Methods, devices, and systems for physiological parameter analysis
Methods, devices, and systems may use a kinetic model to determine physiological parameters related to the kinetics of red blood cell glycation, elimination, and generation. Such physiological parameters can be used, for example, to determine a more reliable calculated HbA1c. In another example, a method may comprise: receiving a plurality of glucose levels over a time period; receiving a glycated hemoglobin (HbA1c) level corresponding to an end of the time period; determining at least one physiological parameter selected from the group consisting of: a red blood cell glycation rate constant (k gly ), a red blood cell generation rate constant (k gen ), a red blood cell elimination constant (k age ), and an apparent glycation constant (K), based on (1) the plurality of glucose levels and (2) the HbA1c level; and adjusting a glucose level target based on the at least one physiological parameter.
1. A system for determining at least one glucose level target comprising:
an analyte sensor configured to measure a glucose level in a bodily fluid of a subject; and
a monitoring device comprising:
one or more processors; and
a memory operatively coupled to the one or more processors storing instructions which, when executed by the one or more processors, causes the one or more processors to:
receive a first plurality of glucose levels in the bodily fluid over a first plurality of time periods (t i =t 1 . . . t z ) from the analyte sensor, where i=1 for a first time period of the plurality of time periods and i=z for a last time period of the plurality of time periods;
receive a first glycated hemoglobin (HbA1c) level for the subject corresponding to an end of the last time period of the first plurality of time periods;
determine, based on (1) the first plurality of glucose levels and (2) the first HbA1c level, an apparent glycation constant (K) using Equation A:
EA =[ G ]/( K −1 +[ G ]) Equation A
where EA is the first HbA1c and [G] is an average glucose level over the first plurality of time periods based on the first plurality of glucose levels,
adjust at least one glucose level target based on the determined apparent glycation constant (K), wherein the at least one glucose level target is selected from the group consisting of a personalized upper glucose limit (GU) based on Equation B and a personalized-target glucose average (GT) based on Equation C:
GU=AU /( K (1− AU )) Equation B
where AU is an accepted normal HbA1c upper limit,
GT=AT /( K (1 −AT )) Equation C
where AT is a target HbA1c level; and
a delivery system configured to receive the at least one glucose level target and treat the subject based on the at least one glucose level target, wherein treating the subject comprises administering and/or adjusting based on the at least one glucose level target: an insulin dosage, a glycation-medication dosage, or a combination thereof.
2. The system of claim 1 , wherein the personalized upper glucose limit equals 0.087/K±7%.
3. The system of claim 1 further comprising:
a display, wherein the instructions which, when executed by the one or more processors, causes the one or more processors to further: display the at least one glucose level target on the display.
4. The system of claim 3 , wherein the instructions which, when executed by the one or more processors, causes the one or more processors to further:
receive a second plurality of glucose levels in the bodily fluid over a second plurality of time periods after the first plurality of time periods from the analyte sensor; and
display an alarm when a glucose level from the second plurality of glucose levels is outside the at least one glucose level target on the display.
5. The system of claim 1 , wherein the instructions, when executed, cause the one or more processors to:
determine the insulin dosage based on the at least one glucose level target; and
transmit the insulin dosage to an insulin pump.
6. A method for determining at least one glucose level target comprising:
receiving a first plurality of glucose levels for a subject over a first plurality of time periods (t i =t 1 . . . t z ), where i=1 for a first time period of the plurality of time periods and i=z for a last time period of the plurality of time periods;
receiving a first glycated hemoglobin (HbA1c) level for the subject corresponding to an end of the last time period (t z ) of the first plurality of time periods;
determining, based on (1) the first plurality of glucose levels and (2) the first HbA1c level, an apparent glycation constant (K) using Equation A:
EA =[ G ]/( K −1 +[ G ]) Equation A
where EA is the first HbA1c and [G] is an average glucose level over the first plurality of time periods based on the first plurality of glucose levels;
adjusting at least one glucose level target based on the determined apparent glycation constant (K), wherein the at least one glucose level target is selected from the group consisting of a personalized upper glucose limit (GU) based on Equation B and a personalized-target glucose average (GT) based on Equation C:
GU=AU /( K (1− AU )) Equation B
where AU is an accepted normal HbA1c upper limit,
GT=AT /( K (1− AT )) Equation C
where AT is a target HbA1c level; and
treating the subject based on the at least one glucose level target, wherein treating the subject comprises administering and/or adjusting based on the at least one glucose level target: an insulin dosage, a glycation-medication dosage, an exercise regime, a meal intake, or a combination thereof.
7. The method of claim 6 , wherein the personalized upper glucose limit equals 0.087/K±7%.
8. The method of claim 6 , wherein the first plurality of glucose levels are measured in a bodily fluid selected from the group consisting of: blood, dermal fluid, interstitial fluid, or a combination thereof.
9. The method of claim 6 further comprising:
displaying the at least one glucose level target.
10. The method of claim 6 further comprising:
receiving a glucose level of the subject after adjusting the at least one glucose level target; and
displaying an alarm when the glucose level of the subject after adjusting the at least one glucose level target is outside the at least one glucose level target.
