Machine learning-based glucose prediction with use of continuous glucose and physical activity monitoring data: The Maastricht Study

• Published in: PloS one Vol. 16; no. 6; p. e0253125
• Main Authors: van Doorn, William P. T. M., Foreman, Yuri D., Schaper, Nicolaas C., Savelberg, Hans H. C. M., Koster, Annemarie, van der Kallen, Carla J. H., Wesselius, Anke, Schram, Miranda T., Henry, Ronald M. A., Dagnelie, Pieter C., de Galan, Bastiaan E., Bekers, Otto, Stehouwer, Coen D. A., Meex, Steven J. R., Brouwers, Martijn C. G. J.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.06.2021; Public Library of Science (PLoS)
• Subjects: Accelerometers; Adult; Aged; Algorithms; Analysis; Biology and Life Sciences; Blood Glucose - analysis; Blood sugar monitoring; Cardiovascular disease; Case-Control Studies; Computer and Information Sciences; Control algorithms; Correlation coefficient; Correlation coefficients; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1 - metabolism; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 1 - therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - pathology; Diabetes Mellitus, Type 2 - therapy; Diabetes therapy; Dosage; Endocrinology; Exercise; Female; Glucose; Glucose metabolism; Glucose monitoring; Health aspects; Humans; Hyperglycemia; Hypoglycemia; Insulin; Internal medicine; Intervals; Laboratories; Learning algorithms; Machine Learning; Male; Medical research; Medicine; Medicine and Health Sciences; Metabolic disorders; Metabolism; Methods; Middle Aged; Monitoring; Monitoring, Ambulatory - methods; Neural Networks, Computer; Performance evaluation; Physical activity; Physical Sciences; Population studies; Prediabetic State - metabolism; Prediabetic State - pathology; Prediabetic State - therapy; Prediction models; Prognosis; Prospective Studies; Public health; Research and Analysis Methods; Root-mean-square errors; Sensors; Stability; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0253125

Closed-loop insulin delivery systems, which integrate continuous glucose monitoring (CGM) and algorithms that continuously guide insulin dosing, have been shown to improve glycaemic control. The ability to predict future glucose values can further optimize such devices. In this study, we used machine learning to train models in predicting future glucose levels based on prior CGM and accelerometry data. We used data from The Maastricht Study, an observational population-based cohort that comprises individuals with normal glucose metabolism, prediabetes, or type 2 diabetes. We included individuals who underwent >48h of CGM (n = 851), most of whom (n = 540) simultaneously wore an accelerometer to assess physical activity. A random subset of individuals was used to train models in predicting glucose levels at 15- and 60-minute intervals based on either CGM data or both CGM and accelerometer data. In the remaining individuals, model performance was evaluated with root-mean-square error (RMSE), Spearman's correlation coefficient (rho) and surveillance error grid. For a proof-of-concept translation, CGM-based prediction models were optimized and validated with the use of data from individuals with type 1 diabetes (OhioT1DM Dataset, n = 6). Models trained with CGM data were able to accurately predict glucose values at 15 (RMSE: 0.19mmol/L; rho: 0.96) and 60 minutes (RMSE: 0.59mmol/L, rho: 0.72). Model performance was comparable in individuals with type 2 diabetes. Incorporation of accelerometer data only slightly improved prediction. The error grid results indicated that model predictions were clinically safe (15 min: >99%, 60 min >98%). Our prediction models translated well to individuals with type 1 diabetes, which is reflected by high accuracy (RMSEs for 15 and 60 minutes of 0.43 and 1.73 mmol/L, respectively) and clinical safety (15 min: >99%, 60 min: >91%). Machine learning-based models are able to accurately and safely predict glucose values at 15- and 60-minute intervals based on CGM data only. Future research should further optimize the models for implementation in closed-loop insulin delivery systems.