A Machine Learning Model for Week-Ahead Hypoglycemia Prediction From Continuous Glucose Monitoring Data.

BACKGROUND: Remote patient monitoring (RPM) programs augment type 1 diabetes (T1D) care based on retrospective continuous glucose monitoring (CGM) data. Few methods are available to estimate the likelihood of a patient experiencing clinically significant hypoglycemia within one week. METHODS: We developed a machine learning model to estimate the probability that a patient will experience a clinically significant hypoglycemic event, defined as CGM readings below 54 mg/dL for at least 15 consecutive minutes, within one week. The model takes as input the patient's CGM time series over a given week, and outputs the predicted probability of a clinically significant hypoglycemic event the following week. We used 10-fold cross-validation and external validation (testing on cohorts different from the training cohort) to evaluate performance. We used CGM data from three different cohorts of patients with T1D: REPLACE-BG (226 patients), Juvenile Diabetes Research Foundation (JDRF; 355 patients) and Tidepool (120 patients). RESULTS: In 10-fold cross-validation, the average area under the receiver operating characteristic curve (ROC-AUC) was 0.77 (standard deviation [SD]: 0.0233) on the REPLACE-BG cohort, 0.74 (SD: 0.0188) on the JDRF cohort, and 0.76 (SD: 0.02) on the Tidepool cohort. In external validation, the average ROC-AUC across the three cohorts was 0.74 (SD: 0.0262). CONCLUSIONS: We developed a machine learning algorithm to estimate the probability of a clinically significant hypoglycemic event within one week. Predictive algorithms may provide diabetes care providers using RPM with additional context when prioritizing T1D patients for review.

Adding glycemic and physical activity metrics to a multimodal algorithm-enabled decision-support tool for type 1 diabetes care: Keys to implementation and opportunities.

Algorithm-enabled patient prioritization and remote patient monitoring (RPM) have been used to improve clinical workflows at Stanford and have been associated with improved glucose time-in-range in newly diagnosed youth with type 1 diabetes (T1D). This novel algorithm-enabled care model currently integrates continuous glucose monitoring (CGM) data to prioritize patients for weekly reviews by the clinical diabetes team. The use of additional data may help clinical teams make more informed decisions around T1D management. Regular exercise and physical activity are essential to increasing cardiovascular fitness, increasing insulin sensitivity, and improving overall well-being of youth and adults with T1D. However, exercise can lead to fluctuations in glycemia during and after the activity. Future iterations of the care model will integrate physical activity metrics (e.g., heart rate and step count) and physical activity flags to help identify patients whose needs are not fully captured by CGM data. Our aim is to help healthcare professionals improve patient care with a better integration of CGM and physical activity data. We hypothesize that incorporating exercise data into the current CGM-based care model will produce specific, clinically relevant information such as identifying whether patients are meeting exercise guidelines. This work provides an overview of the essential steps of integrating exercise data into an RPM program and the most promising opportunities for the use of these data.

Pointing Device Performance in Steering Tasks.

Use of touch-screen-based interactions is growing rapidly. Hence, knowing the maneuvering efficacy of touch screens relative to other pointing devices is of great importance in the context of graphical user interfaces. Movement time, accuracy, and user preferences of four pointing device settings were evaluated on a computer with 14 participants aged 20.1 ± 3.13 years. It was found that, depending on the difficulty of the task, the optimal settings differ for ballistic and visual control tasks. With a touch screen, resting the arm increased movement time for steering tasks. When both performance and comfort are considered, whether to use a mouse or a touch screen for person-computer interaction depends on the steering difficulty. Hence, a input device should be chosen based on the application, and should be optimized to match the graphical user interface.

A model for combined targeting and tracking tasks in computer applications.

Current models for targeted-tracking are discussed and shown to be inadequate as a means of understanding the combined task of tracking, as in the Drury's paradigm, and having a final target to be aimed at, as in the Fitts' paradigm. It is shown that the task has to be split into components that are, in general, performed sequentially and have a movement time component dependent on the difficulty of the individual component of the task. In some cases, the task time may be controlled by the Fitts' task difficulty, and in others, it may be dominated by the Drury's task difficulty. Based on an experiment carried out that captured movement time in combinations of visually controlled and ballistic movements, a model for movement time in targeted-tracking was developed.