11. A system for determining at least one glucose level target comprising:
an analyte sensor configured to measure a glucose level in a bodily fluid of a subject; and
a monitoring device comprising:
one or more processors; and
a memory operatively coupled to the one or more processors storing instructions which, when executed by the one or more processors, causes the one or more processors to:
receive a first plurality of glucose levels in the bodily fluid over a first plurality of time periods from the analyte sensor;
receive a first glycated hemoglobin (HbA1c) level for the subject corresponding to an end of a last time period of the first plurality of time periods;
determine, based on (1) the first plurality of glucose levels and (2) the first HbA1c level, a red blood cell glycation rate constant (k gly ) using Equation A:
H
b
A
1
c
Z
=
(
k
gly
[
G
z
]
k
age
+
k
gly
[
G
z
]
)
(
1
-
e
-
(
k
g
l
y
[
G
z
]
+
k
a
g
e
)
t
z
)
+
∑
i
=
z
z
-
1
[
(
k
gly
[
G
i
]
k
age
+
k
gly
[
G
i
]
)
(
1
-
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
i
)
∏
j
=
i
+
1
z
e
-
(
k
g
l
y
[
G
j
]
+
k
a
g
e
)
t
j
]
Equation
A
where k age , is a red blood cell elimination constant and is an estimated value in Equation A, is the first HbA1c level, where [G z ] is an average glucose level over the last time period of the first plurality of time periods, where [G i ] is an average glucose level over a corresponding time period of the first plurality of time periods, where [G j ] is an average glucose level over a corresponding time period of the first plurality of time periods, where t i is a length of time interval of each time period in the first plurality of time periods;
adjust at least one glucose level target based on the determined red blood cell glycation rate constant (k gly ), wherein the at least one glucose level target is a personalized lower glucose limit (GL) based on Equation B:
GL =(LGL* k gly ref )/ k gly sub Equation B
where k gly ref is the k gly for a normal person, k gly sub is the subject's k gly and where LGL is an accepted normal lower glucose limit; and
a delivery system configured to receive the at least one glucose level target and treat the subject based on the at least one glucose level target, wherein treating the subject comprises administering and/or adjusting based on the at least one glucose level target: an insulin dosage, a glycation-medication dosage, or a combination thereof.
12. The system of claim 11 , wherein the personalized lower glucose limit equals 3.35×10 −4 /k gly ±7%.
13. The system of claim 11 , wherein the instructions which, when executed by the one or more processors, causes the one or more processors to further:
receive a second plurality of glucose levels for a second plurality of time periods after the first plurality of time periods; and
determine a calculated glycated hemoglobin (cHbA1c=HbA1c zz ) level corresponding to an end of a last time period of the second time period using Equations C:
HbA
1
c
zz
=
(
k
gly
[
G
zz
]
k
age
+
k
gly
[
G
zz
]
)
(
1
-
e
-
(
k
g
l
y
[
G
Z
Z
]
+
k
a
g
e
)
t
zz
)
+
∑
i
=
z
zz
-
1
[
(
k
gly
[
G
i
]
k
age
+
k
gly
[
G
i
]
)
(
1
-
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
i
)
∏
j
=
i
+
1
zz
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
j
]
+
HbA
1
c
0
∏
j
=
z
zz
e
-
(
k
g
l
y
[
G
j
]
+
k
a
g
e
)
t
j
Equation
C
where HbA1c 0 is the first HbA1c level, where [G zz ] is an average glucose level over the last time period of the second plurality of time periods, where [G i ] is an average glucose level over a corresponding time period of the second plurality of time periods, where [G j ] is an average glucose level over a corresponding time period of the second plurality of time periods, where t i is a length of time interval of each time period in the second plurality of time periods.
14. The system of claim 11 , wherein the instructions which, when executed by the one or more processors, causes the one or more processors to further:
receive a second plurality of glucose levels for a second plurality of time periods after the first plurality of time periods;
receive a second HbA1c level for an end of a last time period of the second plurality of time periods;
determine an updated k age using the determined k gly and using Equation C:
HbA
1
c
zz
=
(
k
gly
[
G
zz
]
k
age
+
k
gly
[
G
zz
]
)
(
1
-
e
-
(
k
g
l
y
[
G
Z
Z
]
+
k
a
g
e
)
t
zz
)
+
∑
i
=
z
zz
-
1
[
(
k
gly
[
G
i
]
k
age
+
k
gly
[
G
i
]
)
(
1
-
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
i
)
∏
j
=
i
+
1
zz
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
j
]
+
HbA
1
c
0
∏
j
=
z
zz
e
-
(
k
g
l
y
[
G
j
]
+
k
a
g
e
)
t
j
Equation
C
where HbA1c zz is the second HbA1c level, where HbA1c 0 is the first HbA1c level, where [G zz ] is an average glucose level over the last time period of the second plurality of time periods, where [G i ] is an average glucose level over a corresponding time period of the second plurality of time periods, where [G j ] is an average glucose level over a corresponding time period of the second plurality of time periods, where ta is a length of time interval of each time period in the second plurality of time periods; and
identify a presence of an abnormal or diseased physiological condition and/or an indicator of doping based on a comparison of the at least one first physiological parameter and the at least one second physiological parameter.
