U.S. patent application number 12/242799 was filed with the patent office on 2009-06-25 for dynamic display of glucose information.
This patent application is currently assigned to Abbott Diabetes Care, Inc.. Invention is credited to Timothy Christian Dunn, Gary Hayter.
Application Number | 20090164239 12/242799 |
Document ID | / |
Family ID | 42073838 |
Filed Date | 2009-06-25 |
United States Patent
Application |
20090164239 |
Kind Code |
A1 |
Hayter; Gary ; et
al. |
June 25, 2009 |
Dynamic Display Of Glucose Information
Abstract
Method and system including displaying a first representation of
a medication treatment parameter profile, displaying a first
representation of a physiological profile associated with the
medication treatment parameter profile, detecting a modification to
a segment of the medication treatment parameter profile, displaying
a modified representation of the medication treatment parameter
profile and the physiological profile based on the detected
modification to the segment of the medication treatment parameter
profile, modifying an attribute of the first representation of the
medication treatment parameter profile, and modifying an attribute
of the first representation of the physiological profile are
provided.
Inventors: |
Hayter; Gary; (Oakland,
CA) ; Dunn; Timothy Christian; (San Francisco,
CA) |
Correspondence
Address: |
JACKSON & CO., LLP
6114 LA SALLE AVENUE, #507
OAKLAND
CA
94611-2802
US
|
Assignee: |
Abbott Diabetes Care, Inc.
Alameda
CA
|
Family ID: |
42073838 |
Appl. No.: |
12/242799 |
Filed: |
September 30, 2008 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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12024082 |
Jan 31, 2008 |
|
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12242799 |
|
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61015185 |
Dec 19, 2007 |
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Current U.S.
Class: |
705/2 ;
715/771 |
Current CPC
Class: |
A61M 2205/502 20130101;
A61M 2205/52 20130101; H04W 4/80 20180201; A61M 2205/50 20130101;
A61M 5/142 20130101; A61M 2230/005 20130101; A61M 2230/201
20130101; G16H 20/60 20180101; G16H 50/50 20180101; G06F 3/04847
20130101; A61M 2205/3584 20130101; G16H 20/17 20180101; G16H 40/63
20180101; G06K 9/0055 20130101; A61M 5/1723 20130101; A61M
2005/14208 20130101; A61M 2205/18 20130101; A61M 2205/582
20130101 |
Class at
Publication: |
705/2 ;
715/771 |
International
Class: |
G06Q 50/00 20060101
G06Q050/00; G06F 3/048 20060101 G06F003/048 |
Claims
1. A method, comprising: displaying a first representation of a
medication treatment parameter profile; displaying a first
representation of a physiological profile associated with the
medication treatment parameter profile; detecting a modification to
a segment of the medication treatment parameter profile; displaying
a modified representation of the medication treatment parameter
profile and the physiological profile based on the detected
modification to the segment of the medication treatment parameter
profile; modifying an attribute of the first representation of the
medication treatment parameter profile; and modifying an attribute
of the first representation of the physiological profile.
2. The method of claim 1 wherein modifying the attribute of the
first representation of the medication treatment parameter profile
includes modifying a visual attribute without modifying the
underlying value associated with the profile.
3. The method of claim 2 wherein the visual attribute includes one
or more of a color representation, a line representation, visual
contrast representation.
4. The method of claim 1 wherein the modified representation and
the first representation of the medication treatment parameter
profile includes at least an overlapping displayed segment.
5. The method of claim 1 wherein the modified representation and
the first representation of the physiological profile are
substantially non-overlapping.
6. The method of claim 1 wherein the medication treatment parameter
profile includes one or more of a basal rate profile, an insulin
sensitivity profile, an insulin to carbohydrate ratio, an meal
event, a bolus event, or an insulin type profile.
7. The method of claim 1 wherein the physiological profile includes
a glucose level profile, an oxygen level profile, or a blood
pressure level profile.
8. The method of claim 1 wherein modifying the attribute of the
first representation of the physiological profile includes
modifying a visual attribute without modifying the underlying value
associated with the profile.
9. The method of claim 1 wherein when the attribute of the first
representation of the medication treatment parameter profile is
modified, the displayed position of the first representation of the
medication treatment parameter profile is not changed.
10. The method of claim 1 wherein when the attribute of the first
representation of the physiological profile is modified, the
displayed position of the first representation of the physiological
profile is not changed.
11. The method of claim 1 wherein the displayed first
representation of the medication treatment parameter profile and
the physiological profile respectively includes one or more of a
line graph, a bar graph, a 2-dimensional graph, or a 3-dimensional
graph.
13. An apparatus, comprising: a display unit; one or more
processing units coupled to the display unit; and a memory for
storing instructions which, when executed by the one or more
processing units, causes the one or more processing units to
display a first representation of a medication treatment parameter
profile, display a first representation of a physiological profile
associated with the medication treatment parameter profile, detect
a modification to a segment of the medication treatment parameter
profile, display a modified representation of the medication
treatment parameter profile and the physiological profile based on
the detected modification to the segment of the medication
treatment parameter profile, modify an attribute of the first
representation of the medication treatment parameter profile, and
modify an attribute of the first representation of the
physiological profile.
14. The apparatus of claim 13 wherein the memory for storing
instructions which, when executed by the one or more processing
units, causes the one or more processing units to modify a visual
attribute associated with the physiological profile without
modifying the underlying value associated with the first
representation of the physiological profile, and to modify a visual
attribute associated with the first representation of the
medication treatment parameter profile without modifying the
underlying value associated with the medication treatment parameter
profile.
15. The apparatus of claim 14 wherein the visual attribute includes
one or more of a color representation, a line representation,
visual contrast representation.
16. The apparatus of claim 13 wherein the modified representation
and the first representation of the medication treatment parameter
profile includes at least an overlapping displayed segment.
17. The apparatus of claim 13 wherein the modified representation
and the first representation of the physiological profile are
substantially non-overlapping.
18. The apparatus of claim 13 wherein the medication treatment
parameter profile includes one or more of a basal rate profile, an
insulin sensitivity profile, an insulin to carbohydrate ratio, an
meal event, a bolus event, or an insulin type profile.
19. The apparatus of claim 13 wherein the physiological profile
includes a glucose level profile, an oxygen level profile, or a
blood pressure level profile.
20. The apparatus of claim 13 wherein when the attribute of the
first representation of the medication treatment parameter profile
is modified, the displayed position of the first representation of
the medication treatment parameter profile is not changed, and
further, wherein when the attribute of the first representation of
the physiological profile is modified, the displayed position of
the first representation of the physiological profile is not
changed.
Description
RELATED APPLICATIONS
[0001] The present application is a continuation in part of pending
application Ser. No. 12/024,082 filed Jan. 31, 2008 entitled
"Method and Apparatus for Providing Treatment Profile Management"
which claims priority to provisional application No. 61/015,185
filed Dec. 19, 2007, entitled "Medical Devices and Methods"
assigned to the Assignee of the present application, Abbott
Diabetes Care, Inc., of Alameda, Calif., the disclosure of each of
which are incorporated herein by reference for all purposes.
