The potency of a medicament may change over time. Time and/or other factors, like temperature, may change the potency of the medicament. For example, the potency of insulin may change with temperature over time. Insulin ideally is stored in a temperature range between 25° C. to 30° C. (77° F. to 86° F.). When insulin is stored at a temperature above this temperature, the potency decreases as time elapses.
This can be problematic for insulin delivery devices, like insulin pumps. These insulin delivery devices calculate basal insulin dosages based on the assumption that the potency of the insulin is constant over time and for all temperatures. However, this assumption may not hold true in many instances. For on-body insulin delivery devices, the temperature of the insulin stored therein may approach normal body temperature of 98.6° F. Given this heightened temperature relative to the ideal temperature range for storage, the potency of the insulin may decrease over time, and the insulin delivery device may under-deliver the amount of insulin needed to satisfy a user's needs due to the resulting decrease in potency.
In accordance with a first inventive aspect, a method is performed by a processor of an electronic device. The method includes calculating a basal dosage of a medicament to be delivered to a user by a medicament delivery device. The method further includes determining an amount that at least one factor affects a potency of the medicament and adjusting the calculated basal dosage of medicament to compensate for the determined amount that the at least one factor has affected the potency of the medicament.
The medicament may be insulin. The at least one factor may include temperature and/or a duration of time that the medicament has been stored in the medicament delivery device. Other factors that affect potency (e.g., exposure to light, exposure to air, etc.) may also be taken into account. The at least one factor may decrease the potency of the medicament, and the calculated dosage may be adjusted to a larger dosage to compensate. The adjusting may include adjusting the calculated basal dosage based on how much a current temperature is above a target temperature. The adjusting may comprise adjusting the calculated basal dosage based on how much an actual blood glucose level compares with a projected blood glucose level.
In accordance with another inventive aspect, a medicament delivery device includes a medicament storage and a pump for pumping medicament out of the storage for delivery to a user. The medicament delivery device also includes a storage medium for storing data and computer programming instructions. The medicament delivery device includes a processor for executing the computer programming instructions. The computer programming instructions cause the processor to calculate a basal dosage of a medicament to be delivered to a user by the medicament delivery device. The computer programming instructions also cause the processor to determine an amount that at least one factor affects a potency of the medicament and to adjust the calculated basal dosage of medicament to compensate for the determined amount that the at least one factor has affected the potency of the medicament.
The computer programming instructions may additionally cause the processor to control the pump to deliver the adjusted basal dosage of medicament to the user. The medicament may be insulin. The at least one factor may comprise temperature, exposure to light or exposure to air. The at least one factor may comprise a duration of time that the medicament has been stored in the medicament delivery device. The at least one factor may include temperature, an average temperature or a histogram of temperatures and a duration of time that the medicament has been stored in the medicament delivery device or a duration of time that the medicament has been stored in the medicament delivery device at a particular temperature or at an average temperature. The adjusting may include adjusting the calculated basal dosage based on how much a current temperature or an average temperature is above a target temperature. The adjusting may include adjusting the calculated basal dosage based on how much an actual blood glucose level compares with a projected blood glucose level.
In accordance with a further inventive aspect, a method is performed by a processor in an on-body insulin delivery device. The method includes calculating a basal dosage for a user based on at least a current blood glucose level. The method also includes calculating how much a potency of the insulin has decreased over a period and increasing the calculated basal dosage of the insulin to offset the calculated decrease in potency of the insulin.
The calculating of how much the potency of the insulin has decreased over the period may include determining a temperature for the insulin and adjusting for the determined temperature if the determined temperature exceeds a threshold. The method may further include calculating a delta of how much the determined temperature exceeds the threshold, and a magnitude of the adjustment for the determined temperature may be based on a magnitude of the delta. The calculating of how much the potency of the insulin has decreased over the period may entail determining a delta between a projected blood glucose level for the user and an actual blood glucose level for the user and determining how much the potency of the insulin has decreased based on a magnitude of the determined delta.
