The invention generally relates to the field of blood glucose monitoring, and more specifically, to a method and system for calculating indices for diabetes control.
Individuals with diabetes have to control their blood glucose level to avoid a risk of hyperglycemia or hypoglycemia. Recent developments in the area of Self Monitored Blood Glucose (SMBG) systems have assisted diabetic patients in adjusting the intake of insulin and control blood glucose levels on their own. Patients using the SMBG systems need to adjust the insulin dosages based on one or more lifestyle factors such as, but not limited to, frequency of food intake, food intake timings, type of food, physical activity, stress and other medication being taken. Further, the patients need to adjust insulin dosages based on blood glucose values recorded manually during a day. The patients may consult a physician in order to arrive at an acceptable level of insulin dosage. There may be inaccuracies in the aforementioned procedure and there may be a risk of the patient contracting at least one secondary complication arising due to inaccurate dosage of insulin.
Inaccurate dosage of insulin may lead to excessive blood sugar (e.g. due to the patient injecting too little insulin) and the patient becoming hyperglycemic while a low blood sugar (e.g. due to the patient injecting too much insulin) may cause the patient to become hypoglycemic. In particular, excessive levels of sugar in the blood result in sugar combining with protein to form glycosylated protein. Glycosylated proteins (e.g. HbA1c in hemoglobin) are substantially insoluble and lead to thickening of the walls of veins and myelination of nerves. An HbA1c level reflects the effectiveness of blood glucose treatment over the 6-8 week period preceding the HbA1c measurement. Typically, a range of 6%-7% of HbA1c in the blood of a diabetic patient is a good indication that the dosage is effective and the risk of secondary problems related to HbA1c is low. Taking only HbA1c level as the risk indicator may not always provide accurate results.
Therefore, there is a need for calculating indices for diabetes control based on the blood glucose values and HbA1c values so that the patients can regulate the insulin dosage effectively.
The accompanying figures where like reference numerals refer to identical or functionally similar elements throughout the separate views and which together with the detailed description below are incorporated in and form part of the specification, serve to further illustrate various embodiments and to explain various principles and advantages all in accordance with the invention.
Skilled artisans will appreciate that elements in the figures are illustrated for simplicity and clarity and have not necessarily been drawn to scale. For example, the dimensions of some of the elements in the figures may be exaggerated relative to other elements to help to improve understanding of embodiments of the invention.
Before describing in detail embodiments that are in accordance with the invention, it should be observed that the embodiments reside primarily in combinations of method steps and apparatus components related to method and system for calculating indices for diabetes control. Accordingly, the apparatus components and method steps have been represented where appropriate by conventional symbols in the drawings, showing only those specific details that are pertinent to understanding the embodiments of the invention so as not to obscure the disclosure with details that will be readily apparent to those of ordinary skill in the art having the benefit of the description herein.
In this document, relational terms such as first and second, top and bottom, and the like may be used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. The terms “comprises,” “comprising,” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. An element proceeded by “comprises . . . a” does not, without more constraints, preclude the existence of additional identical elements in the process, method, article, or apparatus that comprises the element.
Various embodiments of the invention provide methods and system for calculating indices for diabetes control. The method involves collecting a plurality blood glucose (BG) data of a subject. Further, the method involves calculation of one or more parameters based on the plurality of BG data such as, but not limited to, a HbA1c estimate, a standard deviation of the plurality of BG data and a percentage of plurality of BG data above/below a threshold value. Thereafter, a Blood Glucose Control Index (BGCI) and a Severe Hypoglycemia Risk Index (SHRI) are calculated based on the one or more parameters calculated using the plurality of BG data. The BGCI and SHRI reflects a current state of diabetes of the subject and provides an indication if there is a chance of the subject contracting a diabetes related complication, such as, but not limited to, severe hypoglycemia in the future.
Reference will now be made to
The plurality of BG data for calculating the BGCI for the subject can be collected using a Self Monitored Blood Glucose (SMBG) system or using other suitable systems and methods. The plurality of BG data includes a set of BG data of the subject collected over a first period of time and a sample BG data of the subject collected over a second period of time. In an embodiment, the set of BG data is collected prior to the sample BG data. The first period of time during which the set of BG data is collected is a follow-up period ranging from 14-28 days. In some embodiments, the first period of time is longer and is used to define statistical properties of the BG samples and generate parameters such as, continuous HbA1c estimate and Avg_High. Further, the first period of time provides the information to generate statistical models to estimate the physiological occurrences that may take place in the future, in accordance with the state of the subject at the beginning of the follow-up period. The second period of time during which the sample BG data is collected can be a time period of 24 hours. In some embodiments, the second period of time is shorter and is used as a baseline to estimate a risk of hypoglycemia for the next 24 hours. Additionally, the second period of time provides a current state of the subject regarding BG values, insulin dosages, meals, activities, etc. In an exemplary instance, the sample BG data is collected every day before a stipulated time, for example, before 9.00 AM. In some embodiments, the second period of time can extend to a few days, for example, 3-4 days.
