The first observational study of recreational athletes with T1D during a meaningful athletic competition and a non-competitive exercise... Show moreThe first observational study of recreational athletes with T1D during a meaningful athletic competition and a non-competitive exercise session was conducted. Non-invasive wearable devices and surveys are used to identify the presence or absence of competition stress during physical activity and to estimate physical activity intensity. An elevated glycemic trend on the day of an athletic competition is a frequent complaint among people with T1D and this increase was consistently observed in our study population. The elevation in glycemia is impacted by the individual behavior related to diabetes management and this behavioral change is impacted by the individual’s duration of diabetes and other demographic traits. A physical activity-intensity dependent model of glucose-insulin dynamics was developed for a type 1 diabetes simulator as a basis for the development of multivariable artificial pancreas systems. Several potential model structures were compared to assess the influence of model terms related to endogenous glucose production, glucose utilization, and glucose transfer. The model including all three terms accurately describes the relation of plasma insulin and physical activity intensity upon glucose production and glucose utilization to generate the appropriate glucose response for each physical activity condition ranging from low to maximal intensity efforts. All artificial pancreas performance metrics have been determined based upon physician-defined metrics for success. An online survey was conducted to assess individual goals for diabetes management, and for many individuals, the ability to achieve personalized metrics is unnecessary as their goals match the general metrics. As individual targets may be set by the individual or their doctor, the ability to achieve those are still of interest. A framework to target the individual management goals with the multivariable artificial pancreas system is developed which increased the percentage of time spent in each individual target range in simulations. Show less