BACKGROUND
[0002] Analyte, e.g., glucose, monitoring systems including
continuous and discrete monitoring systems generally include a
small, lightweight battery powered and microprocessor controlled
system which is configured to detect signals proportional to the
corresponding measured glucose levels using an electrometer, and RF
signals to transmit the collected data. One aspect of certain
analyte monitoring systems include a transcutaneous or subcutaneous
analyte sensor configuration which is, for example, partially
mounted on the skin of a subject whose analyte level is to be
monitored. The sensor cell may use a two or three-electrode (work,
reference and counter electrodes) configuration driven by a
controlled potential (potentiostat) analog circuit connected
through a contact system.
[0003] With increasing use of pump therapy for Type 1 diabetic
patients, young and old alike, the importance of controlling the
infusion device such as external infusion pumps is evident. Indeed,
presently available external infusion devices typically include an
input mechanism such as buttons through which the patient may
program and control the infusion device. Such infusion devices also
typically include a user interface such as a display which is
configured to display information relevant to the patient's
infusion progress, status of the various components of the infusion
device, as well as other programmable information such as patient
specific basal profiles.
[0004] In the course of using the analyte monitoring system and the
infusion device, data associated with a patient's physiological
condition such as monitored analyte levels, insulin dosage
information, for example, may be stored and processed. As the
complexity of these systems and devices increase, so do the amount
of data and information associated with the system/device.
SUMMARY
[0005] In accordance with the various embodiments of the present
disclosure, there are provided method system including displaying a
first representation of a medication treatment parameter profile,
displaying a first representation of a physiological profile
associated with the medication treatment parameter profile,
detecting a modification to a segment of the medication treatment
parameter profile, displaying a modified representation of the
medication treatment parameter profile and the physiological
profile based on the detected modification to the segment of the
medication treatment parameter profile, modifying an attribute of
the first representation of the medication treatment parameter
profile, and modifying an attribute of the first representation of
the physiological profile are provided.
[0006] These and other objects, features and advantages of the
present disclosure will become more fully apparent from the
following detailed description of the embodiments, the appended
claims and the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] FIG. 1 is a block diagram illustrating a therapy management
system for practicing one embodiment of the present disclosure;
[0008] FIG. 2 is a block diagram of a fluid delivery device of FIG.
1 in one embodiment of the present disclosure;
[0009] FIG. 3 is a flow chart illustrating therapy management
procedure based on real time monitored analyte levels in accordance
with one embodiment of the present disclosure;
[0010] FIG. 4 is a flowchart illustrating analyte trend information
updating procedure based on real time monitored analyte levels in
accordance with one embodiment of the present disclosure;
[0011] FIG. 5 is a flowchart illustrating modified therapy
management procedure based on real time monitored analyte levels in
accordance with one embodiment of the present disclosure;
[0012] FIG. 6 is a flowchart illustrating contextual based dosage
determination in accordance with one embodiment of the present
disclosure;
[0013] FIG. 7 is a flowchart illustrating contextual based dosage
determination in accordance with one embodiment of the present
disclosure;
[0014] FIG. 8 illustrates dynamic medication level determination in
accordance with one embodiment of the present disclosure;
[0015] FIG. 9 illustrates dynamic medication level determination in
accordance with another embodiment of the present disclosure;
[0016] FIG. 10 illustrates metric analysis in accordance with one
embodiment of the present disclosure;
[0017] FIG. 11 illustrates metric analysis in accordance with
another embodiment of the present disclosure;
[0018] FIG. 12 is illustrates metric analysis in accordance with
yet another embodiment of the present disclosure;
[0019] FIG. 13 illustrates metric analysis in accordance with a
further embodiment of the present disclosure;
[0020] FIG. 14 illustrates condition detection or notification
analysis in accordance with one embodiment of the present
disclosure;
[0021] FIG. 15 illustrates condition detection or notification
analysis in accordance with another embodiment of the present
disclosure;
[0022] FIG. 16 illustrates therapy parameter analysis in accordance
with one embodiment of the present disclosure;
[0023] FIG. 17 is a flowchart illustrating dynamic physiological
profile simulation routine in accordance with one embodiment of the
present disclosure;
[0024] FIG. 18 is a flowchart illustrating dynamic physiological
profile simulation routine in accordance with another embodiment of
the present disclosure;
[0025] FIG. 19 is a flowchart illustrating dynamic physiological
profile simulation routine in accordance with still another
embodiment of the present disclosure;
[0026] FIG. 20 is a flowchart illustrating visual medication
delivery profile programming in accordance with one embodiment of
the present disclosure;
[0027] FIG. 21 is a flowchart illustrating visual medication
delivery profile programming in accordance with another embodiment
of the present disclosure;
[0028] FIG. 22 is an exemplary screen display of a medication
delivery profile;
[0029] FIG. 23 is an exemplary screen display illustrating vertical
modification of the medication delivery profile;
[0030] FIG. 24 is an exemplary screen display illustrating
horizontal modification of the medication delivery profile;
[0031] FIG. 25 is an exemplary screen display illustrating addition
of a transition in the medication delivery profile;
[0032] FIG. 26 is an exemplary screen display illustrating deletion
of a transition in the medication delivery profile;
[0033] FIG. 27 is an exemplary display illustrating an initial
glucose level and a corresponding parameter value as a function of
time in one embodiment;
[0034] FIG. 28 is an exemplary display illustrating response to the
manipulation of the initial parameter value of FIG. 27 and
corresponding modification to the displayed glucose profile as a
function of time in one embodiment; and
[0035] FIG. 29 is an exemplary display illustrating response to the
manipulation of the initial parameter value of FIG. 27 and
corresponding modification to the displayed glucose profile as a
function of time in another embodiment.
DETAILED DESCRIPTION
[0036] FIG. 1 is a block diagram illustrating an insulin therapy
management system for practicing one embodiment of the present
disclosure. Referring to FIG. 1, the therapy management system 100
includes an analyte monitoring system 110 operatively coupled to an
fluid delivery device 120, which may be in turn, operatively
coupled to a remote terminal 140. As shown the Figure, the analyte
monitoring system 110 is, in one embodiment, coupled to the patient
130 so as to monitor or measure the analyte levels of the patient.
Moreover, the fluid delivery device 120 is coupled to the patient
using, for example, and infusion set and tubing connected to a
cannula (not shown) that is placed transcutaneously through the
skin of the patient so as to infuse medication such as, for
example, insulin, to the patient.
[0037] Referring to FIG. 1, in one embodiment the analyte
monitoring system 110 may include one or more analyte sensors
subcutaneously positioned such that at least a portion of the
analyte sensors are maintained in fluid contact with the patient's
analytes. The analyte sensors may include, but not limited to short
term subcutaneous analyte sensors or transdermal analyte sensors,
for example, which are configured to detect analyte levels of a
patient over a predetermined time period, and after which, a
replacement of the sensors is necessary.
[0038] The one or more analyte sensors of the analyte monitoring
system 110 is coupled to a respective one or more of a data
transmitter unit which is configured to receive one or more signals
from the respective analyte sensors corresponding to the detected
analyte levels of the patient, and to transmit the information
corresponding to the detected analyte levels to a receiver device,
and/or fluid delivery device 120. That is, over a communication
link, the transmitter units may be configured to transmit data
associated with the detected analyte levels periodically, and/or
intermittently and repeatedly to one or more other devices such as
the insulin delivery device and/or the remote terminal 140 for
further data processing and analysis.
