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

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. Approx. 1 million diabetics in the Netherlands
/ biomedical engineering PAGE 26/25/2014

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. 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. 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. 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. 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. 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. 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
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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. Physiology-based model
/ biomedical engineering PAGE 116/25/2014
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12. Physiology-based model
/ biomedical engineering PAGE 126/25/2014
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13. Simulation
/ biomedical engineering PAGE 1325-6-2014

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. m-Health
• Practice safely
• Independently
• At any time and any place
/ biomedical engineering PAGE 156/25/2014

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. e/DES smartphone app
/ biomedical engineering PAGE 176/25/2014

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. 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. 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