Determination of personalized diabetes treatment plans using a two-delay model

TL;DR

This paper develops a mathematical model to personalize diabetes treatment, emphasizing the importance of controlling insulin sensitivity and oscillations in blood glucose, and proposes tailored strategies for type I and II diabetics.

Contribution

It introduces a two-delay model for blood glucose regulation and provides personalized treatment guidelines based on control of oscillations and insulin sensitivity.

Findings

Type II diabetics can maintain healthy glucose oscillations with exercise and combined medication.

Type I diabetics can achieve glucose control with a specific range of insulin infusion.

Strategies are compatible with existing clinical techniques and suitable for artificial pancreas design.

Abstract

Diabetes cases worldwide have risen steadily over the past decades, lending urgency to the search for more efficient, effective, and personalized ways to treat the disease. Current treatment strategies, however, may fail to maintain ultradian oscillations in blood glucose concentration, an important element of a healthy alimentary system. Building upon recent successes in mathematical modeling of the human glucose-insulin system, we show that both food intake and insulin therapy likely demand increasingly precise control over insulin sensitivity if oscillations at a healthy average glucose concentration are to be maintained. We then suggest guidelines and personalized treatment options for diabetic patients that maintain these oscillations. We show that for a type II diabetic, both blood glucose levels can be controlled and healthy oscillations maintained when the patient gets an hour of daily exercise and is placed on a combination of Metformin and sulfonylurea drugs. We note that insulin therapy and an additional hour of exercise will reduce the patient's need for sulfonylureas. Results of a modeling analysis suggest that a typical type I diabetic's blood glucose levels can be properly controlled with a constant insulin infusion between 0.45 and 0.7 microU/(ml*min). Lastly, we note that all suggested strategies rely on existing clinical techniques and established treatment measures, and so could potentially be of immediate use in the design of an artificial pancreas.