913. The regions may be defined by one or more user-customizable threshold values.
- above target range region 911 may be defined by a high threshold value (such as 220 mg/dL)
- below target range region 913 may be defined by a low threshold value (such as 80 mg/dL)
- target range regions 912 may be defined as region between high and low threshold values. Additional thresholds and regions may also be used.
- each region may be color-coded with a different color, such as yellow for above target range region 911, grey for target range region 912, and red for below target range region 913.
- Glucose measurement display widget 920 displays the value of most recent glucose measurement 914 as well as trend arrow 922.
- the central portion of glucose measurement display widget 920 may be color-coded to match the region in which most recent glucose measurement 914 is disposed, such as yellow for above target range region 911, grey for target range region 912, and red for below target range region 913.
- Trend arrow 922 indicates certain trends in a recent number of recent glucose measurement data 915, #8512806_1 - 60 - 0890-PCT01 PATENT including a trend direction (i.e., increasing, decreasing or steady glucose measurement levels) and a trend speed (i.e., rate-of-change of glucose measurement levels).
- GDM prediction display 930 includes prediction widget 932 and output data 144, which may include, inter alia, the GDM prediction such as predicted class label 750 (such as “Normal” or “Gestational Diabetes”, FIGS.9A, 9B) and GestScore 760 (“72”, FIG. 9C). Selection of prediction widget 932 by the user may cause additional GDM prediction information to be displayed within GUI 160.
- the GDM prediction such as predicted class label 750 (such as “Normal” or “Gestational Diabetes”, FIGS.9A, 9B) and GestScore 760 (“72”, FIG. 9C).
- the trained model generates the GDM prediction each time the prediction system receives measured glucose data for a user, and then outputs the GDM prediction (as output data 144) to smartphone 154 for display within GDM prediction display 930.
- output data 144 may be selected by the user to cause the prediction system to generate and output an updated GDM prediction (as output data 144) to smartphone 154 for display.
- Output data 144 may be continuously displayed within GDM prediction display 930, displayed for a predetermined period of time after an update is received from the prediction system (such as 5 minutes, 10 minutes, etc.), periodically displayed within GDM prediction display 930 and then removed, etc.
- FIG.9A depicts most recent glucose measurement 914 as disposed within target range region 912 with a value of 140 mg/dL, a slowly decreasing trend arrow 922, and a GDM prediction of “Normal.”
- FIG.9B depicts most recent glucose measurement 914 as disposed within target range region 912 with a value of 180 mg/dL, a falling trend arrow 922, and a GDM prediction of “Gestational Diabetes.”
- FIG.9C depicts most recent glucose measurement 914 as disposed within target range region 912 with a value of 180 mg/dL, a falling trend arrow 922, and GestScore 760 of “72.”
- FIG.10A depicts process flow diagram 1000 representing operations for evaluating and selecting a model and a combination of glucose features for predicting GDM, in accordance with embodiments of the present disclosure.
- blocks 1010, 1020, 1030, 1040, 1050, 1060, 1070, and 1080 may be performed by training system 140, in accordance with the processes described above.
- biased glucose data are generated by adding glucose sensor bias to historical glucose data.
- the glucose analyte data are associated with clinical GDM diagnoses associated with the historical glucose data.
- features are extracted from the biased glucose data. Blocks 1040 and 1050 are repeated for each model under consideration.
- GDM predictions are generated based on different combinations of the features extracted from the biased glucose data.
- FIG. 10B depicts process flow diagram 1002 representing operations for training a model based on a combination of glucose features to predict GDM, in accordance with embodiments of the present disclosure.
- the selected combination of features are determined from the historical glucose data.
- the selected model is trained based on the selected combination of features determined from the historical glucose data, and the clinical GDM diagnoses associated with the historical glucose data.
- FIG.11 depicts process flow diagram 1100 representing operations for training an ML model to generate a GDM prediction, in accordance with embodiments of the present disclosure.
