Comparative Study between In-silico and Clinical Works on the Control of Blood Glucose Level in People with Type 1 Diabetes using Improved Hovorka Equations

Abstract

Background: Hovorka model is one of the diabetic models which is widely used in the artificial pancreas device (APD) also known as closed loop system, meant for people with type 1 diabetes (T1D). Previous workers had modified some equations in the sub-sections of the Hovorka model, which is also known as improved Hovorka equations, in regulating the blood glucose level (BGL) within normoglycemic range (4.0 to 7.0 mmol/L). However, the improved Hovorka equations have not been tested yet in terms of its usability to regulate and control the BGL in safe range for two or more people with T1D. This study aims to simulate their BGL with meal disturbances for 24 hours using the improved Hovorka equations. Methods: Data for people with T1D were obtained from Clinic 1, Clinical Training Centre (CTC), UiTM Medical Specialist Centre, Sungai Buloh, Selangor. Data collected include gender, age, body weight, mealtimes, meal amount, and duration. Three patients whose ages range from 11 to 14 years old were selected. All patients consumed three meals daily: breakfast, lunch, and dinner. The simulation (in-silico work) was done using MATLAB software, and the BGL profile from both in-silico and clinical works were compared and analysed. Results: It was revealed that the BGLs for all three people with T1D were far better in the in-silico work compared to the clinical work. The BGL for patient 1 was able to achieve normoglycaemia 73% of the time in the in-silico work. Meanwhile, patient 2 managed to stay in the normoglycemic range for 85% of the time in the in-silico work compared to clinical work, which was merely 31%. For Patient 3, the time duration spent in the normoglycemic range was only 16% in the in-silico work compared to none as in the clinical work. The p-values obtained in the study were less than 0.05, indicating that the in-silico work using the improved Hovorka equations was acceptable for predicting the BGL for people with T1D. Conclusions: It can be concluded that the improved Hovorka equations are reliable in simulating the meal disturbances effect on BGL and increasing people in T1D times' duration in the normoglycemic range compared to the clinical work.