Managing Exercise-Related Glycemic Events in Type 1 Diabetes: Development and Validation of Predictive Models for a Practical Decision Support Tool
Notice bibliographique
Résumé
Background: Exercise is an important aspect of diabetes self-management. Patients with type 1 diabetes frequently struggle with exercise-induced hyperglycemia and hypoglycemia, decreasing their willingness to exercise. Objective: We aim to build accurate and easy-to-deploy models to forecast exercise-induced glycemic events in real-world settings. Methods: We analyzed free-living data from the Type 1 Diabetes Exercise Initiative study, where adults with type 1 diabetes wore a continuous glucose monitor (CGM) while performing video-guided exercises (30-minute exercises at least 6 times over 4 weeks), along with concurrent detailed phenotyping of their insulin program and diet. We built models to predict glycemic events (blood glucose ≤54 mg/dL, ≤70 mg/dL, ≥200 mg/dL, and ≥250 mg/dL) during and 1 hour post exercise with variables from 4 data modalities, such as demographic and clinical (eg, glycated hemoglobin; CGM (blood glucose value and their summary statistics); carbohydrate intake and insulin administration; and exercise type, duration, and intensity. We used repeated stratified nested cross-validation for model selection and performance estimation. We evaluated the relative contribution of the 4 input data modalities for predicting glycemic events, which informs the cost and benefit for including them in the decision support tool for risk prediction. We also evaluated other important aspects related to model translation into decision support tools, including model calibration and sensitivity to noisy inputs. Results: Our models were built based on 1901 exercise episodes for 329 participants. The median age for the participants was 34 (IQR 26-48) years. Of the participants, 74.8% (246/329) are female and 94.5% (311/329) are White. A total of 182/329 (55.3%) participants used a closed-loop insulin delivery system, while the rest used a pump without a closed-loop system. Models incorporating information from all 4 data modalities showed excellent predictive performance with cross-validated area under the receiver operating curves (AUROCs) ranging from mean 0.880 (SD 0.057) to mean 0.992 (SD 0.001) for different glycemic events. Models built with CGM data alone have statistically indistinguishable performance compared to models using all data modalities, indicating the other 3 data modalities do not add additional information with respect to predicting exercise-related glycemic events. The models based solely on CGM data also showed outstanding calibration (Brier score ≤0.08) and resilience to noisy input. Conclusions: We successfully constructed models to forecast exercise-induced glycemic events using only CGM data as input with excellent predictive performance, calibration, and robustness. In addition, these models are based on automatically captured CGM data, thus easy to deploy and maintain and incurring minimal user burden, enabling model translation into a decision support tool.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».