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Design and In Silico Evaluation of an Exercise Decision Support System Using Digital Twin Models.
Gavin Young1,2, Robert Dodier2, Joseph El Youssef3
1School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Journal of Diabetes Science and Technology
|February 23, 2024
Summary
An exercise-aware decision support system (exDSS) improved glucose control for type 1 diabetes (T1D) patients during exercise. The system provided personalized recommendations, significantly increasing time in target glucose range and reducing hypoglycemia.
Area of Science:
- Endocrinology
- Biomedical Engineering
- Exercise Physiology
Background:
- Managing blood glucose levels during physical activity is complex for individuals with type 1 diabetes (T1D).
- Existing decision support tools lack personalization and do not differentiate between aerobic and resistance exercise.
- Safe glucose management (70-180 mg/dL) requires considering multiple exercise-related factors.
Purpose of the Study:
- To develop and evaluate an exercise-aware decision support system (exDSS) for T1D management during exercise.
- To provide personalized glucose control recommendations using digital twin technology.
- To help individuals with T1D maintain safe glucose levels and prevent hypoglycemia during and after physical activity.
Main Methods:
- The exDSS was evaluated using real-world data from a large study involving aerobic and resistance exercise.
- Simulations incorporated participant data including heart rate, insulin, and meal intake.
- Glucose responses were modeled during and after 30-minute exercise sessions for 247 participants (676 aerobic, 631 resistance).
Main Results:
- exDSS significantly improved mean time in glucose range for both aerobic (92.3%) and resistance (87.3%) exercise compared to no intervention and clinical guidelines.
- The system substantially reduced time spent in hypoglycemia for both exercise types (aerobic: 5.1%, resistance: 6.6%) compared to no intervention.
- Glucose outcomes with exDSS were comparable to following clinical guidelines, with significant improvements over no intervention.
Conclusions:
- The exDSS tool demonstrated significant improvements in glucose management during and after exercise for individuals with T1D.
- These findings support the clinical evaluation of exDSS for enhancing exercise safety and efficacy in T1D management.
- Personalized, exercise-aware decision support holds promise for improving glucose control in T1D during physical activity.
