Computer-Implemented System And Method For Improving Glucose Management Through Modeling Of Circadian Profiles

Abstract

A computer-implemented system and method for improving glucose management through modeling of circadian profiles is provided. Meal period data is assembled, which includes, for each stated period, at least two measurements of pre-meal and post-meal self-measured blood glucose. Diabetes medication dosed over the periods is identified. The assembled meal period data and the medication are organized into a circadian profile for a diabetic patient. A model including expected blood glucose values and their predicted errors at each period is created from the blood glucose measurements and is visualized in a log-normal distribution. Target ranges for blood glucose at each period are determined and superimposed over the expected blood glucose values. Pharmacodynamics of the medication are obtained. An incremental change in dosing of the medication is propagated over a model day and the expected blood glucose values and their predicted errors are adjusted in response to the incremental dosing change.

What is claimed is: 
     
         1 . A computer-implemented method for improving glucose management through modeling of circadian profiles, comprising the steps of:
 assembling meal period data comprising, for each of a plurality of stated daily meal periods occurring over a recent observational time frame, at least two typical measurements of pre-meal and post meal self-measured blood glucose;   identifying diabetes medication dosed over the stated daily meal periods;   organizing the assembled meal period data and the identified diabetes medication into a circadian profile for a diabetic patient;   creating a model comprising expected blood glucose values and their predicted errors at each meal period from the self-measured blood glucose measurements in the circadian profile and visualizing the model of the expected blood glucose values and their predicted errors in a log-normal distribution;   determining target ranges for blood glucose at each meal period and superimposing the target ranges over the expected blood glucose values;   obtaining pharmacodynamics of the identified diabetes medication; and   propagating an incremental change in dosing of the identified diabetes medication over a model day and adjusting the expected blood glucose values and their predicted errors in response to the suggested incremental dosing change,   wherein the steps are performed on a suitably-programmed computer.   
     
     
         2 . A method according to  claim 1 , further comprising the steps of:
 incrementally changing the dosing of the identified diabetes medication in the model;   applying the pharmacodynamics of the identified diabetes medication as incrementally changed until the expected blood glucose values move into the target ranges; and   providing the incrementally changed dosing of the identified diabetes medication as the suggested incremental dosing change.   
     
     
         3 . A method according to  claim 1 , further comprising the steps of:
 defining a threshold of hypoglycemic risk expressed as a blood glucose value; and   identifying each of the expected blood glucose values exhibiting a risk of falling below the hypoglycemic risk threshold.   
     
     
         4 . A method according to  claim 1 , further comprising the steps of:
 defining a threshold of hyperglycemic occurrence expressed as a blood glucose value; and   identifying each of the expected blood glucose values exhibiting a rise of rising above the hyperglycemic occurrence threshold.   
     
     
         5 . A method according to  claim 1 , further comprising the step of:
 defining the stated daily meal periods as comprising, within each day, breakfast, lunch, dinner, and bedtime meal periods.   
     
     
         6 . A method according to  claim 1 , further comprising the step of:
 deriving the target ranges for the blood glucose from high and low blood glucose values as published in consensus practice guidelines or as specified by a caregiver of the diabetic patient.   
     
     
         7 . A method according to  claim 1 , further comprising the step of:
 modeling the identified diabetes medication as no more than one shorter-acting drug, which comprises a physiologic mechanism of action principally spanning no more than three to eight hours, and one longer-acting drug, which comprises a physiologic mechanism of action principally spanning one half day to no more than one full day.   
     
     
         8 . A method according to  claim 1 , further comprising the step of:
 modeling the identified diabetes medication as a glucose lowering medication taken by the patient either in addition to or in lieu of insulin.   
     
     
         9 . A method according to  claim 1 , further comprising the step of: deriving expected glycated hemoglobin from a mean of the self-measured blood glucose measurements during the recent observational time frame. 
     
     
         10 . A method according to  claim 1 , further comprising the step of:
 collectively adjusting the target ranges for the blood glucose upward or downward based on a physiological condition specific to the diabetic patient.   
     
     
         11 . A method according to  claim 1 , further comprising the steps of:
 including a body weight of the diabetic patient in the circadian profile; and   performing a trend analysis of the body weight over any preceding observational time frames.   
     
     
         12 . A non-transitory computer readable storage medium storing code for executing on a computer system to perform the method according to  claim 1 . 
     