[0039] The transmitter units of the analyte monitoring system 110
may in one embodiment configured to transmit the analyte related
data substantially in real time to the fluid delivery device 120
and/or the remote terminal 140 after receiving it from the
corresponding analyte sensors such that the analyte level such as
glucose level of the patient 130 may be monitored in real time. In
one aspect, the analyte levels of the patient may be obtained using
one or more of a discrete blood glucose testing devices such as
blood glucose meters, or a continuous analyte monitoring systems
such as continuous glucose monitoring systems.
[0040] Additional analytes that may be monitored, determined or
detected the analyte monitoring system 110 include, for example,
acetyl choline, amylase, bilirubin, cholesterol, chorionic
gonadotropin, creatine kinase (e.g., CK-MB), creatine, DNA,
fructosamine, glucose, glutamine, growth hormones, hormones,
ketones, lactate, peroxide, prostate-specific antigen, prothrombin,
RNA, thyroid stimulating hormone, and troponin. The concentration
of drugs, such as, for example, antibiotics (e.g., gentamicin,
vancomycin, and the like), digitoxin, digoxin, drugs of abuse,
theophylline, and warfarin, may also be determined.
[0041] Moreover, within the scope of the present disclosure, the
transmitter units of the analyte monitoring system 110 may be
configured to directly communicate with one or more of the remote
terminal 140 or the fluid delivery device 120. Furthermore, within
the scope of the present disclosure, additional devices may be
provided for communication in the analyte monitoring system 110
including additional receiver/data processing unit, remote
terminals, such as a physician's terminal and/or a bedside terminal
in a hospital environment, for example. In addition, within the
scope of the present disclosure, one or more of the analyte
monitoring system 110, the fluid delivery device 120 and the remote
terminal 140 may be configured to communicate over a wireless data
communication link such as, but not limited to RF communication
link, Bluetooth communication link, infrared communication link, or
any other type of suitable wireless communication connection
between two or more electronic devices, which may further be
unidirectional or bi-directional communication between the two or
more devices. Alternatively, the data communication link may
include wired cable connection such as, for example, but not
limited to RS232 connection, USB connection, or serial cable
connection.
[0042] Referring back to FIG. 1, in one embodiment, the analyte
monitoring system 100 includes a strip port configured to receive a
test strip for capillary blood glucose testing. In one aspect, the
glucose level measured using the test strip may in addition, be
configured to provide periodic calibration of the analyte sensors
of the analyte monitoring system 110 to assure and improve the
accuracy of the analyte levels detected by the analyte sensors.
[0043] Exemplary analyte systems that may be employed are described
in, for example, U.S. Pat. Nos. 6,134,461, 6,175,752, 6,121,611,
6,560,471, 6,746,582, and elsewhere, the disclosures of which are
herein incorporated by reference.
[0044] Referring again to FIG. 1, the fluid delivery device 120 may
include in one embodiment, but not limited to, an external infusion
device such as an external insulin infusion pump, an implantable
pump, a pen-type insulin injector device, an on-body patch pump, an
inhalable infusion device for nasal insulin delivery, or any other
type of suitable delivery system. In addition, the remote terminal
140 in one embodiment may include for example, a desktop computer
terminal, a data communication enabled kiosk, a laptop computer, a
handheld computing device such as a personal digital assistant
(PDAs), or a data communication enabled mobile telephone.
[0045] FIG. 2 is a block diagram of an insulin delivery device of
FIG. 1 in one embodiment of the present disclosure. Referring to
FIG. 2, the fluid delivery device 120 in one embodiment includes a
processor 210 operatively coupled to a memory unit 240, an input
unit 220, a display unit 230, an output unit 260, and a fluid
delivery unit 250. In one embodiment, the processor 210 includes a
microprocessor that is configured to and capable of controlling the
functions of the fluid delivery device 120 by controlling and/or
accessing each of the various components of the fluid delivery
device 120. In one embodiment, multiple processors may be provided
as safety measure and to provide redundancy in case of a single
processor failure. Moreover, processing capabilities may be shared
between multiple processor units within the insulin delivery device
120 such that pump functions and/or control maybe performed faster
and more accurately.
[0046] Referring back to FIG. 2, the input unit 220 operatively
coupled to the processor 210 may include a jog dial, a key pad
buttons, a touch pad screen, or any other suitable input mechanism
for providing input commands to the fluid delivery device 120. More
specifically, in case of a jog dial input device, or a touch pad
screen, for example, the patient or user of the fluid delivery
device 120 will manipulate the respective jog dial or touch pad in
conjunction with the display unit 230 which performs as both a data
input and output units. The display unit 230 may include a touch
sensitive screen, an LCD screen, or any other types of suitable
display unit for the fluid delivery device 120 that is configured
to display alphanumeric data as well as pictorial information such
as icons associated with one or more predefined states of the fluid
delivery device 120, or graphical representation of data such as
trend charts and graphs associated with the insulin infusion rates,
trend data of monitored glucose levels over a period of time, or
textual notification to the patients.
[0047] Referring to FIG. 2, the output unit 260 operatively coupled
to the processor 210 may include audible alarm including one or
more tones and/or preprogrammed or programmable tunes or audio
clips, or vibratory alert features having one or more
pre-programmed or programmable vibratory alert levels. In one
embodiment, the vibratory alert may also assist in priming the
infusion tubing to minimize the potential for air or other
undesirable material in the infusion tubing. Also shown in FIG. 2
is the fluid delivery unit 250 which is operatively coupled to the
processor 210 and configured to deliver the insulin doses or
amounts to the patient from the insulin reservoir or any other
types of suitable containment for insulin to be delivered (not
shown) in the fluid delivery device 120 via an infusion set coupled
to a subcutaneously positioned cannula under the skin of the
patient.
[0048] Referring yet again to FIG. 2, the memory unit 240 may
include one or more of a random access memory (RAM), read only
memory (ROM), or any other types of data storage units that is
configured to store data as well as program instructions for access
by the processor 210 and execution to control the fluid delivery
device 120 and/or to perform data processing based on data received
from the analyte monitoring system 110, the remote terminal 140,
the patient 130 or any other data input source.
[0049] FIG. 3 is a flow chart illustrating insulin therapy
management procedure based on real time monitored analyte levels in
accordance with one embodiment of the present disclosure. Referring
to FIG. 3, in one embodiment of the present disclosure, a
predetermined number of consecutive glucose levels are received or
detected over a predetermined or defined time period. For example,
in one embodiment, referring to FIG. 1, the monitored glucose
levels of a patient is substantially continuously received or
detected substantially in real time for a predetermined time
period. In one embodiment, the predefined time period may include
one or more time periods, the data within which may provide a
therapeutically meaningful basis for associated data analysis.
[0050] That is, the predefined time period of the real time
monitored glucose data in one embodiment may include one or more
time periods sufficient to provide glucose trend information or
sufficient to provide analysis of glucose levels to adjust insulin
therapy on an on-going, and substantially real time basis. For
example, the predefined time period in one embodiment may include
one or more of a 15 minute time period, a 30 minute time period, a
45 minute time period, a one hour time period, a two hour time
period and a 6 hour time period. While exemplary predefined time
periods are provided herein, within the scope of the present
disclosure, any suitable predefined time period may be employed as
may be sufficient to be used for glucose trend determination and/or
therapy related determinations (such as, for example, modification
of existing basal profiles, calculation of temporary basal profile,
or determination of a bolus amount).
