Population physiology: leveraging population scale (EHR) data to understand human endocrine dynamics

TL;DR

This study demonstrates that population-scale EHR data can be used to test and validate mechanistic physiological models of glucose dynamics, revealing diurnal patterns and differences based on feeding behavior.

Contribution

The paper introduces a methodology for testing physiological models using uncontrolled, population-scale EHR data, overcoming data aggregation and diversity challenges.

Findings

No daily variation in normalized mean glucose across populations.

TDMI revealed diurnal variation in glucose levels in the general population.

Controlled feeding populations showed no TDMI-based diurnal signal.

Abstract

Studying physiology over a broad population for long periods of time is difficult primarily because collecting human physiologic data is intrusive, dangerous, and expensive. Electronic health record (EHR) data promise to support the development and testing of mechanistic physiologic models on diverse population, but limitations in the data have thus far thwarted such use. For instance, using uncontrolled population-scale EHR data to verify the outcome of time dependent behavior of mechanistic, constructive models can be difficult because: (i) aggregation of the population can obscure or generate a signal, (ii) there is often no control population, and (iii) diversity in how the population is measured can make the data difficult to fit into conventional analysis techniques. This paper shows that it is possible to use EHR data to test a physiological model for a population and over long time scales. Specifically, a methodology is developed and demonstrated for testing a mechanistic, time-dependent, physiological model of serum glucose dynamics with uncontrolled, population-scale, physiological patient data extracted from an EHR repository. It is shown that there is no observable daily variation the normalized mean glucose for any EHR subpopulations. In contrast, a derived value, daily variation in nonlinear correlation quantified by the time-delayed mutual information (TDMI), did reveal the intuitively expected diurnal variation in glucose levels amongst a wild population of humans. Moreover, in a population of intravenously fed patients, there was no observable TDMI-based diurnal signal. These TDMI-based signals, via a glucose insulin model, were then connected with human feeding patterns. In particular, a constructive physiological model was shown to correctly predict the difference between the general uncontrolled population and a subpopulation whose feeding was controlled.