     
         13 . A computer-implemented system for managing diabetes with circadian profiles, comprising:
 an electronically-stored database comprising a plurality of records, each record comprising a circadian profile, comprising:
 meal period categories that divide each circadian profile; 
 typical measurements of pre-meal and post-meal self-measured blood glucose occurring over a recent observational time frame stored into each of the meal period categories in at least two of the circadian profiles; and 
 diabetes medication dosed during each of the meal period categories in the at least two of the circadian profiles; and 
   an executable application configured to model predicted blood glucose levels, comprising:
 a collection module configured to collect the self-measured blood glucose measurements along a category axis comprising each of the meal period categories; 
 a statistical engine configured to determine expected blood glucose values and their predicted errors from the self-measured blood glucose measurements at each meal period category on the category axis and to visualize the expected blood glucose values and their predicted errors for a model day in a log-normal distribution; and 
 a dosing module configured to propagate a suggested incremental change in dosing of the diabetes medication over a model day and to adjust the visualized expected blood glucose values and their predicted errors based on pharmacodynamics of the diabetes medication in proportion to the incremental change in dosing. 
   
     
     
         14 . A system according to  claim 13 , further comprising:
 target ranges stored in the database for the expected blood glucose values at each meal period in the model day; and   a target module configured to superimpose the target ranges over the visualized expected blood glucose values.   
     
     
         15 . A system according to  claim 14 , further comprising;
 an incremental dosing submodule configured to incrementally and quantitatively change the dosing of the diabetes medication, to adjust the visualized expected blood glucose values and their predicted errors based on the pharmacodynamics of the diabetes medication as incrementally quantitatively changed until the expected blood glucose values move into the target ranges, and to suggest the incrementally quantitatively changed dosing of the diabetes medication.   
     
     
         16 . A system according to  claim 13 , further comprising:
 a threshold of at least one of hypoglycemic risk and hyperglycemic occurrence, which are both expressed as blood glucose values stored in the database; and   a warning module configured to identify each of the expected blood glucose values exhibiting either a risk of falling below the hypoglycemic risk threshold or rising above the hyperglycemic occurrence threshold.   
     
     
         17 . A computer-implemented method for managing diabetes with circadian profiles, comprising the steps of:
 structuring a database comprising a plurality of records, each record comprising a circadian profile, comprising:
 dividing each circadian profile into meal period categories; 
 storing typical measurements of pre-meal and post-meal self-measured blood glucose occurring, over a recent observational time frame into each of the meal period categories in at least two of the circadian profiles; and 
 identifying diabetes medication dosed during each of the meal period categories in the at least two of the circadian profiles; 
   modeling predicted blood glucose levels, comprising:
 collecting the self-measured blood glucose measurements along a category axis comprising each of the meal period categories; 
 determining expected blood glucose values and their predicted errors from the self-measured blood glucose measurements at each meal period category on the category axis and visualizing the expected blood glucose values and their predicted errors for a model day in a log-normal, distribution; and 
 propagating a suggested incremental change in dosing of the diabetes medication over the model day and adjusting the visualized expected blood glucose values and their predicted errors based on pharmacodynamics of the diabetes medication in proportion to the incremental change in dosing, 
   wherein the steps are performed on a suitably-programmed computer.   
     
     
         18 . A method according to  claim 17 , further comprising the steps of:
 determining target ranges for the expected blood glucose values at each meal period in the model day; and   superimposing the target ranges over the visualized expected blood glucose values.   
     
     
         19 . A method according to  claim 18 , further comprising the steps of:
 incrementally and quantitatively changing the dosing of the diabetes medication;   adjusting the visualized expected blood glucose values and their predicted errors based on the pharmacodynamics of the diabetes medication as incrementally quantitatively changed until the expected blood glucose values move into the target ranges; and   suggesting the incrementally quantitatively changed dosing of the diabetes medication.   
     
     
         20 . A method according to  claim 17 , further comprising the steps of:
 defining a threshold of at least one of hypoglycemic risk and hyperglycemic occurrence, which are both expressed as blood glucose values; and   identifying each of the expected blood glucose values exhibiting either a risk of falling below the hypoglycemic risk threshold or rising above the hyperglycemic occurrence threshold.   
     
     
         21 . A non-transitory computer readable storage medium storing code for executing on a computer system to perform the method according to  claim 17 .