Precision Medicine and Artificial Intelligence: A Pilot Study on Deep Learning for Hypoglycemic Events Detection based on ECG

Abstract

Tracking the fluctuations in blood glucose levels is important for healthy subjects and crucial diabetic patients. Tight glucose monitoring reduces the risk of hypoglycemia, which can result in a series of complications, especially in diabetic patients, such as confusion, irritability, seizure and can even be fatal in specific conditions. Hypoglycemia affects the electrophysiology of the heart. However, due to strong inter-subject heterogeneity, previous studies based on a cohort of subjects failed to deploy electrocardiogram (ECG)-based hypoglycemic detection systems reliably. The current study used personalised medicine approach and Artificial Intelligence (AI) to automatically detect nocturnal hypoglycemia using a few heartbeats of raw ECG signal recorded with non-invasive, wearable devices, in healthy individuals, monitored 24 hours for 14 consecutive days. Additionally, we present a visualisation method enabling clinicians to visualise which part of the ECG signal (e.g., T-wave, ST-interval) is significantly associated with the hypoglycemic event in each subject, overcoming the intelligibility problem of deep-learning methods. These results advance the feasibility of a real-time, non-invasive hypoglycemia alarming system using short excerpts of ECG signal.Tracking the fluctuations in the blood glucose level is relevant for both healthy individuals and diabetic patients. High glucose levels (hyperglycemia) result in long-term complications and can damage the kidneys, nerves, blood vessels in the eye and can bring many other complications 14 . Low blood glucose levels (hypoglycemia) may result in acute short-term alterations of health status such as confusion, irritability, palpitations, feeling shaky and sweaty and can even result in severe loss of attention, coma or death 15 . In fact, hypoglycemia can be particularly dangerous during specific activities requiring great attention (e.g. while driving, performing complicated surgeries). Thus, technologies for non-invasive, continuous monitoring of glucose concentration aiming at early-detecting hypoglycemic events are highly required.The most diffuse methods for blood glucose testing consist of analysing a drop of blood resulted from a finger prick. However, this method does not allow continuous monitoring, is invasive, cumbersome, expensive, and it has been demonstrated that it affects patient compliance with the glucose measurements 16 . As an alternative, Continuous Glucose Monitoring Devices (CGMs) can infer the blood glucose levels in real-time based on the glucose in the interstitial fluid. These devices significantly empowered diabetic patients, but still, they present some limitations that make them unattractive for pre-diabetic patients and diabetics. Commercially available CGMs can be worn for a limited number of days, usually between 7 and 14 days. Most of the CGMs require finger prick calibration; some studies reported that the reliability of CGMs is limited 17-19 during low blood glucose level events and they sample from the interstitial fluid whi...

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