- the training server system such as training system 140 illustrated in FIG.1, retrieves data from historical records database, such as historical records database 112 illustrated in FIG. 1.
- historical records database 112 may provide a repository of up-to-date information and historical information for users of a continuous #8512806_1 - 62 - 0890-PCT01 PATENT analyte monitoring system and connected mobile health application, such as users of CAM system 200 and GUI 160 illustrated in FIG.1, as well as data for one or more pregnant patients who are not, or were not previously, users of CAM system 200 and/or GUI 160.
- historical records database 112 may include one or more data sets of historical pregnant users who are healthy pregnant users and pregnant users that have been diagnosed with GDM.
- Retrieval of data from historical records database 112 by training system 140, at 1110 may include the retrieval of all, or any subset of, information maintained by historical records database 112.
- data retrieved by training system 140 to train one or more ML models may include information for all 1,000 pregnant patients or only a subset of the data for those patients, e.g., data associated with only 200 pregnant patients or only data from the last ten years.
- integrating with on premises or cloud based medical record databases through Fast Healthcare Interoperability Resources (FHIR), web application programming interfaces (APIs), Health Level 7 (HL7), and or other computer interface language may enable aggregation of healthcare historical records for baseline assessment in addition to the aggregation of de-identifiable pregnant patient data from a cloud based repository.
- FHIR Fast Healthcare Interoperability Resources
- APIs web application programming interfaces
- HL7 Health Level 7
- the integration may be accomplished by directly interfacing with the electronic medical record system or through one or more intermediary systems (e.g., an interface engine, etc.).
- training system 140 may retrieve information for 400 pregnant patients (with about 1,200 wear sessions) with various classifications (such as a healthy user or a GDM user) stored in historical records database 112 to train an ML model to generate a GDM prediction and/or a quantitative GDM risk value for the user.
- Each of the 400 pregnant patients may have a corresponding data record (e.g., based on their corresponding user profile), stored in historical records database 112.
- Each user profile 118 may include information, such as information discussed with respect to FIG.3.
- the training system 140 then uses information in each of the records to train an ML model. Examples of types of information included in a patient’s user profile were provided above.
- a patient record may include or be used to generate features related to the patient’s #8512806_1 - 63 - 0890-PCT01 PATENT demographic information (e.g., an age of a patient, a gender of the patient, etc.), analyte information, such as glucose metrics (e.g., post-prandial glucose spike, post-prandial glucose area under the curve, nocturnal hypoglycemia, glucose baseline level, other glucose metrics described herein), non-analyte information, and/or any other data points in the patient record (e.g., input data 128, metric data 130, etc.).
- glucose metrics e.g., post-prandial glucose spike, post-prandial glucose area under the curve, nocturnal hypoglycemia, glucose baseline level, other glucose metrics described herein
- non-analyte information e.g., input data 128, metric data 130, etc.
- each historical patient record retrieved from historical records database 112 is further associated with a label indicating a user classification, such as a healthy user, a user with GDM, a current GDM state, etc. What label may depend on what particular metric the model is being trained to predict.
- training system 140 trains one or more ML models based on the features and labels associated with the historical pregnant patient records. In some embodiments, training system 140 does so by providing the features as input into an ML model.
- This ML model may be a new ML model initialized with random weights and parameters, or may be partially or fully pre-trained (e.g., based on prior training rounds).
- the ML model-in-training Based on the input features, the ML model-in-training generates some output.
- the output may include a GDM prediction for the user, a current or future GDM state, a quantitative GDM risk value (such as GestScore 760), etc. Note that the output could be in the form of a classification, a recommendation, and/or other types of output.
- training system 140 compares this generated output with the actual label associated with the corresponding historical pregnant patient record to compute a loss based on the difference between the actual result and the generated result.
- This loss is then used to refine one or more internal weights and parameters of the model (such as via backpropagation) such that the model learns to predict a current or future GDM state, a quantitative GDM risk value (such as GestScore 760), etc.