The exemplary embodiments may account for a change in potency of a medicament and adjust the dosage of medicament delivered to a user via a medicament delivery device to compensate for the change in potency. The medicament delivery device may determine the amount of change in the potency in the medicament and may make adjustments in dosage of the medicament delivered to the user automatically without user input. The net result is that the dosage of medicament delivered to the user is better matched to the user's true needs for the medicament.
The exemplary embodiments may account for different factors that affect potency. For example, the exemplary embodiments may account for duration of time that a medicament has been in an environment that affects potency. The exemplary embodiments may also account for temperature as a factor that affects potency of the medicament. For instance, when a temperature is above a threshold, the potency of the medicament may be affected. The exemplary embodiments may account for multiple such factors jointly affecting the potency of the medicament, including other factors, such as exposure to air and/or exposure to light. The dosage of medicament delivered to the user may be increased when the potency decreases and decreased when the potency increases.
In some embodiments, the medicament is insulin, and the medicament delivery device is an insulin delivery device, such as an insulin pump. In these embodiments, the control system of the insulin delivery device may determine changes in potency of the insulin and compensate for the changes in potency when calculating dosages, such as basal dosages, that are delivered to the user. The control system may determine changes in potency of the insulin based on how long the insulin has been stored in the drug delivery device or how long the insulin has been at a heightened temperature that is above a threshold temperature. Moreover, the magnitude of change in the potency may be proportional to how much the temperature exceeds the threshold temperature. Alternatively, the changes in potency may be determined based on actual analyte levels versus projected analyte levels. For example, the difference between actual glucose levels and projected glucose levels may be analyzed to identify changes in potency.
The medicament delivery device 102 may include a controller 110. The controller 110 may be implemented in hardware, software, or any combination thereof. The controller 110 may, for example, be a microprocessor, a logic circuit, a field programmable gate array (FPGA), an application specific integrated circuit (ASIC), etc. The controller 110 may maintain a date and time as well as other functions (e.g., calculations or the like). The controller 110 may be operable to execute a control application 116 stored in the storage 114 that enables the controller 110 to implement a control system for controlling operation of the medicament delivery device 102. The control application 116 may control medicament delivery to the user 108 as described herein. The storage 114 may hold histories 111 for a user, such as a history of automated basal medicament deliveries, a history of bolus medicament deliveries, meal event history, activity event history, sensor data and the like. In addition, the controller 110 may be operable to receive data or information. The storage 114 may include both primary memory and secondary memory. The storage 114 may include random access memory (RAM), read only memory (ROM), optical storage, magnetic storage, removable storage media, solid state storage or the like.
The medicament delivery device 102 may include a reservoir 112 for storing medicament for delivery to the user 108 as warranted. A fluid path to the user 108 may be provided, and the medicament delivery device 102 may expel the medicament from the reservoir 112 to deliver the medicament to the user 108 via the fluid path. The fluid path may, for example, include tubing coupling the medicament delivery device 102 to the user 108 (e.g., tubing coupling a cannula to the reservoir 112).
There may be one or more communications links with one or more devices physically separated from the medicament delivery device 102 including, for example, a management device 104 of the user and/or a caregiver of the user and/or sensor(s) 106. In some embodiments, no management device 104 is provided. The communication links may include any wired or wireless communication link operating according to any known communications protocol or standard, such as Bluetooth®, Wi-Fi, a near-field communication standard, a cellular standard or another wireless protocol. The medicament delivery device 102 also may include a user interface 117, such as an integrated display device for displaying information to the user 108 and in some embodiments, receiving information from the user 108. The user interface 117 may include a touchscreen and/or one or more input devices, such as a button, a knob or a keyboard.
The medicament delivery device 102 may interface with a network 122. The network 122 may include a local area network (LAN), a wide area network (WAN) or a combination therein. A computing device 126 may be interfaced with the network, and the computing device may communicate with the medicament delivery device 102.
