Application of Machine Learning to Assess Interindividual Variability in Rapid-Acting Insulin Responses After Subcutaneous Injection in People With Type 1 Diabetes
Jazyk angličtina Země Kanada Médium print-electronic
Typ dokumentu časopisecké články
PubMed
35568422
DOI
10.1016/j.jcjd.2021.09.002
PII: S1499-2671(21)00246-X
Knihovny.cz E-zdroje
- Klíčová slova
- apprentissage automatique, diabète de type 1, insulin pharmacokinetics, interpersonal variability, machine learning, pharmacocinétique de l’insuline, type 1 diabetes, variabilité interpersonnelle,
- MeSH
- diabetes mellitus 1. typu * komplikace MeSH
- fibrinogen terapeutické užití MeSH
- hypoglykemika farmakologie terapeutické užití MeSH
- inhibitor aktivátoru plazminogenu 1 terapeutické užití MeSH
- injekce subkutánní MeSH
- inzulin terapeutické užití MeSH
- inzulinová rezistence * MeSH
- krátkodobě působící inzuliny terapeutické užití MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- postprandiální období MeSH
- strojové učení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- fibrinogen MeSH
- hypoglykemika MeSH
- inhibitor aktivátoru plazminogenu 1 MeSH
- inzulin MeSH
- krátkodobě působící inzuliny MeSH
- krevní glukóza MeSH
OBJECTIVES: Circulating insulin concentrations mediate vascular-inflammatory and prothrombotic factors. However, it is unknown whether interindividual differences in circulating insulin levels are associated with different inflammatory and prothrombotic profiles in type 1 diabetes (T1D). We applied an unsupervised machine-learning approach to determine whether interindividual differences in rapid-acting insulin levels associate with parameters of vascular health in patients with T1D. METHODS: We re-analyzed baseline pretreatment meal-tolerance test data from 2 randomized controlled trials in which 32 patients consumed a mixed-macronutrient meal and self-administered a single dose of rapid-acting insulin individualized by carbohydrate counting. Postprandial serum insulin, tumour necrosis factor (TNF)-alpha, plasma fibrinogen, human tissue factor (HTF) activity and plasminogen activator inhibitor-1 (PAI-1) were measured. Two-step clustering categorized individuals based on shared clinical characteristics. For analyses, insulin pharmacokinetic summary statistics were normalized, allowing standardized intraindividual comparisons. RESULTS: Despite standardization of insulin dose, individuals exhibited marked interpersonal variability in peak insulin concentrations (48.63%), time to peak (64.95%) and insulin incremental area under the curve (60.34%). Two clusters were computed: cluster 1 (n=14), representing increased serum insulin concentrations; and cluster 2 (n=18), representing reduced serum insulin concentrations (cluster 1: 389.50±177.10 pmol/L/IU h-1; cluster 2: 164.29±41.91 pmol/L/IU h-1; p<0.001). Cluster 2 was characterized by increased levels of fibrinogen, PAI-1, TNF-alpha and HTF activity; higher glycated hemoglobin; increased body mass index; lower estimated glucose disposal rate (increased insulin resistance); older age; and longer diabetes duration (p<0.05 for all analyses). CONCLUSIONS: Reduced serum insulin concentrations are associated with insulin resistance and a prothrombotic milieu in individuals with T1D, and therefore may be a marker of adverse vascular outcome.
Department of Internal Medicine 2nd Faculty of Medicine Charles University Prague Czech Republic
Diabetes Research Centre Leicester General Hospital University of Leicester Leicester United Kingdom
Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds United Kingdom
School of Food Science and Nutrition University of Leeds Leeds United Kingdom
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