[0051] Referring back to FIG. 3, the consecutive glucose levels
received over the predefined time period in one embodiment may not
be entirely consecutive due to, for example, data transmission
errors and/or one or more of potential failure modes associated
with data transmission or processing. As such, in one embodiment of
the present disclosure, there is provided a predetermined margin of
error for the received real time glucose data such that, a given
number of data points associated with glucose levels which are
erroneous or alternatively, not received from the glucose sensor,
may be ignored or discarded.
[0052] Referring back to FIG. 3, upon receiving the predetermined
number of glucose levels over a predefined time period, the glucose
trend information based on the received glucose levels is updated.
For example, in one embodiment, the glucose trend information
estimating the rate of change of the glucose levels may be
determined, and based upon which the projecting the level of
glucose may be calculated. Indeed, in one embodiment, the glucose
trend information may be configured to provide extrapolated glucose
level information associated with the glucose level movement based
on the real time glucose data received from the glucose sensor.
That is, in one embodiment, the real time glucose levels monitored
are used to determine the rate at which the glucose levels is
either increasing or decreasing (or remaining substantially stable
at a given level). Based on such information and over a
predetermined time period, a glucose projected information may be
determined.
[0053] Referring again to FIG. 3, the therapy related parameters
associated with the monitored real time glucose levels is updated.
That is, in one embodiment, one or more insulin therapy related
parameters of an insulin pump such as including, but not limited
to, insulin on board information associated with the fluid delivery
device 120 (FIG. 1), insulin sensitivity level of the patient 130
(FIG. 1), insulin to carbohydrate ratio, and insulin absorption
rate. Thereafter, in one embodiment, one or more modifications to
the current therapy profile are determined. That is, in one
embodiment of the present disclosure, one or more current basal
profiles, calculated bolus levels, temporary basal profiles, and/or
any other suitable pre-programmed insulin delivery profiles stored
in the fluid delivery device 120 (FIG. 1) for example, are
retrieved and analyzed based on one or more of the received real
time glucose levels, the updated glucose trend information, and the
updated therapy related parameters.
[0054] Referring back to FIG. 3, after determining one or more
modifications to the therapy profiles, the modified one or more
therapy profiles is generated and output to the patient 130 (FIG.
1) so that the patient 130 may select, store and/or ignore the one
or more modified therapy profiles based on one or more of the
monitored real time glucose values, updated glucose trend
information, and updated therapy related parameters.
[0055] For example, in one embodiment, the patient 130 may be
provided with a recommended temporary basal profile based on the
monitored real time glucose levels over a predetermined time period
as well as the current basal profile which is executed by the fluid
delivery device 120 (FIG. 1) to deliver a predetermined level of
insulin to the patient 130 (FIG. 1). Alternatively, the patient 130
in a further embodiment may be provided with one or more additional
recommended actions for selection as the patient sees suitable to
enhance the insulin therapy based on the real time monitored
glucose levels. For example, the patient may be provided with a
recommended correction bolus level based on the real time monitored
glucose levels and the current basal profile in conjunction with,
for example, the patient's insulin sensitivity and/or insulin on
board information.
[0056] In this manner, in one embodiment of the present disclosure,
based on real time monitored glucose levels, the patient may be
provided with an on-going, real time insulin therapy options and
modifications to the pre-programmed insulin delivery basal profiles
so as to improve upon the initially programmed therapy profiles
based on the monitored real time glucose data.
[0057] FIG. 4 is a flowchart illustrating analyte trend information
updating procedure based on real time monitored analyte levels in
accordance with one embodiment of the present disclosure. Referring
to FIG. 4, in one embodiment, real time data associated with
monitored analyte levels is received. Thereafter it is determined
whether the real time data has been received for a predetermined
time period. If it is determined that the real time data has not
been received for at least the predetermined time period, then the
routine continues to receive the real time data associated with the
monitored analyte levels such as glucose levels.
[0058] On the other hand, referring back to FIG. 4, if it is
determined that the real time data associated with the monitored
analyte levels has been received for the predetermined time period
(for example, as described above in conjunction with FIG. 3), then
the received real time data associated with the monitored analyte
levels is stored. Thereafter, analyte level trend information is
determined based on the received real time data associated with the
monitored analyte levels.
[0059] For example, in one embodiment, the real time data
associated with the monitored analyte levels is analyzed and an
extrapolation of the data based on the rate of change of the
monitored analyte levels is determined. That is, the real time data
associated with the monitored analyte levels is used to determined
the rate at which the monitored analyte level changed over the
predetermined time period, and accordingly, a trend information is
determined based on, for example, the determined rate at which the
monitored analyte level changed over the predetermined time
period.
[0060] In a further embodiment, the trend information based on the
real time data associated with the monitored analyte levels may be
dynamically modified and continuously updated based on the received
real time data associated with the monitored analyte levels for one
or more predetermined time periods. As such, in one embodiment, the
trend information may be configured to dynamically change and be
updated continuously based on the received real time data
associated with the monitored analyte levels.
[0061] FIG. 5 is a flowchart illustrating modified therapy
management procedure based on real time monitored analyte levels in
accordance with one embodiment of the present disclosure. Referring
to FIG. 5, in one embodiment, the current therapy parameters are
retrieved and, the retrieved current therapy parameters are
analyzed based on the received real time data associated with the
monitored analyte levels and/or updated analyte trend information.
For example, one or more preprogrammed basal profiles, correction
bolus, carbohydrate bolus, temporary basal and associated
parameters are retrieved and analyzed based on, for example, the
received real time data associated with the monitored analyte
levels and/or updated analyte trend information, and further,
factoring in the insulin sensitivity of the patient as well as
insulin on board information.
[0062] Referring to FIG. 5, based upon the analysis of the current
therapy parameters, one or more modified therapy profiles are
calculated. That is, based upon the real time glucose levels
monitored by the analyte monitoring system 110 (FIG. 1), a
modification or adjustment to the pre-programmed basal profiles of
the fluid delivery device 120 (FIG. 1) may be determined, and the
modified therapy profiles is output to the patient 130 (FIG. 1).
That is, the modification or adjustment to the pre-programmed basal
profiles may be provided to the patient for review and/or execution
to implement the recommended modification or adjustment to the
pre-programmed basal profiles.
[0063] In this manner, the patient may be provided with one or more
adjustments to the existing or current basal profiles or any other
pre-programmed therapy profiles based on continuously monitored
physiological levels of the patient such as analyte levels of the
patient. Indeed, in one embodiment of the present disclosure, using
continuously monitored glucose levels of the patient, modification
or adjustment to the pre-programmed basal profiles may be
calculated and provided to the patient for review and
implementation as desired by the patient. In this manner, for
example, a diabetic patient may improve the insulin therapy
management and control.
[0064] FIG. 6 is a flowchart illustrating contextual based dosage
determination in accordance with one embodiment of the present
disclosure. Referring to the Figure, one or more user input
parameters is received such as, for example, the amount of
carbohydrate to ingest, type of exercise to perform, current time
of day information, or any other appropriate information that may
potentially impact the determination of the suitable medication
level. Based on the one or more user input parameters, one or more
database is queried. In one embodiment, the database may be
provided in the analyte monitoring system 110. Alternatively or in
addition, the one or more database may be provided in the fluid
delivery device 120 and/or remote terminal 140.