The medicament delivery system 100 may include sensor(s) 106 for sensing the levels of one or more analytes. The sensor(s) 106 may be coupled to the user 108 by, for example, adhesive or the like and may provide information or data on one or more medical conditions and/or physical attributes of the user 108. The sensor(s) 106 may, in some exemplary embodiments provide periodic glucose concentration measurements and may be a continuous glucose monitor (CGM), or another type of device or sensor that provides glucose level measurements. The sensor(s) 106 may be physically separate from the medicament delivery device 102 or may be an integrated component thereof. The sensor(s) 106 may provide the controller 110 with data indicative of one or more measured or detected analyte levels of the user 108. The information or data provided by the sensor(s) 106 may be used to adjust medicament delivery operations of the medicament delivery device 102.
The medicament delivery system 100 may also include the management device 104. In some embodiments, no management device 104 is needed; rather the medicament delivery device 102 may manage itself. The management device 104 may be a special purpose device, such as a dedicated personal diabetes manager (PDM) device. The management device 104 may be a programmed general-purpose device, such as any portable electronic device including, for example, a dedicated controller, such as a processor, a microcontroller, or the like. The management device 104 may be used to program or adjust operation of the medicament delivery device 102 and/or the sensor(s) 106. The management device 104 may be any portable electronic device including, for example, a customized handheld electronic device, a smartphone, a smartwatch, or a tablet. In the depicted example, the management device 104 may include a processor 119 and a storage 118. The processor 119 may execute processes to manage and control the delivery of the medicament to the user 108. The processor 119 may also be operable to execute programming code stored in the storage 118. For example, the storage 118 may be operable to store one or more control applications 120 for execution by the processor 119. The one or more control applications 120 may be responsible for controlling the medicament delivery device 102, e.g., the automatic insulin delivery (AID) delivery of insulin to the user 108. The storage 118 may store the one or more control applications 120, histories 121 like those described above for the medicament delivery device 102 and other data and/or programs.
The management device 104 may include a user interface (UI) 123 for communicating with the user 108. The user interface 123 may include a display, such as a touchscreen, for displaying information. The touchscreen may also be used to receive input when it is a touch screen. The user interface 123 may also include input elements, such as a keyboard, button, knob or the like.
The management device 104 may interface with a network 124, such as a LAN or WAN or combination of such networks. The management device 104 may communicate over network 124 with one or more servers or cloud services 128.
Other devices, like smartwatch 130, fitness monitor 132 and other wearable device 134 may be part of the medicament delivery system 100. These devices 130, 132 and 134 may communicate with the medicament delivery device 102 to receive information and/or issue commands to the medicament delivery device 102. These devices 130, 132 and 134 may execute computer programming instructions to perform some of the control functions otherwise performed by controller 110 or processor 119. These devices 130, 132 and 134 may include displays for displaying information, e.g., analyte levels like current blood glucose level, medicament on board, medicament delivery history, etc. The displays may show a user interface for providing input, such as to request a change in basal medicament dosage or delivery of a bolus of medicament. These devices 130, 132 and 134 may also have wireless communication connections with the sensor 106 to directly receive analyte data.
Because the medicament delivery device 300 rests directly on the skin surface of the user 108, the medicament delivery device 300 is prone to heating to near 98.6° F. For medicaments, like insulin, that are susceptible to elevated temperatures, the arrangement of the medicament delivery device 102 on the skin surface may affect the potency of the medicament. To that end, exemplary embodiments may determine the degree that the potency of the medicament has changed and compensate for the change in determining dosages of the medicament. The exemplary embodiments may provide multiple approaches for determining the degree that the potency of the medicament has changed and for compensating for the change, as will be detailed below.
In many instances, a medicament delivery device 102 may be used to deliver medicament on an ongoing basis. The medicament delivery device 102 may deliver basal dosages at periodic intervals while in use.
