J Korean Med Sci.  2016 Feb;31(2):231-239. 10.3346/jkms.2016.31.2.231.

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

Affiliations
  • 1Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, Korea.
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 4Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea. sungwan@snu.ac.kr
  • 5Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.
  • 6Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Korea.
  • 7Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract

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

Keyword

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

MeSH Terms

Blood Glucose/analysis
Diabetes Mellitus, Type 2/*drug therapy
Hospitalization
Humans
Hypoglycemic Agents/*therapeutic use
Insulin/*therapeutic use
Models, Theoretical
Blood Glucose
Hypoglycemic Agents
Insulin
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