Using Stochastic modelling to identify unusual continuous glucose monitor measurements and behaviour, in newborn infants

Matthew Signal, Aaron Le Compte, Deborah Harris, Phil J. Weston, Jane Harding, J. G. Chase, Jane Alsweiler, Geoff Chase, Jane Harding, Deborah Harris, Ben Thompson, Trecia Wouldes, Judith Ansell, Nicola Anstice, Jo Arthur, Coila Bevan, Kate Bluett, Ellen Campbell, Arijit Chakraborty, Tineke CrawfordKaren Frost, Greg Gamble, Rob Jacobs, Kelly Jones, Aaron Le Compte, Sapphire Martin, Gill Matheson, Grace McKnight, Christina McQuoid, Janine Paynter, Jenny Rogers, Matthew Signal, Heather Stewart, Anna Timmings, Rebecca Young, Sandy Yu

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Abstract

Background: Abnormal blood glucose (BG) concentrations have been associated with increased morbidity and mortality in both critically ill adults and infants. Furthermore, hypoglycaemia and glycaemic variability have both been independently linked to mortality in these patients. Continuous Glucose Monitoring (CGM) devices have the potential to improve detection and diagnosis of these glycaemic abnormalities. However, sensor noise is a trade-off of the high measurement rate and must be managed effectively if CGMs are going to be used to monitor, diagnose and potentially help treat glycaemic abnormalities.Aim: To develop a tool that will aid clinicians in identifying unusual CGM behaviour and highlight CGM data that potentially need to be interpreted with care.Methods: CGM data and BG measurements from 50 infants at risk of hypoglycaemia were used. Unusual CGM measurements were classified using a stochastic model based on the kernel density method and historical CGM measurements from the cohort. CGM traces were colour coded with very unusual measurements coloured red, highlighting areas to be interpreted with care. A 5-fold validation of the model was Monte Carlo simulated 25 times to ensure an adequate model fit.Results: The stochastic model was generated using ~67,000 CGM measurements, spread across the glycaemic range ~2-10 mmol/L. A 5-fold validation showed a good model fit: the model 80% confidence interval (CI) captured 83% of clinical CGM data, the model 90% CI captured 91% of clinical CGM data, and the model 99% CI captured 99% of clinical CGM data. Three patient examples show the stochastic classification method in use with 1) A stable, low variability patient which shows no unusual CGM measurements, 2) A patient with a very sudden, short hypoglycaemic event (classified as unusual), and, 3) A patient with very high, potentially un-physiological, glycaemic variability after day 3 of monitoring (classified as very unusual).Conclusions: This study has produced a stochastic model and classification method capable of highlighting unusual CGM behaviour. This method has the potential to classify important glycaemic events (e.g. hypoglycaemia) as true clinical events or sensor noise, and to help identify possible sensor degradation. Colour coded CGM traces convey the information quickly and efficiently, while remaining computationally light enough to be used retrospectively or in real-time.

Original languageEnglish
Article number45
Pages (from-to)1-12
Number of pages12
JournalBioMedical Engineering OnLine
Volume11
DOIs
Publication statusPublished - 6 Aug 2012

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    Signal, M., Le Compte, A., Harris, D., Weston, P. J., Harding, J., Chase, J. G., Alsweiler, J., Chase, G., Harding, J., Harris, D., Thompson, B., Wouldes, T., Ansell, J., Anstice, N., Arthur, J., Bevan, C., Bluett, K., Campbell, E., Chakraborty, A., ... Yu, S. (2012). Using Stochastic modelling to identify unusual continuous glucose monitor measurements and behaviour, in newborn infants. BioMedical Engineering OnLine, 11, 1-12. [45]. https://doi.org/10.1186/1475-925X-11-45