Symposium ‘The Soft Machine – the future of high tech in health care’

The Eindhoven Diabetes Education Simulator (e/DES)Eindhoven - June 24, 2014

Natal van Riel

Eindhoven University of Technology, the NetherlandsDept. of Biomedical Engineering

n.a.w.v.riel@tue.nl

@nvanriel

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Approx. 1 million diabetics in the Netherlands

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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

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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

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Glucose control on a daily basis

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• Glycated hemoglobin (HbA1c) is the averaged effect of changing plasma glucose concentration

• Glucose changes every minute based on a complex set of factors

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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

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Norris 2002 Diabetes Care 25:1159–1171, 2002

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Improve efficacy of DSME

• More efficient Diabetes Self-Management Education• More patients can benefit • At reduced costs

• e-Health and m-Health

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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

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EducateEngage

EncourageEmpower

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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

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food

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–

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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, drugsinsulin therapy

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Physiology-based model

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time

Plasma glucose concentration

Gpl

Plasma insulin concentration

time

Ipl

Interstitial insulin concentration

time

Irem

Glucose mass in gut

time

MGgu

t

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Physiology-based model

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Simulation

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Understanding

• Understanding the factors contributing to glucose control and diabetes management

• Importance of blood glucose monitoring

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continuous glucose monitor (CGM)

hyperglycemia

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m-Health

• Practice safely

• Independently • At any time and any place

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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

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www.sugarpal.nl

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e/DES smartphone app

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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)

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0 60 120 180 240 300 360

4

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time [min]

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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

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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

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