In an exemplary embodiment, various other data associated with daily activities of the subject may be recorded and utilized together with the BGCI and the SHRI (calculation of SHRI has been described in description of
At step 102, an HbA1c estimate (HbA1c—E) is determined based on the sample BG data. In an exemplary embodiment, the HbA1c—E is calculated using a stabilized HbA1c estimation algorithm. For example, the HbA1c estimation algorithm may be the HbA1c estimation algorithm or similar to the algorithm explained in U.S. Pat. No. 6,421,633. The HbA1c estimation algorithm can be based on a mathematical model to estimate a variation of the HbA1c level relative to the plurality of BG data. In some embodiments, the HbA1c estimation algorithm is stabilized by providing previous HbA1c values of the subject.
At step 104, a standard deviation of the HbA1c—E (Std_HbA1c—E) is determined based on a plurality of HbA1c—E values of the subject collected over a period of time. The Std_HbA1c—E is calculated by first determining a mean HbA1c—E value of the plurality of HbA1c—E. Subsequently, the mean HbA1c—E value is subtracted from each HbA1c—E data of the plurality of HbA1c—E data resulting in mean subtracted plurality of HbA1c—E data. Thereafter, a square root of the average of mean subtracted plurality of HbA1c—E data is taken for calculating the Std_HbA1c—E.
At step 106, an average of high BG data (Avg_high) is determined based on the plurality of BG data. In an exemplary instance, the Avg_high includes an average of highest 10% of the plurality of BG data collected during the follow-up period. For example, if the plurality of BG data has 100 values, then Avg_high includes average of the top 10 values of the 100 values.
At step 108, the BGCI is calculated based on the HbA1c—E, the Std_HbA1c—E and the Avg_high.
In an exemplary embodiment, the BGCI is calculated using a formula as below,
BGCI=A×HbA1c+f1(Std_HbA1c—E)+f2(Avg_high)
wherein A is a decimal number and f1 and f2 are functions of Std_HbA1c—E and Avg_high, respectively. In an exemplary implementation, the scaling factor A can be adjusted according to the population group based on the risk factors involved with the population group. For example, coefficient A can be set to 1 for Caucasian males whereas the coefficient A may be set to 0.8 for Afro-Caribbean males based on lower myocardial infarction risk factors associated with the respective population groups, as described in the article “Development of life-expectancy tables for people with type 2 diabetes” by Jose Leal et. Al published in European Heart Journal, 2009. In an exemplary embodiment, f1 is defined as below:
f1=B×Std_HbA1c—E,
wherein B is defined to provide statistical correlation between recognized risk of diabetes related secondary diseases and the variation of HbA1c estimate. In an exemplary embodiment, f2 is defined as below:
f
2
=C×(Avg_high−6 mmol/l),
wherein C is defined to provide statistical correlation between recognized risk of diabetes related secondary diseases and the difference between Avg_high and blood glucose level of 6 mmol/l. In some embodiments, the value of blood glucose level can be changed based on the physiological parameters of the subject.
In some embodiments, the method calculates short term HbA1c values (where HbA1c values are calculated daily) which in turn are used to calculate a BGCI value. The BGCI value indicates a probability of contracting secondary complications in the future.
At step 110, the BGCI is displayed to the subject. In an embodiment, the BGCI is displayed using a visual indicator on a display interface. In some embodiments, a severity of BGCI is displayed using different colors. The visual indicator is explained in detail in conjunction with
Turning now to
At step 402, a HbA1c estimate (HbA1c—E) is determined based on the sample BG data. The HbA1c—E is determined as explained in the description of step 102 of
At step 404, a percentage of BG data that is below a predefined threshold (LT4) is determined by comparing each BG data of the plurality of BG data with the predefined threshold. In an exemplary implementation, the threshold is 4 mmol/l. In an example, the plurality of BG data includes 100 BG values of which 25 are below 4 mmol/l. As a result, LT4 is calculated as 25% of the plurality of BG data. In some embodiments, the threshold can be changed based on parameters such as, but not limited to, a physiological status, a genetic history, an ethnic group and smoking habits of the subject. The parameter LT4 gives the percentage of low BG data, which indicates the variation of the BG data. A risk of hypoglycemia increases when the parameter LT4 increases.