[0065] Referring back to FIG. 6, the database query in one
embodiment may be configured to search or query for medication
dosage levels that are associated with similar parameters as the
received one or more user input parameters. Thereafter, the queried
result is generated and provided to the user which may be acted
upon by the user, for example, to administer the medication dosage
level based on the queried result. The user selection of the
administered medication dosage level is stored in the database with
the associated one or more user input parameters as well as the
time and date information of when the user has administered the
medication dosage level.
[0066] In this manner, in one embodiment, insulin dosages and
associated contextual information (e.g., user input parameters) may
be stored and tracked in one or more databases. For example, a
bolus amount for a diabetic patient may be determined in the manner
described above using historical information without performing a
mathematical calculation which takes into account of variables such
as sensitivity factors vary with time and/or user's physiological
conditions, and which may need to be estimated.
[0067] In particular, in one embodiment of the present disclosure,
insulin dependent users may determine their appropriate insulin
dosages by, for example, using historical dosage information as
well as associated physiological condition information. For
example, the historical data may be stored in one or more databases
to allow search or query based on one or more parameters such as
the user's physiological condition and other contextual information
associated with each prior bolus dosage calculated and
administered. In this manner, the user may be advised on the proper
amount of insulin under the particular circumstances, the user may
be provided with descriptive statistical information of insulin
dosages under the various conditions, and the overall system may be
configured to learn and customize the dosage determination for the
particular user over an extended time period.
[0068] For example, in one aspect, contextual information may be
stored with the insulin bolus value. The contextual data in one
aspect may include one or more of blood glucose concentration,
basal rate, type of insulin, exercise information, meal
information, carbohydrate content estimate, insulin on board
information, and any other parameters that may be used to determine
the suitable or appropriate medication dosage level. Some or all of
the contextual information may be provided by the user or may be
received from another device or devices in the overall therapy
management system such as receiving the basal rate information from
the fluid delivery device 120 (FIG. 1), or receiving the blood
glucose concentration from the analyte monitoring system 110 (FIG.
1).
[0069] By way of an example, a contextually determined medication
dosage level in one embodiment may be provided to the user along
with a suitable or appropriate notification or message to the user
that after a predetermined time period since the prior
administration of the medication dosage level, the blood glucose
level was still above a target level. That is, the queried result
providing the suitable medication dosage level based on user input
or other input parameters may be accompanied by other relevant
physiological condition information associated with the
administration of the prior medication dosage administration. In
this manner, when the user is provided with the contextually
determined medication dosage level, the user is further provided
with information associated with the effects of the determined
medication dosage level to the user's physiological condition (for
example, one hour after the administration of the particular
medication dosage level determined, the user's blood glucose level
changed by a given amount). Accordingly, the user may be better
able to adjust or modify, as desired or needed, the contextually
determined medication dosage level to the current physiological
conditions.
[0070] In this manner, in one embodiment, to determine and provide
the user with proper medication dosage levels, the present or
current context including the patient's current physiological
condition (such as current blood glucose level, current glucose
trend information, insulin on board information, the current basal
profile, and so on) is considered and the database is queried for
one or more medication dosage levels which correlate (for example,
within a predetermined range of closeness or similarity) to the one
or more current contextual information associated with the user's
physiological condition, among others.
[0071] Accordingly, in one embodiment, statistical determination of
the suitable medication dosage based on contextual information may
be determined using, one or more of mean dosage determination,
using a standard deviation or other appropriate statistical
analysis of the contextual information for medication dosages which
the user has administered in the past. Further, in one aspect, in
the case where no close match is found in the contextual query for
the desired medication dosage level, the medication dosage level
with the most similar contextual information may be used to
interpolate an estimated medication dosage level.
[0072] In still another aspect, the database query may be
configured to provide time based weighing of prior medication
dosage level determinations such that, for example, more recent
dosage level determination which similar contextual information may
be weighed heavier than aged dosage level determination under
similar conditions. For example, older or more aged bolus amounts
determined may be weighed less heavily than the more recent bolus
amounts. Also, over an extended period of time, in one aspect, the
older or aged bolus amounts may be aged out or weighed with a value
parameter that minimally impacts the current contextual based bolus
determination. In this manner, in one aspect, a highly personalized
and individualistic profile for medication dosage determination may
be developed and stored in the database with the corresponding
contextual information associated therewith.
[0073] FIG. 7 is a flowchart illustrating contextual based dosage
determination in accordance with one embodiment. Referring to FIG.
7, in one aspect, when the user input parameters are received at
step 710, the current infusion profile of the user's insulin pump
is determined at step 720. Thereafter, the database is queried
based on the input parameters and the current infusion profile at
step 730, and which results in one or more contextually determined
bolus amount associated with the input parameters and the current
infusion profile at step 740 that is provided to the user. The
determined bolus amount is then stored in the database with the
associated input parameters and the current infusion profile and
any other contextual information associated with the determined
bolus amount.
[0074] In this manner, in one aspect, in addition to the user
provided input parameters, other relevant contextual information
may be retrieved (for example, the current infusion profile such as
basal rate from the insulin pump, the current blood glucose level
and/or glucose trend information from the analyte monitoring
system, and the like) prior to the database query to determine the
suitable bolus amount.
[0075] As discussed above, optionally, the contextual information
including the user input parameters and other relevant information
may be queried to determine the suitable medication dosage level
based on one or more statistical analysis such as, for example, but
not limited to, descriptive statistics with the use of numerical
descriptors such as mean and standard deviation, or inferential
statistics including, for example, estimation or forecasting,
correlation of parameters, modeling of relationships between
parameters (for example, regression), as well as other modeling
approaches such as time series analysis (for example,
autoregressive modeling, integrated modeling and moving average
modeling), data mining, and probability.
[0076] By way of a further non-limiting example, when a diabetic
patient plans to ingest insulin of a particular type, the patient
enters contextual information such as that the patient has
moderately exercised and is planning to consume a meal with a
predetermined estimated carbohydrate content. The database in one
embodiment may be queried for insulin dosages determined under
similar circumstances in the past for the patient, and further,
statistical information associated with the determined insulin
dosage is provided to the user. In one aspect, the displayed
statistical information associated with the determined insulin
dosage may include, for example, an average amount of insulin
dosage, a standard deviation or a median amount and the 25.sup.th
and the 75.sup.th percentile values of the determined insulin
dosage.
[0077] The patient may consider the displayed statistical
information associated with the determined insulin dosage, and
determines the most suitable or desired insulin amount based on the
information received. When the patient programs the insulin pump to
administer the desired insulin amount (or otherwise administer the
desired insulin amount using other medication administration
procedures such as injection (using a pen-type injection device or
a syringe), intaking inhalable or ingestable insulin, and the like,
the administered dosage level is stored in the database along with
the associated contextual information and parameters.