When the medicament is insulin, one approach to adjusting the basal dosage to compensate for changes in potency is captured by the following equation which adjusts the insulin dosage based on duration:
where i is the current cycle, If(i) is the compensated basal dosage of insulin at cycle i, and IAID(i) is the basal dosage the automated insulin delivery (AID) control algorithm would have delivered without compensation. Equation 1 is based on the notion that basal insulin is delivered at cycles of 5 minutes each so that there are 288 cycles per day. It has been shown that the potency of insulin may decrease by 18% over 28 days. That equates to a decrease of 0.6% a day. Other percentages of decrease values may be used. Thus, the potency decreases by 0.006/288 per cycle. Hence, 0.006×i/288 in the above equation relates to how much the potency has decreased during the present day up to the current cycle. As shown in the flowchart 510 of
It should be appreciated that the above formulation of Equation 1 is particular to insulin. Other formulations may be necessitated for other medicaments.
It should be appreciated that the potency of some medicaments may increase rather decrease over time or in response to other factors. In such instances, the basal delivery dosage should be decreased to compensate for the increase in potency.
In an alternate approach, the temperature and duration may both be considered in determining changes in the potency of a medicament.
A suitable equation for this approach where the medicament is insulin is:
where i is the current cycle, If(i) is the compensated basal dosage of insulin at cycle i, IAID(i) is the basal dosage the automated insulin delivery (AID) control algorithm of control application 116 or 120 would have delivered without compensation, max( ) is a maximum function that returns a maximum value and T(i) is the current temperature in Fahrenheit at cycle i. The value 21.6 is the difference between the body temperature of the user 98.6° F. and the lower bound of the acceptable temperature range 77° F. This approach assumes that there is some decay for any temperature above the lower threshold but not at or below the threshold. In addition, this approach assumes that the magnitude of the elevated temperature relative to the threshold affects the magnitude of loss potency. In other words, higher temperatures produce greater loss in potency. Thus, the loss in potency is based on both temperature and duration.
A third approach to compensating for changes in potency of a medicament involves looking at a projected analyte level versus an actual analyte level.
It should be appreciated that these differences in actual glucose concentration value versus projected glucose concentration value may vary significantly based on the user's meal ingestion's and based upon location of the medicament delivery device. That said, the average deviation should not change as such, long-term changes in residuals between predictions and actual values may be attributed to the reduction and insulin potency or other medicament delivery site issues. Thus, the exemplary embodiments may rely upon the longer-term change in residuals in determining the potency variable p.
Where the medicament is insulin and the analyte values are glucose concentration values, the adjusted basal medicament dosage may be calculated as:
where p is a parameter rather than 0.006 that represents the reduction in insulin potency each cycle. By using the parameter p, this approach allows more customization per medicament delivery device and per user.
As part of determining a suitable value for p, the exemplary embodiments may calculate the average daily residuals between the projected glucose concentration values in the actual glucose concentration values. A suitable equation for calculating the average daily residuals is:
where
d
i=Σk=112G(i−k)−pi-12(k) (Equation 5)
Where G(i−k) is the actual glucose concentration value at cycle i−k and pi-12(k) is the last available prediction of the glucose concentration value (i.e., the projected glucose concentration value) twelve cycles prior to the current cycle i. The prediction horizon is 12 cycles. Where the cycles are 5 minutes in length, the prediction horizon is one hour.
Next, the reduction in potency in the insulin for jth day may be determined by calculating the change in daily residuals as:
The control application 116 or 120 may then adjust the basal insulin dosages based on the determined reduction in potency. The potency for day 1 may be calculated as:
This value pj may serve as a baseline for calculating the potency p.
While exemplary embodiments have been described herein, various changes in form and detail relative to the exemplary embodiments may made without departing from the intended scope of the claims as appended hereto.
This application claims the benefit of U.S. Provisional Patent Application No. 63/238,291, filed Aug. 30, 2021, the contents of which are incorporated herein by reference in their entirety.
Number | Date | Country | |
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63238291 | Aug 2021 | US |