15. A method for determining at least one glucose level target comprising:
receiving a first plurality of glucose levels for a subject over a first plurality of time periods;
receiving a first glycated hemoglobin (HbA1c) level for the subject corresponding to an end of a last time period of the first plurality of time periods;
determining, based on (1) the first plurality of glucose levels and (2) the first HbA1c level, a red blood cell glycation rate constant (k gly ) using Equation A:
H
b
A
1
c
Z
=
(
k
gly
[
G
z
]
k
age
+
k
gly
[
G
z
]
)
(
1
-
e
-
(
k
g
l
y
[
G
z
]
+
k
a
g
e
)
t
z
)
+
∑
i
=
z
z
-
1
[
(
k
gly
[
G
i
]
k
age
+
k
gly
[
G
i
]
)
(
1
-
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
i
)
∏
j
=
i
+
1
z
e
-
(
k
g
l
y
[
G
j
]
+
k
a
g
e
)
t
j
]
Equation
A
where k age is a red blood cell elimination constant and is an estimated value in Equation A, HbA1c z is the first HbA1c level, where [G z ] is an average glucose level over the last time period of the first plurality of time periods, where [G i ] is an average glucose level over a corresponding time period of the first plurality of time periods, where [G j ] is an average glucose level over a corresponding time period of the first plurality of time periods, where t i is a length of time interval of each time period in the first plurality of time periods;
adjusting at least one glucose level target based on the red blood cell glycation rate constant (k gly ), wherein the at least one glucose level target is a personalized lower glucose limit (GL) based on Equation B:
GL =(LGL* k gly ref )/ k gly sub Equation 9
where k gly ref is the k gly for a normal person, k gly sub is the subject's k gly and where LGL is an accepted normal lower glucose limit; and
treating the subject based on the at least one glucose level target, wherein treating the subject comprises administering and/or adjusting based on the at least one glucose level target: an insulin dosage, a glycation-medication dosage, an exercise regime, a meal intake, or a combination thereof.
16. The method of claim 15 further comprising:
receiving a second plurality of glucose levels for a second plurality of time periods after the first plurality of time periods; and
determining a calculated glycated hemoglobin (cHbA1c=HbA1c zz ) level corresponding to an end of a last time period of the second time period using Equations C:
HbA
1
c
zz
=
(
k
gly
[
G
zz
]
k
age
+
k
gly
[
G
zz
]
)
(
1
-
e
-
(
k
g
l
y
[
G
Z
Z
]
+
k
a
g
e
)
t
zz
)
+
∑
i
=
z
zz
-
1
[
(
k
gly
[
G
i
]
k
age
+
k
gly
[
G
i
]
)
(
1
-
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
i
)
∏
j
=
i
+
1
zz
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
j
]
+
HbA
1
c
0
∏
j
=
z
zz
e
-
(
k
g
l
y
[
G
j
]
+
k
a
g
e
)
t
j
Equation
C
where HbA1c 0 is the first HbA1c level, where [G zz ] is an average glucose level over the last time period of the second plurality of time periods, where [G i ] is an average glucose level over a corresponding time period of the second plurality of time periods, where [G i ] is an average glucose level over a corresponding time period of the second plurality of time periods, where t i is a length of time interval of each time period in the second plurality of time periods.
17. The method of claim 15 further comprising:
receiving a second plurality of glucose levels for a second plurality of time periods after the first plurality of time periods;
receiving a second HbA1c level for an end of a last time period of the second plurality of time periods;
calculating an updated k age using the determined k gly and using Equation C:
HbA
1
c
zz
=
(
k
gly
[
G
zz
]
k
age
+
k
gly
[
G
zz
]
)
(
1
-
e
-
(
k
g
l
y
[
G
Z
Z
]
+
k
a
g
e
)
t
zz
)
+
∑
i
=
z
zz
-
1
[
(
k
gly
[
G
i
]
k
age
+
k
gly
[
G
i
]
)
(
1
-
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
i
)
∏
j
=
i
+
1
zz
e
-
(
k
g
l
y
[
G
i
]
+
k
a
g
e
)
t
j
]
+
HbA
1
c
0
∏
j
=
z
zz
e
-
(
k
g
l
y
[
G
j
]
+
k
a
g
e
)
t
j
Equation
C
where HbA1c zz is the second HbA1c level, where HbA1c 0 is the first HbA1c level, where [G zz ] is an average glucose level over the last time period of the second plurality of time periods, where [G i ] is an average glucose level over a corresponding time period of the second plurality of time periods, where [G j ] is an average glucose level over a corresponding time period of the second plurality of time periods, where t i is a length of time interval of each time period in the second plurality of time periods; and
identifying a presence of an abnormal or diseased physiological condition and/or an indicator of doping based on a comparison of the at least one first physiological parameter and the at least one second physiological parameter.
18. The method of claim 15 , wherein the personalized lower glucose limit equals 3.35×10 −4 /k gly ±7%.