[0078] In this manner, the database for use in the contextual based
query may be continuously updated with each administration of the
insulin dosage such that, each subsequent determination of
appropriate insulin dosage level may be determined with more
accuracy and is further customized to the physiological profile of
the particular patient. Additionally, the database queried may be
used for other purposes, such as, for example, but not limited to
tracking medication information, providing electronic history of
the patient related medical information, and the like. Further,
while the above example is provided in the context of determining
an insulin level determination, within the scope of the present
disclosure, other medication dosage may be determined based on the
contextual based database query approaches described herein.
[0079] In a further aspect, the contextual based medication dosage
query and determination may be used in conjunction with the
standard or available medication dosage determination (for example,
standard bolus calculation algorithms) as a supplement to provide
additional information or provide a double checking ability to
insure that the estimated or calculated bolus or medication dosage
level is appropriate for the particular patient under the
physiological condition at the time of the dosage level
determination.
[0080] Within the scope of the present disclosure, the processes
and routines described in conjunction with FIGS. 3-7 may be
performed by the analyte monitoring system 110 (FIG. 1) and/or the
fluid delivery device 120 (FIG. 1). Furthermore, the output of
information associated with the context based database query for
medication dosage determination may be displayed on a display unit
of the receiver of the analyte monitoring system 110 (FIG. 1), or
the infusion device display of the fluid delivery device 120 (FIG.
1), the display unit of the remote terminal 140 (FIG. 1), or any
other suitable output device that is configured to receive the
results of the database query associated with the medication dosage
level determination. Alternatively, one or more such information
may be output to the patient audibly as sound signal output.
[0081] In this manner, there are provided methods and system for
receiving one or more parameters associated with a user
physiological condition, querying a database based on the one or
more parameters associated with the user physiological condition,
generating a medication dosage amount based on the database query,
and outputting the medication dosage amount to the user.
[0082] Optionally, statistical analysis may be performed based on
the database query and factored into generating the medication
dosage amount for the user.
[0083] In other aspects, there are provided methods and system for
providing information associated with the direction and rate of
change of analyte (e.g., glucose) levels changes for determination
of, for example, bolus or basal rate change recommendations, for
comparing expected glucose level changes to actual real time
glucose level changes to update, for example, insulin sensitivity
factor in an ongoing basis, and for automatically confirming the
monitored glucose values within a preset time period (e.g., 30
minutes) after insulin therapy initiation to determine whether the
initiated therapy is having the intended therapeutic effect.
[0084] Indeed, in accordance with the various embodiments of the
present disclosure, the use of glucose trend information in insulin
delivery rate determinations provides for a more accurate insulin
dosing and may lead to a decrease in hypoglycemic events and
improved HbAlCs.
[0085] Accordingly, a method in one embodiment of the present
disclosure includes receiving data associated with monitored
analyte related levels for a predetermined time period
substantially in real time, retrieving one or more therapy profiles
associated with the monitored analyte related levels, generating
one or more modifications to the retrieved one or more therapy
profiles based on the data associated with the monitored analyte
related levels.
[0086] The method may further include displaying the generated one
or more modifications to the retrieved one or more therapy
profiles.
[0087] In one aspect, the generated one or more modifications to
the retrieved one or more therapy profiles may be displayed as one
or more of an alphanumeric output display, a graphical output
display, an icon display, a video output display, a color display
or an illumination display.
[0088] In a further aspect, the predetermined time period may
include one of a time period between 15 minutes and six hours.
[0089] The one or more therapy profiles in yet another aspect may
include a basal profile, a correction bolus, a temporary basal
profile, an insulin sensitivity, an insulin on board level, and an
insulin absorption rate.
[0090] In still another aspect, retrieving the one or more therapy
profiles associated with the monitored analyte related levels may
include retrieving a current analyte rate of change
information.
[0091] In yet still another aspect, generating the one or more
modifications to the retrieved one or more therapy profiles may
include determining a modified analyte rate of change information
based on the received data associated with monitored analyte
related levels.
[0092] Moreover, the method may further include generating an
output alert based on the modified analyte rate of change
information.
[0093] Still, the method may also include determining an analyte
level projection information based on the modified analyte rate of
change information.
[0094] A system for providing diabetes management in accordance
with another embodiment of the present disclosure includes an
interface unit, one or more processors coupled to the interface
unit, a memory for storing instructions which, when executed by the
one or more processors, causes the one or more processors to
receive data associated with monitored analyte related levels for a
predetermined time period substantially in real time, retrieve one
or more therapy profiles associated with the monitored analyte
related levels, and generate one or more modifications to the
retrieved one or more therapy profiles based on the data associated
with the monitored analyte related levels.
[0095] The interface unit may include an input unit and an output
unit, the input unit configured to receive the one or more analyte
related data, and the output unit configured to output the one or
more of the generated modifications to he retrieved one or more
therapy profiles.
[0096] The interface unit and the one or more processors in a
further embodiment may be operatively coupled to one or more of a
housing of an infusion device or a housing of an analyte monitoring
system.
[0097] The infusion device may include one of an external insulin
pump, an implantable insulin pump, an on-body patch pump, a
pen-type injection device, an inhalable insulin delivery system,
and a transdermal insulin delivery system.
[0098] The memory in a further aspect me ye configured for storing
instructions which, when executed by the one or more processors,
causes the one or more processors to display the generated one or
more modifications to the retrieved one or more therapy
profiles.
[0099] Further, the memory may be configured for storing
instructions which, when executed by the one or more processors,
causes the one or more processors to display the generated one or
more modifications to the retrieved one or more therapy profiles as
one or more of an alphanumeric output display, a graphical output
display, an icon display, a video output display, a color display
or an illumination display.
[0100] In one aspect, the predetermined time period may include one
of a time period between 15 minutes and six hours.
[0101] The one or more therapy profiles may include a basal
profile, a correction bolus, a temporary basal profile, an insulin
sensitivity, an insulin on board level, and an insulin absorption
rate.
[0102] In another aspect, the memory may be further configured for
storing instructions which, when executed by the one or more
processors, causes the one or more processors to retrieve a current
analyte rate of change information.
[0103] In still another aspect, the memory may be further
configured for storing instructions which, when executed by the one
or more processors, causes the one or more processors to determine
a modified analyte rate of change information based on the received
data associated with monitored analyte related levels.
[0104] Additionally, in yet still another aspect, the memory may be
further configured for storing instructions which, when executed by
the one or more processors, causes the one or more processors to
generate an output alert based on the modified analyte rate of
change information.
[0105] Further, the memory may be further configured for storing
instructions which, when executed by the one or more processors,
causes the one or more processors to determine an analyte level
projection information based on the modified analyte rate of change
information.
[0106] A system for providing diabetes management in accordance
with yet another embodiment of the present disclosure includes an
analyte monitoring system configured to monitor analyte related
levels of a patient substantially in real time, a medication
delivery unit operatively for wirelessly receiving data associated
with the monitored analyte level of the patient substantially in
real time from the analyte monitoring system, a data processing
unit operatively coupled to the one or more of the analyte
monitoring system or the medication delivery unit, the data
processing unit configured to retrieve one or more therapy profiles
associated with the monitored analyte related levels, and generate
one or more modifications to the retrieved one or more therapy
profiles based on the data associated with the monitored analyte
related levels.
[0107] In one aspect, the analyte monitoring system may be
configured to wirelessly communicate with one or more of the
medication delivery unit or the remote terminal such as a computer
terminal (PC) or a server terminal over a radio frequency (RF)
communication link, a Bluetooth communication link, an Infrared
communication link, or a wireless local area network (WLAN).
