Corrigendum: Automatic inference of hypoglycemia causes in type 1 diabetes: a feasibility study.

[This corrects the article DOI: 10.3389/fcdhc.2023.1095859.].

Automatic inference of hypoglycemia causes in type 1 diabetes: a feasibility study.

Background: Hypoglycemia is the most common adverse consequence of treating diabetes, and is often due to suboptimal patient self-care. Behavioral interventions by health professionals and self-care education helps avoid recurrent hypoglycemic episodes by targeting problematic patient behaviors. This relies on time-consuming investigation of reasons behind the observed episodes, which involves manual interpretation of personal diabetes diaries and communication with patients. Therefore, there is a clear motivation to automate this process using a supervised machine learning paradigm. This manuscript presents a feasibility study of automatic identification of hypoglycemia causes. Methods: Reasons for 1885 hypoglycemia events were labeled by 54 participants with type 1 diabetes over a 21 months period. A broad range of possible predictors were extracted describing a hypoglycemic episode and the subject's general self-care from participants' routinely collected data on the Glucollector, their diabetes management platform. Thereafter, the possible hypoglycemia reasons were categorized for two major analysis sections - statistical analysis of relationships between the data features of self-care and hypoglycemia reasons, and classification analysis investigating the design of an automated system to determine the reason for hypoglycemia. Results: Physical activity contributed to 45% of hypoglycemia reasons on the real world collected data. The statistical analysis provided a number of interpretable predictors of different hypoglycemia reasons based on self-care behaviors. The classification analysis showed the performance of a reasoning system in practical settings with different objectives under F1-score, recall and precision metrics. Conclusion: The data acquisition characterized the incidence distribution of the various hypoglycemia reasons. The analyses highlighted many interpretable predictors of the various hypoglycemia types. Also, the feasibility study presented a number of concerns valuable in the design of the decision support system for automatic hypoglycemia reason classification. Therefore, automating the identification of the causes of hypoglycemia may help objectively to target behavioral and therapeutic changes in patients' care.

Analysis of real-world capillary blood glucose data to help reduce HbA1c and hypoglycaemia in type 1 diabetes: Evidence in favour of using the percentage of readings in target and coefficient of variation.

AIMS: To examine real-world capillary blood glucose (CBG) data according to HbA1c to define proportions of CBG readings at different HbA1c levels, and evaluate patterns in CBG measurements to suggest areas to focus on with regard to self-management. METHODS: A retrospective analysis stratified 682 adults with type 1 diabetes split into quartiles based on their HbA1c . The proportions of results in different CBG ranges and associations with HbA1c were evaluated. Patterns in readings following episodes of hyperglycaemia and hypoglycaemia were examined, using glucose to next glucose reading table (G2G). RESULTS: CBG readings in the target range (3.9-10 mmol/L) increase by ~10% across each CBG quartile (31% in the highest versus 63% in the lowest quartile, p < 0.05). The novel G2G table helps the treatment-based interpretation of data. Hypoglycaemia is often preceded by hyperglycaemia, and vice-versa, and is twice as likely in the highest HbA1c quartile. Re-testing within 30 min of hypoglycaemia is associated with less hypoglycaemia, 1.6% versus 7.2%, p < 0.001, and also reduces subsequent hyperglycaemia and further hypoglycaemia in the proceeding 24 h. The coefficient of variation, but not standard deviation, is highly associated with hypoglycaemia, r = 0.71, and a CV ≤ 36% equates to 3.3% of CBG readings in the hypoglycaemic range. CONCLUSIONS: HbA1c <58 mmol/mol (7.5%) is achievable even when only ~60% of CBG readings are between 3.9-10 mmol/L. Examining readings subsequent to out-of-range readings suggests useful behaviours which people with type 1 diabetes could be supported to adhere to, both in a clinic and structured education programmes, thereby decreasing the risk of hypoglycaemia whilst also reducing hyperglycaemia and improving HbA1c .

COVID-19 mortality risk assessments for individuals with and without diabetes mellitus: Machine learning models integrated with interpretation framework.

This research develops machine learning models equipped with interpretation modules for mortality risk prediction and stratification in cohorts of hospitalised coronavirus disease-2019 (COVID-19) patients with and without diabetes mellitus (DM). To this end, routinely collected clinical data from 156 COVID-19 patients with DM and 349 COVID-19 patients without DM were scrutinised. First, a random forest classifier forecasted in-hospital COVID-19 fatality utilising admission data for each cohort. For the DM cohort, the model predicted mortality risk with the accuracy of 82%, area under the receiver operating characteristic curve (AUC) of 80%, sensitivity of 80%, and specificity of 56%. For the non-DM cohort, the achieved accuracy, AUC, sensitivity, and specificity were 80%, 84%, 91%, and 56%, respectively. The models were then interpreted using SHapley Additive exPlanations (SHAP), which explained predictors' global and local influences on model outputs. Finally, the k-means algorithm was applied to cluster patients on their SHAP values. The algorithm demarcated patients into three clusters. Average mortality rates within the generated clusters were 8%, 20%, and 76% for the DM cohort, 2.7%, 28%, and 41.9% for the non-DM cohort, providing a functional method of risk stratification.

