Choi Karam, Oh Tae Jung, Lee Jung Chan, Kim Myungjoon, Kim Hee Chan, Cho Young Min, Kim Sungwan
Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
J Korean Med Sci. 2016 Feb;31(2):231-9. doi: 10.3346/jkms.2016.31.2.231. Epub 2016 Jan 26.
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.
尽管在临床环境中已使用了各种基础-餐时胰岛素治疗（BBIT）方案，但对于2型糖尿病（T2D）住院患者的血糖控制，仍需要更安全、更有效的BBIT方案。建模方法可以在临床试验之前以低成本且无危险风险的方式提供一个评估环境，用于开发最佳的BBIT方案。在本研究中，提出了一种计算机模拟模型来评估T2D住院患者的皮下BBIT方案。通过比较BBIT方案和胰岛素滑动剂量疗法（SSIT）方案对所提出的模型进行了验证。该模型用于计算机模拟试验，以比较调整基础胰岛素剂量的方案（BBIT1）与调整每日总胰岛素剂量的方案（BBIT2）。该模型还用于评估不同肾功能水平下两种不同的初始每日总胰岛素剂量。BBIT的结果优于SSIT，这与早期研究一致。BBIT2也优于BBIT1，可降低每日平均血糖水平并延长目标范围内的时间。此外，对于所有肾功能程度，使用标准剂量时每日总体平均血糖水平比使用减少剂量时更快达到目标范围。计算机模拟研究显示了几个重要发现，包括调整每日总胰岛素剂量比仅改变基础胰岛素剂量更有效。这项研究是朝着最终开发用于评估各种BBIT方案的先进模型迈出的第一步。
