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糖尿病管理的个性化给药策略优化:在妊娠期糖尿病中的应用

A Personalized Dosing Strategy Optimization for Diabetes Management: Applications to Gestational Diabetes Mellitus.

作者信息

Lee Eva K, Wei Xin, Wright Michael D, Baker-Witt Francine

机构信息

Center for Operations Research in Medicine and Healthcare, Atlanta, Georgia, USA.

Georgia Institute of Technology, Atlanta, Georgia, USA.

出版信息

AMIA Annu Symp Proc. 2025 May 22;2024:638-647. eCollection 2024.

Abstract

Type II diabetes mellitus is a disorder that disrupts the way the body uses glucose. It is managed by close monitoring of blood glucose levels while the clinician experiments with a dosing strategy based on some clinical guidelines and his/her own experience. In this study, we propose a treatment planning model that optimizes the dosing strategy for diabetes treatment. The model utilizes a patient's personalized characteristics of disease progression and dose-response to optimize the drug dosage. Such personalized evidence is estimated by a drug-dose-drug-effect predictive model using the daily blood glucose data recorded during the titration period. We apply these to a group of patients suffering from gestational diabetes. For each patient, drug-dose-drug-effect prediction was established based on the first four weeks of self-monitored blood glucose. The treatment model then individualizes and optimizes the dose regimen based on the patient's personalized drug-dose-drug-effect characteristics. Consistently, the optimized dose regimens use less amount of drug while achieving better glycemic control than the original regimens used to treat the patients. This results in the first mathematical model that is data-driven and evidence-based and that quantitatively optimizes dosage for the treatment of diabetes. The model can generate a personalized dose regimen that has a better treatment outcome and is more drug-efficient. Clinical trials must be conducted to gauge the overall effectiveness.

摘要

2型糖尿病是一种扰乱人体利用葡萄糖方式的病症。在临床医生依据一些临床指南并结合自身经验试验给药策略时,需通过密切监测血糖水平来对其进行管理。在本研究中,我们提出了一种治疗规划模型,该模型可优化糖尿病治疗的给药策略。该模型利用患者疾病进展和剂量反应的个性化特征来优化药物剂量。这种个性化证据是通过一个药物剂量-药物效应预测模型,利用滴定期记录的每日血糖数据来估计的。我们将这些应用于一组妊娠期糖尿病患者。对于每位患者,基于前四周自我监测的血糖建立药物剂量-药物效应预测。然后,治疗模型根据患者的个性化药物剂量-药物效应特征对剂量方案进行个体化和优化。与用于治疗患者的原始方案相比,优化后的剂量方案始终使用更少的药物量,同时实现更好的血糖控制。这产生了第一个基于数据驱动和证据的数学模型,该模型可定量优化糖尿病治疗的剂量。该模型可以生成具有更好治疗效果且更具药物效率的个性化剂量方案。必须进行临床试验以评估总体有效性。

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