Blood Glucose Level Prediction: Advanced Deep-Ensemble Learning Approach.

Optimal and sustainable control of blood glucose levels (BGLs) is the aim of type-1 diabetes management. The automated prediction of BGL using machine learning (ML) algorithms is considered as a promising tool that can support this aim. In this context, this paper proposes new advanced ML architectures to predict BGL leveraging deep learning and ensemble learning. The deep-ensemble models are developed with novel meta-learning approaches, where the feasibility of changing the dimension of a univariate time series forecasting task is investigated. The models are evaluated regression-wise and clinical-wise. The performance of the proposed ensemble models are compared with benchmark non-ensemble models. The results show the superior performance of the developed ensemble models over developed non-ensemble benchmark models and also show the efficacy of the proposed meta-learning approaches.

Intelligent Data-Driven Model for Diabetes Diurnal Patterns Analysis.

In type 1 diabetes, diurnal activity routines are influential factors in insulin dose calculations. Bolus advisors have been developed to more accurately suggest doses of meal-related insulin based on carbohydrate intake, according to pre-set insulin to carbohydrate levels and insulin sensitivity factors. These parameters can be varied according to the time of day and their optimal setting relies on identifying the daily time periods of routines accurately. The main issues with reporting and adjustments of daily activity routines are the reliance on self-reporting which is prone to inaccuracy and within bolus calculators, the keeping of default settings for daily time periods, such as within insulin pumps, glucose meters, and mobile applications. Moreover, daily routines are subject to change over periods of time which could go unnoticed. Hence, forgetting to change the daily time periods in the bolus calculator could contribute to sub-optimal self-management. In this paper, these issues are addressed by proposing a data-driven model for identification of diabetes diurnal patterns based on self-monitoring data. The model uses time-series clustering to achieve a meaningful separation of the patterns which is then used to identify the daily time periods and to advise of any time changes required. Further improvements in bolus advisor settings are proposed to include week/weekend or even modifiable daily time settings. The proposed model provides a quick, granular, more accurate, and personalized daily time setting profile while providing a more contextual perspective to glycemic pattern identification to both patients and clinicians.

Classification before regression for improving the accuracy of glucose quantification using absorption spectroscopy.

This work contributes to the improvement of glucose quantification using near-infrared (NIR), mid-infrared (MIR), and combination of NIR and MIR absorbance spectroscopy by classifying the spectral data prior to the application of regression models. Both manual and automated classification are presented based on three homogeneous classes defined following the clinical definition of the glycaemic ranges (hypoglycaemia, euglycaemia, and hyperglycaemia). For the manual classification, partial least squares and principal component regressions are applied to each class separately and shown to lead to improved quantification results compared to when applying the same regression models for the whole dataset. For the automatic classification, linear discriminant analysis coupled with principal component analysis is deployed, and regressions are applied to each class separately. The results obtained are shown to outperform those of regressions for the entire dataset.

A Deep Neural Network Application for Improved Prediction of [Formula: see text] in Type 1 Diabetes.

[Formula: see text] is a primary marker of long-term average blood glucose, which is an essential measure of successful control in type 1 diabetes. Previous studies have shown that [Formula: see text] estimates can be obtained from 5-12 weeks of daily blood glucose measurements. However, these methods suffer from accuracy limitations when applied to incomplete data with missing periods of measurements. The aim of this article is to overcome these limitations improving the accuracy and robustness of [Formula: see text] prediction from time series of blood glucose. A novel data-driven [Formula: see text] prediction model based on deep learning and convolutional neural networks is presented. The model focuses on the extraction of behavioral patterns from sequences of self-monitored blood glucose readings on various temporal scales. Assuming that subjects who share behavioral patterns have also similar capabilities for diabetes control and resulting [Formula: see text], it becomes possible to infer the [Formula: see text] of subjects with incomplete data from multiple observations of similar behaviors. Trained and validated on a dataset, containing 1543 real world observation epochs from 759 subjects, the model has achieved the mean absolute error of 4.80 [Formula: see text] mmol/mol, median absolute error of 3.81 [Formula: see text] mmol/mol and [Formula: see text] of 0.71 ± 0.09 on average during the 10 fold cross validation. Automatic behavioral characterization via extraction of sequential features by the proposed convolutional neural network structure has significantly improved the accuracy of [Formula: see text] prediction compared to the existing methods.