Analyzing Basal Insulin Dosing as Perturbations in Compositional Glycemic Profiles for Time in Range in Type 1...

Basal insulin dosing is essential in multiple daily injection therapy for Type 1 Diabetes, yet adjustments remain challenging. This study models basal insulin changes as perturbations in Compositional Data Analysis (CoDa) to assess their impact on glycemic control. In silico simulations were conducted with a virtual cohort of 49 adults over 180 days, considering controlled meal intake and insulin therapy. Basal insulin adjustments (±5%, ±10%, ±15%) were analyzed using CoDa to assess the effects on time in range (TIR: 70-180 mg/dL) and the glycemic distribution. A multivariate linear regression model predicted outcomes based on basal adjustments. The CoDa framework quantified the impact of basal insulin perturbations on TIR, as shown by multivariate models with high R² values (up to 0.85). Furthermore, we observed a strong correlation between a CoDa-derived log-ratio coordinate and an established glycemic risk index (r = -0.9141). A visualization panel integrates: (i) arithmetic mean TIR (clinically common), (ii) geometric mean (aligned with CoDa) and (iii) glycemic profile distributions (to describe daily variability). This improvement aids physicians in adjusting therapy.Clinical relevance- This study introduces a decision support system leveraging CoDa analysis to predict glycemic outcomes based on basal insulin adjustments. By modeling basal perturbations, the approach enables disease profiling and personalized treatment strategies, reducing the trial-and-error process in basal insulin titration and optimizing T1D management.