- a quantitative GDM risk value such as GestScore 760
- One of a variety of machine learning algorithms may be used for training the model(s) described above. For example, one of a supervised learning algorithm, a neural network algorithm, a deep neural network algorithm, a deep learning algorithm, etc. may be used.
- training system 140 deploys the trained ML model(s) to generate a GDM prediction associated with a current or future GDM state and/or generate a quantitative GDM risk value during runtime (such as GestScore 760).
- this includes transmitting some indication of the trained ML model(s) (e.g., a weights vector) that can be #8512806_1 - 64 - 0890-PCT01 PATENT used to instantiate the ML model(s) on another device.
- some indication of the trained ML model(s) e.g., a weights vector
- training system 140 may transmit the weights of the trained ML model(s) to decision support engine 114, which could execute on display device 150, etc.
- the ML model(s) can then be used to determine, in real- time, a current or future GDM state of a user using GUI 160, and/or make other types of recommendations discussed above.
- the training system 140 may continue to train the ML model(s) in an “online” manner by using input features and labels associated with new pregnant patient records.
- similar methods for training illustrated in FIG. 5 using historical pregnant patient records may also be used to train ML models using patient-specific records to create more personalized ML models for making predictions associated with user classification, and/or current or future GDM state.
- an ML model trained using historical pregnant patient records that is deployed for a particular user may be further re-trained after deployment.
- the ML model may be re-trained after the ML model is deployed for a specific pregnant patient to create a more personalized ML model for the patient.
- FIG. 12 depicts process flow diagram 1200 representing operations for predicting GDM, in accordance with embodiments of the present disclosure.
- blocks 1210, 1220 and 1230 may be performed at CAM system 200, and blocks 1240, 1250 and 1260 may be performed at a computing device, such as network computing device 142 or one of display devices 150.
- blocks 1210, 1220, 1230, 1250 and 1260 may be performed at CAM system 200, and block 1240 may be performed at one of display devices 150, in accordance with the processes described above.
- glucose concentration levels are measured by an analyte sensor.
- sensor data packages are generated based on the measured glucose concentration levels.
- the sensor data packages include, inter alia, measured glucose data.
- the measure glucose data includes the measured glucose concentration levels with associated time stamps.
- the sensor data packages are transmitted to a computing device, such as display device 150, network computing device 142, etc.
- the sensor data packages are received.
- a glucose feature combination is determined from the measured analyte data.
- the GDM prediction is generated based on the analyte feature combination.
- the glucose feature combination is provided to a trained diagnostic model, which generates the GDM prediction based on the glucose feature combination.
- the glucose feature combination is provided to a trained screening model, which generates a GDM “predisposition” prediction based on the glucose feature combination.
- a quantitative GDM risk value is generated based on the glucose feature combination, such as GestScore 760, etc.
- the glucose feature combination is provided to a trained model, which generates the quantitative GDM risk value based on the glucose feature combination, as described above.
- Example Clauses [0326] Implementation examples are described in the following numbered clauses: [0327]
- Clause 1 A method for predicting gestational diabetes mellitus (GDM), the method comprising at a continuous analyte monitoring (CAM) system: measuring at least glucose concentration levels, generating sensor data packages including measured glucose concentration levels, and transmitting the sensor data packages; and at a computing device: receiving the sensor data packages, determining a glucose feature combination from the measured glucose concentration levels, and generating a GDM prediction based on the glucose feature combination, wherein: at least one glucose feature has a high performance metric, and at least one glucose feature has a high robustness metric that is relatively insensitive to analyte sensor bias.
- CAM continuous analyte monitoring
- Clause 5 The method according to Clause 4, wherein the autocorrelation skew feature is determined by determining at least one autocorrelation function based on the measured glucose concentration levels; and determining a skew of the autocorrelation function
- Clause 6 The method according to Clause 4, wherein the mean peak width feature is determined by identifying locations of peaks in the measured glucose concentration levels, including: applying a noise filter to the measured glucose concentration levels to generate filtered glucose concentration levels, and determining the locations of peaks within the filtered glucose concentration levels based on a prominence value; determining a width of each peak; and calculating a mean peak width based on the width of each peak.