[0108] FIG. 8 illustrates dynamic medication level determination in
accordance with one embodiment of the present disclosure. In one
aspect, the analyte monitoring system 110 (FIG. 1) may be
configured to receive and store available and/or valid analyte
sensor data including continuous glucose level measurement data
(8100) which are indicative of the user or patient's current and
past glucose levels. When the patient or the user is anticipating a
meal event or any other event which may likely impact the glucose
level, the patient or the user may activate or call a bolus
determination function (8110) using, for example, a user interface
input/output unit of the analyte monitoring system 110 (FIG. 1) or
that of the fluid delivery unit 120 (FIG. 1).
[0109] Referring to FIG. 8, in one aspect the patient enters the
anticipated carbohydrate intake amount, or other form of meal
selection or one or more other parameters as desired for bolus
determination function. With the retrieved glucose level
information (8010) it is not necessary for the patient or the user
to manually enter the glucose level information. In alternate
embodiment, the glucose level information may be manually entered
by the patient or the user. Optionally, blood glucose level may be
provided to the system based on a finger stick test using a blood
glucose meter device.
[0110] In one aspect, the patient or the user may enter anticipated
carbohydrate information based on a pre-programmed food library
stored, for example, in the analyte monitoring system 110 or the
fluid delivery device 120 (FIG. 1). Such stored information may
include, for example, serving size and associated carbohydrate
value for different types of food, or other relevant food
information related to the physiology of food update (such as fat
content, for example) which may be preloaded into the analyte
monitoring system 110 or the fluid delivery device 120, or
alternatively, personalized by the patient or the user using custom
settings and stored in the memory device of the analyte monitoring
system 110 or the fluid delivery device 120.
[0111] Referring again to FIG. 8, the bolus level determination is
performed in one embodiment (8110) upon patient or user activation
of a user input button or component, or alternatively, in an
automatic manner upon user entry of the meal information (8120). In
one aspect, the bolus determination may include glucose level
information from the analyte monitoring system 110 (FIG. 1) and the
meal information received from the patient or the user, in
conjunction with one or more of other relevant parameters described
below, to propose an insulin dosage or level information to attain
an anticipated blood glucose level or the future or target glucose
profile (8190). In one aspect, the future or target glucose profile
may be preset or alternatively, may be adjusted or modified based,
for example, on the patient or user's physiological condition or
profile. I none aspect, the future or target glucose profile may
include a single glucose target value, or a range of desired
glucose levels. Other parameters may be included in the target or
future glucose profile such as, for example, maximum peak glucose
value, minimum glucose value, time to achieve within 5% of the
target glucose value, or other dynamic parameters. In a further
aspect, the future or target glucose profile may be specified as a
cost function to minimize, such as, the area defined by the
accumulation in time of deviations from a target value and control
sensitivity parameters, such as overshoot and undershoot. Within
the scope of the present disclosure, other glucose target profiles
and/or cost functions may be contemplated.
[0112] Referring back to FIG. 8, the determination of required
insulin infusion to achieve the target glucose profile (8130) may
include other parameters which may be predefined or patient
adjustable, and/or automatically adjusted using, for example, an
adaptive learning algorithm or routine that may be configured to
tune the particular parameter based on a particular patient/user's
physiological condition or therapy profile.
[0113] For example, one input parameter may be associated with the
patient's physiological glucose response to meal intake and/or
insulin intake (8160). Factors such as carbohydrate ratio and
insulin sensitivity are contemplated. In one aspect, this parameter
may be configured to be responsive to the various meal types or
components, response time parameters and the like, such that it is
updated, real time or semi real-time, based on the change to the
patient's physiological condition related to the glucose level
monitored by, for example, the analyte monitoring system 110 (FIG.
1).
[0114] Another input parameter may include factors associated with
the meal--meal dynamics parameters (8170). In one aspect, the meal
dynamics parameters may include the timing of the meal (for
example, meal event starts immediately), and the full carbohydrate
intake is an impulse function--that is, the meal is substantially
ingested in a short amount of time. Alternatively, factors
associated with the meal dynamics parameters may be specified or
programmed such as, for example, time to meal intake onset
(relative to the start time of the bolus delivery), carbohydrate
intake profile over time (for example, carbohydrate intake may be
configured to remain substantially constant over a predetermined
time period). Within the scope of the present disclosure, other
elaborate intake models are contemplated.
[0115] Referring again to FIG. 8, a further input parameter may
include insulin dynamic response parameters (8180) which may
include physiological dynamic glucose response associated with the
different types of insulin that may be delivered by, for example,
fluid delivery device 120 (FIG. 1). For example, a factor
associated with the insulin dynamic response parameters may include
time to peak effect of the relevant insulin formulation, or a time
constant associated with the glucose response which may be
established by the type of insulin for delivery.
[0116] In one aspect, the calculation of the required insulin to
attain the targeted glucose profile (8130) may be configured in
different manner. For example, the determination may be configured
as a lookup table, with input values as described above, and
associated outputs of insulin profiles. In one aspect, the dynamic
functional relationship that defines the physiological glucose
response to the measurement inputs and parameters described above
may be incorporated for determination of the desired insulin
amount. The calculation or determination function may be
incorporated in a regulator control algorithm that may be
configured to model functional relationships and measured input
values or parameters to define a control signal to drive the
therapy system 100 (FIG. 1) to achieve the desired response. That
is, in one aspect, the dynamic functional relationship may be
defined by the physiological relationships and/or the parameter
inputs. The measured input values may include the current and prior
glucose values, for example, received from the analyte sensor in
the analyte monitoring system 110 (FIG. 1) and the user or patient
specified meal related information. The control signal discussed
above may include determined or calculated insulin amount to be
delivered, while the desired response includes the target or
desired future glucose profile.
[0117] Referring yet again to FIG. 8, the determined insulin level,
based on the calculation described above, may be displayed
optionally with other relevant information, to the patient or the
user (8140). In one aspect, the patient or the user may modify the
determined insulin level to personalize or customize the dosage
based on the user's knowledge of her own physiological conditions,
for example. The patient or the user may be also provided with a
function or a user input command to execute the delivery of the
determined bolus amount (8150), which, upon activation is
configured to control the fluid delivery device 120 (FIG, 1) to
deliver the determined amount of insulin to the patient. A further
embodiment may not permit the patient modification of the
determined bolus amount, and/or include automatic delivery of the
determined insulin amount without patient or user intervention. In
still a further embodiment, based on the monitored analyte levels
of the patient, the determined insulin amount may be displayed to
the user with a recommendation to defer the activation or
administration of the determined insulin amount for a predetermined
time period.
[0118] FIG. 9 illustrates dynamic medication level determination in
accordance with another embodiment of the present disclosure.
Referring to FIG. 9, in another embodiment, the bolus determination
function may include additional data from the analyte monitoring
system 110 (FIG. 1), the fluid delivery device 120 (FIG. 1), and/or
the remote terminal 140 (FIG. 1). More specifically, in one aspect,
one or more blood glucose measurement data (9110) and/or the
current and previous insulin administration profiles or
measurements (9120) may be retrieved from one or more of the
analyte monitoring system 110, the fluid delivery device 120 and/or
the remote terminal 140 of the therapy management system 100 (FIG.
