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The Eindhoven Diabetes Education Simulator (e/DES)

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Symposium ‘The Soft Machine – the future of high tech in health care’
June 24, 2014
Eindhoven University of Technology, the Netherlands

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The Eindhoven Diabetes Education Simulator (e/DES)

  1. 1. Symposium ‘The Soft Machine – the future of high tech in health care’ Eindhoven - June 24, 2014 Natal van Riel Eindhoven University of Technology, the Netherlands Dept. of Biomedical Engineering n.a.w.v.riel@tue.nl @nvanriel
  2. 2. Approx. 1 million diabetics in the Netherlands / biomedical engineering PAGE 26/25/2014
  3. 3. Complications of unmanaged diabetes • Poorly controlled diabetes is the leading cause of adult blindness, end-stage renal disease and non-traumatic lower- limb amputations • Diabetes also doubles the risk of stroke and heart disease / biomedical engineering PAGE 36/25/2014
  4. 4. Glucose control is everything • Glycated hemoglobin (HbA1c) • Biomarker for average plasma glucose concentration over prolonged periods of time • Higher amounts of glycated hemoglobin: • indicate poorer control of blood glucose levels • associated with cardiovascular disease, nephropathy, and retinopathy • Reducing HbA1c in diabetic patients may improve outcomes / biomedical engineering PAGE 46/25/2014
  5. 5. Glucose control on a daily basis / biomedical engineering PAGE 56/25/2014 • Glycated hemoglobin (HbA1c) is the averaged effect of changing plasma glucose concentration • Glucose changes every minute based on a complex set of factors
  6. 6. Diabetes Self-Management Education (DSME) • DSME teaches life style intervention • Diabetes education focuses on the Self-Care Behaviors that are essential for improved health status and greater quality of life • Healthy Eating • Being Active • Monitoring • Taking Medication • Problem Solving • Healthy Coping • Reducing Risk / biomedical engineering PAGE 66/25/2014 Norris 2002 Diabetes Care 25:1159–1171, 2002
  7. 7. Improve efficacy of DSME • More efficient Diabetes Self-Management Education • More patients can benefit • At reduced costs • e-Health and m-Health / biomedical engineering PAGE 76/25/2014
  8. 8. e/DES • The Eindhoven Diabetes Education Simulator • A safe (in silico) environment to explore the complex human glucoregulatory system • Improve patient’s understanding of the disease • Better understanding is better disease self-management / biomedical engineering PAGE 86/25/2014 Educate Engage Encourage Empower
  9. 9. e/DES • Glucose-insulin interaction dynamics over a period of 24 hours • Healthy, Type 1 Diabetes and Type 2 Diabetes • Insulin (type and dosage) • Real-life, daily conditions • diet / food intake • exercise • mood / biomedical engineering PAGE 96/25/2014 food insulin – stress + physical activity – + blood glucose level
  10. 10. The human glucoregulatory system • Impaired regulatory system: diabetes mellitus • type 1: insulin deficiency • type 2: insulin resistance peripheral tissues glucose insulinpancreas insulin therapy lifestyle modification, drugs insulin therapy / biomedical engineering PAGE 106/25/2014
  11. 11. Physiology-based model / biomedical engineering PAGE 116/25/2014 time Plasma glucose concentration G pl Plasma insulin concentration time I pl Interstitial insulin concentration time I rem Glucose mass in gut time MG gut
  12. 12. Physiology-based model / biomedical engineering PAGE 126/25/2014     gut 2 pl meal 1 1 1 meal gutplmealmeal gut ))(exp( , d d GG G GGG G Mkm Dtktkm MmtDm t M                                              plpl plplplpl1 ren pl pl rem 5 it pl pl pl pl liv 0 itnon gut b2 pl b gut rem 4 plpl 3 livliv plrenremplitplitnongutgutremplliv pl ,0 , ,, d d th ththb G M Mb bM G G G G bb G GGif GGifGG Mν c g GK G Ikg GK G G GK gg M Mν f km Mν f g IkGGkgg GgIGgGgMgIGg t G                         plpl 12 rem pl 11 liv la 5.0 la 2 5.0 b 1 5.0la sc2 9 sc1 2 sc2 sc1 10 sa sc1 sc2 b 9sa pl d8 plpl i 7plpl 6 1pnc plrempllivlalasc2sc1saplpnc pl d d d d d d d ,, d d b hh I hh II I I I I I bb II IIki Iki baUt U ttMv tth i UkUc t U Uku t U U Mv k i t G ktGG k GGki IiIitUiUUiGi t I                                     rem 13 it plpl 12 rempl remitplpl rem d d Iki IIkii IiIi t I b   
  13. 13. Simulation / biomedical engineering PAGE 1325-6-2014
  14. 14. Understanding • Understanding the factors contributing to glucose control and diabetes management • Importance of blood glucose monitoring / biomedical engineering PAGE 146/25/2014 continuous glucose monitor (CGM) hyperglycemia
  15. 15. m-Health • Practice safely • Independently • At any time and any place / biomedical engineering PAGE 156/25/2014
  16. 16. Diabetes apps Most existing apps: • Focus on logging of blood glucose instead of self-management • Do not differentiate between T1DM and T2DM • Do not give individualized feedback • Are not evidence-based / biomedical engineering PAGE 166/25/2014 www.sugarpal.nl
  17. 17. e/DES smartphone app / biomedical engineering PAGE 176/25/2014
  18. 18. We are developing e/DES • An evidence-based educational simulator • Different daily-life conditions • Distinguishes different groups of diabetics (model parameters determined for patient groups) • Can be individualized (subject-specific parameters) / biomedical engineering PAGE 1825-6-2014
  19. 19. 0 60 120 180 240 300 360 4 5 6 7 8 time [min] G pl [mmol/L] e/DES is under construction • Limitations of existing data • clinical studies often use a glucose drink (75g) – Oral Glucose Tolerance Test • after an overnight fast • excluding subjects using exogenous insulin • Collecting data • A library with different types of food (currently 35 different food products/meals included) • Full day • Healthy subjects, T1DM, T2DM • Develop the user interface (‘game’) • Test efficacy for diabetes education / biomedical engineering PAGE 1925-6-2014
  20. 20. Acknowledgements • Anne Maas MMC, TU/e • Yvonne Rozendaal TU/e, BMT • Ruben Deneer TU/e, BMT • Harm Haak MMC • Carola van Pul MMC • Peter Hilbers TU/e, BMT • Ward Cottaar TU/e, SMPE/e / biomedical engineering PAGE 206/25/2014

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