At step 406, a standard deviation of the BG data (Std_BG) of the subject is determined based on the plurality of BG data. The Std_BG is calculated by first determining a mean BG value of the plurality of BG data. Subsequently, the mean BG value is subtracted from each BG data of the plurality of BG data resulting in mean subtracted plurality of BG data. Thereafter, a square root of the average of mean subtracted plurality of BG data is taken for calculating the Std_BG. Subsequently, at step 408 the SHRI is calculated based on the HbA1c—E, the LT4 and the Std_BG.
In an embodiment, the SHRI can be calculated using a formula as below:
SHRI=A×LT4×Std_BG/HbA1c—E
where A is a numeric value dependent on the characteristics of a group of people that the subject belongs. In an embodiment, the scaling factor A is defined over multiple time periods so that there are accurate estimates regarding the percentages of LT4 and LT3, respectively. In an exemplary embodiment, LT3 is defined as below:
LT3=A×LT4×Std_BG/HbA1c—E
In an exemplary embodiment, scaling factor A is calculated as below:
A=0.1×HbA1c—E/Std_BG
When the parameters LT3, LT4, HbA1c—E and Std_BG values are known, a set of A_d values is also calculated. Thereafter, the best estimate of A for that person is determined by taking the average of the set of values A_d, AVE(set of A_d values).
In an exemplary scenario, an observed LT3 value (LT3_o) may not be equal to 0.1×LT4_o, thus the scaling factor A calculated as below:
A=LT3—o/(0.1×LT4—o)×AVE(set of A—d values)
As an example, a person with BG_STD=3.5, HbA1c—E=7.0, LT4_o=20%, and LT3_o=2%, respectively, has an LT3 value equal to 0.1×LT4. In this duration, scaling factor A has a value of 0.2 calculated as 0.1×7/3.5=0.2. SHRI for the person is given by
SHRI=0.2×LT4×Std_BG/HbA1c—E
In another exemplary case, if the observed LT3_o is 4%, the scaling factor A is 0.4, and SHRI would be two times higher for each set of observations.
At step 410, the SHRI is displayed to the subject. In an embodiment, the SHRI is displayed using a visual indicator on a display interface. In some embodiments, a severity of SHRI is indicated using different colors. The visual indicator is explained in detail in conjunction with
In an exemplary scenario, the subject can adjust the insulin intake based on the BGCI and SHRI values. The subject can make changes in lifestyle by adjusting one or more of, but not limited to, food intake timings, type of food and an exercise regime, along with the insulin dosage to control the diabetes. For example, the subject may decrease an intake of carbohydrates and increase the duration of physical activity, while keeping the insulin dosage constant to maintain healthy BGCI and SHRI values.
Turning now to
In an exemplary embodiment, processor 504 includes an adaptive model which is automatically updated to clearly reflect a risk level of the subject. As and when the plurality of BG data accumulates, the adaptive model continuously segregates the plurality of BG data into one or more clusters based on, for example, an ethnic background, a genetic history, smoking habits, age, type of diabetes and body mass index (BMI). Thereafter, statistical analysis is performed on the plurality of BG data in each cluster to verify if each of the one or more clusters is statistically different from one another. Further, accuracy of risk curves associated with the one or more clusters is increased with the accumulation of the plurality of BG data, thereby enabling the subject to have an accurate calculation regarding the risk of secondary complications.
System 500 also includes a display unit 506 configured to show an overall status of diabetes control of the subject which includes the values of BGCI and SHRI. Further, display unit 506 is configured to provide a visual feedback to the subject regarding the quality of BG measurements that are taken.
Referring now to
Various embodiments of the invention provide methods and systems for calculating indices for diabetes control of the subject. The method and system provides the subject with the BGCI and SHRI which indicate the probability of contracting secondary complications in the future. The method and system also provides visual indications to the subject regarding an overall state of diabetes control. The subject can make appropriate changes in the life style in order to bring diabetes under control. Furthermore, the method and system profiles variations in risk factor across population groups thereby providing an accurate estimation of risk curves associated with the diabetes related secondary complications.
Those skilled in the art will realize that the above recognized advantages and other advantages described herein are merely exemplary and are not meant to be a complete rendering of all of the advantages of the various embodiments of the invention.
In the foregoing specification, specific embodiments of the invention have been described. However, one of ordinary skill in the art appreciates that various modifications and changes can be made without departing from the scope of the invention as set forth in the claims below. Accordingly, the specification and figures are to be regarded in an illustrative rather than a restrictive sense, and all such modifications are intended to be included within the scope of the invention. The benefits, advantages, solutions to problems, and any element(s) that may cause any benefit, advantage, or solution to occur or become more pronounced are not to be construed as a critical, required, or essential features or elements of any or all the claims. The invention is defined solely by the appended claims including any amendments made during the pendency of this application and all equivalents of those claims as issued.