- Clause 7 The method according to Clauses 1, 2, 3, 4, 5, or 6, wherein the glucose feature combination includes at least an average duration of time within 5% of set point feature, and a tenth to ninetieth percentile range feature.
- Clause 8 The method according to Clauses 2, 3, 4, 5, 6, or 7, wherein generating the quantitative GDM risk value includes executing a machine learning (ML) model; and the ML model is trained based on a combination of glucose features extracted from historical glucose data, and clinical GDM diagnoses associated with the historical glucose data.
- ML machine learning
- Clause 9 The method of any one of Clauses 2, 3, 4, 5, 6, 7, or 8, further comprising displaying the quantitative GDM risk value in a graphical user interface (GUI), wherein the sensor data packages are received over a wireless connection.
- GUI graphical user interface
- Clause 10 A system for predicting gestational diabetes mellitus (GDM), the system comprising a continuous analyte monitoring (CAM) system, including: an analyte sensor configured to measure at least glucose concentration levels, and a sensor electronics module (SEM) configured to: generate sensor data packages including measured glucose concentration levels, and transmit the sensor data packages; and a computing device comprising: a memory storing executable instructions, and a processor, in data communication with the memory, the processor configured to execute the instructions to cause the computing device to: receive the sensor data packages, determine a glucose feature combination from the measured glucose concentration levels, and generate a GDM prediction based on the glucose feature combination, wherein: at least one glucose feature has a high performance metric, and at least one glucose feature has a high
- Clause 11 The system according to Clause 10, wherein the computing device is further configured to generate a quantitative GDM risk value based on the glucose feature combination; and the quantitative GDM risk value has a range from a minimum GDM risk value to a maximum GDM risk value.
- Clause 12 The system according to Clauses 10 or 11, wherein the glucose feature combination includes at least four glucose features.
- Clause 13 The system according to Clauses 10, 11, or 12, wherein the glucose feature combination includes at least an autocorrelation skew feature, a mean peak width feature, an average duration of time within 5% of set point feature, and a tenth to ninetieth percentile range feature.
- Clause 14 The system according to Clause 13, wherein the autocorrelation skew feature is determined by: determining at least one autocorrelation function based on the measured glucose concentration levels, and determining a skew of the autocorrelation function; and the mean peak width feature is determined by: identifying locations of peaks in the measured glucose concentration levels, including: applying a noise filter to the measured glucose concentration levels to generate filtered glucose concentration levels, and determining the locations of peaks within the filtered glucose concentration levels based on a prominence value; determining a width of each peak; and calculating a mean peak width based on the width of each peak.
- Clause 15 The system according to Clauses 11, 12, 13, or 14, wherein the processor is configured to execute a machine learning (ML) model to generate the quantitative GDM risk value; and the ML model is trained based on a combination of glucose features extracted from historical glucose data, and clinical GDM diagnoses associated with the historical glucose data.
- ML machine learning
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| SG11201909708VA (en) * | 2017-04-21 | 2019-11-28 | Mellitus Llc | Methods and antibodies for diabetes-related applications |
| US11701019B2 (en) * | 2019-03-27 | 2023-07-18 | Glaukos Corporation | Intraocular physiological sensor |
| US11426102B2 (en) * | 2020-06-30 | 2022-08-30 | Dexcom, Inc. | Diabetes prediction using glucose measurements and machine learning |
| US20230162023A1 (en) * | 2021-11-25 | 2023-05-25 | Mitsubishi Electric Research Laboratories, Inc. | System and Method for Automated Transfer Learning with Domain Disentanglement |
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| CN120766970A (en) * | 2025-07-09 | 2025-10-10 | 中国人民解放军陆军军医大学第一附属医院 | A comprehensive diagnosis and treatment system for neurosurgery patients |
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