Model based study on monitoring ketone bodies to improve safety in intensive insulin therapy.
OBJECTIVE
The present study explores new signals (capillary 3betahydroxybutyrate - 3betaOHB) for improving the safety of a closed loop insulin infusion system (external wearable artificial pancreas).


METHODS
Data collected during a clinical trial on diabetic subjects including a period of insulin deprivation were interpreted through mathematical models to simulate the effect of monitoring ketone bodies (capillary 3betaOHB, KB) compared to blood glucose in subjects on Continuous Subcutaneous Insulin Infusion (CSII) treatment.


RESULTS
The estimation of model coefficients satisfactorily fits experimental data. The evaluation of dynamic changes of capillary 3betaOHB levels showed a more rapid response than blood glucose.


CONCLUSIONS
The effect of the combination of monitoring of glucose and ketone bodies can consistently improve the safety and efficacy of the use of a closed loop system for glycemic control in dangerous situations like ketoacidosis. If a subcutaneous glucose-ketone bodies sensor were to become available in the near future it would be a key component of an external artificial pancreas.
Fabietti
P G
PG
DIMI Department of Internal Medicine, University of Perugia, Perugia - Italy. bioingegneria@dimisem.med.unipg.it
Canonico
V
V
Orsini Federici
M
M
Sarti
E
E
Massi Benedetti
M
M
D020155:3-Hydroxybutyric Acid / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002196:Capillaries; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy; D006801:Humans; D007332:Insulin Infusion Systems / Q000009:adverse effects; D007657:Ketone Bodies / Q000097:blood*; D007700:Kinetics; D008954:Models, Biological; D008991:Monitoring, Physiologic; D012449:Safety
D001786:Blood Glucose; D007657:Ketone Bodies; D020155:3-Hydroxybutyric Acid