1).
[0119] Each of the measured or monitoring data or information such
as analyte sensor data, blood glucose measurements, insulin
delivery information and the like, in one aspect, are associated
with a time stamp and stored in the one or more memory devices of
the therapy management system 100. Thus, this information may be
retrieved for therapy related determination such as bolus dosage
calculation, or further data analysis for therapy management for
the patient.
[0120] In accordance with aspect of the present disclosure, the
various sources of glucose level determination (in some instances
redundant), in several different ways. For example, Kalman filter
may be used to provide for multiple measurements of the same
measurable quantity. The Kalman filter may be configured to use the
input parameters and/or factors discussed above, to generate an
optimal estimate of the measured quantity. In a further
configuration, the Kalman filter may be configured to validate the
analyte sensor data based on the blood glucose measurements, where
one or more sensor data may be disqualified if the blood glucose
data in the relevant time period deviates from the analyte sensor
data by a predetermined level or threshold. Alternatively, the
blood glucose measurements may be used to validate the analyte
sensor data or otherwise, calibrate the sensor data.
[0121] In a further aspect, the bolus determination function may
include a subroutine to indicate unacceptable error in one or more
measured data values. For example, in the case where analyte sensor
data include attenuations (or "dropouts"), in one aspect, a
retrospective analysis may be performed to detect the incidence of
such signal attenuation in the analyte sensor data, and upon
detection, the bolus determination function may be configured to
ignore or invalidate this portion of data in its calculation of the
desired insulin amount. Additionally, the therapy management system
100 may be configured such that insulin dosage or level calculation
or determination includes a validation of analyte sensor data
and/or verification of the sensor data for use in conjunction with
the bolus determination (or any other therapy related
determination) function.
[0122] In a further aspect of the present disclosure, various
metrics may be determined to summarize a patient's monitored
glucose data and related information such as, but not limited to
insulin delivery data, exercise events, meal events, and the like,
to provide indication of the degree or status of the management and
control of the patient's diabetic conditions. Metrics may be
determined or calculated for a specified period of time (up to
current time), and include, but not limited to, average glucose
level, standard deviation, percentage above/below a target
threshold, number of low glucose alarms, for example. The metrics
may be based on elapsed time, for example, since the time of the
patient's last reset of particular metric(s), or based on a fixed
time period prior to the current time. Such determined metrics may
be visually or otherwise provided to the patient in an easy to
understand and navigate manner to provide the progression of the
therapy management to the user and also, with the option to adjust
or modify the related settings or parameters.
[0123] In one aspect, the output of the determined metrics may be
presented to the user on the output unit 260 (FIG. 2) of the fluid
delivery device 120 (FIG. 1), a display deice on the analyte
monitoring system 110, a user interface, and/or an output device
coupled to the remote terminal 140 (FIG. 1). In one aspect, the
metrics may be configured to provide a visual indication, tactile
indication, audible indication or in other manner in which the
patient or the user of the therapy management system 100 (FIG. 1)
is informed of the condition or status related to the therapy
management. Each metric may be user configurable to allow the
patient or the user to obtain additional information related to the
metric and associated physiological condition or the operational
state of the devices used in the therapy management system 100. The
metric may be associated with indicators or readings other than
glucose, such as, for example, the amount and/or time of insulin
delivered, percentage of bolus amount as compared to the total
insulin delivered, carbohydrate intake, alarm events, analyte
sensor replacement time periods, and in one aspect, the user or the
patient may associate one or more alarms, alerts or notification
with one or more of the metrics as may be desired.
[0124] FIG. 10 illustrates metric analysis in accordance with one
embodiment of the present disclosure. Referring to FIG. 10, upon
activation of the display (1010) or a user interface device coupled
to the one or more devices in the therapy management system 100
(FIG. 1), the desired metric information is determined (1020), for
example, based on the current available information (e.g., the
insulin delivery information for the past 2 hours). After
determining the metric information, the determined metric
information is displayed on the main or home screen or display of
the user interface device (1030).
[0125] In one aspect, as shown in FIG. 10, the displayed metric may
be selected, for example, based on user activation on a display
element (1040). Upon detecting the selection of the particular
metric displayed, additional detail information related to the
selected metric as well as, optionally, other related information
are determined or calculated (1050), and thereafter provided to the
user or the patient on the user interface device (1060). In this
manner, in one aspect, the user interface device may be configured
with layered menu hierarchy architecture for providing current
information associated with a particular metric or condition
associated with the therapy management system. The patient or the
user may configure the user interface device to display or output
the desired metrics at a customizable levels of detail based on the
particular patient or the user's settings. While the above
description is provided in conjunction with a visual indication on
the user interface device, within the scope of the present
invention, other output indications may be similarly configured and
used, such as audible notifications, vibratory or tactile
notifications, and the like, each of which may be similarly
configured by the patient or the user.
[0126] Within the scope of the present disclosure, the metrics may
be provided on other devices that may be configured to receive
periodic updates from the user interface device of the therapy
management system. In one aspect, such other devices may include
mobile telephones, personal digital assistants, pager devices,
Blackberry devices, remote care giver devices, remote health
monitoring system or device, which may be configured for
communication with the therapy management system 100, and that may
be configured to process the data from the therapy management
system 100 to determine and output the metrics. This may be based
on real time or substantially real time data communication with the
therapy management system 1 00. In other aspects, the therapy
management system 100 may be configured to process and determine
the various metrics, and transmit the determined metrics to the
other devices asynchronously, or based on a polling request
received from the other devices by the therapy management system
100.
[0127] The user interface device in the therapy management system
100 may be configurable such that the patient or the user may
customize which metric they would like to view on the home screen
(in the case of visual indication device such as a display unit).
Moreover, other parameters associated with the metrics
determination, such as, for example, but not limited to the
relevant time period for the particular metric, the number of
metrics to be output or displayed on a screen, and the like may be
configured by the user or the patient.
[0128] In a further aspect, the metric determination processing may
include routines to account for device anomalies (for example, in
the therapy management system 100), such as signal attenuation
(ESA) or dropouts, analyte sensor calibration, or other
physiological conditions associated with the patient as well as
operational condition of the devices in the therapy management
system such as the fluid delivery device 120 (FIG. 1) or the
analyte monitoring system 110 (FIG. 1).
[0129] Some glucose measurement anomalies may not be detected in
real time and thus require retrospective detection and/or
compensation. When processing a batch current and past analyte
sensor data to, for example, determine a particular metric,
determine a desired bolus dosage amount, evaluate data to detect
glucose control conditions, perform a data fit function to a model
to execute therapy simulations, or perform any other process that
may be contemplated which requires the processing of prior glucose
related data, anomalies such as signal attenuation, dropouts, noise
burse, calibration errors or other anomalies may be detected and/or
compensated. For example, a signal dropout detector may be used to
invalidate a portion of the prior glucose related data, to
invalidate an entire data set, or to notify the patient or the user
of the corresponding variation or uncertainly in accuracy in a
predetermined one or more metrics or calculations.
[0130] For example, referring to FIG. 11 which illustrates metric
analysis in accordance with another embodiment of the present
disclosure, based on current and past stored sensor data and blood
glucose data received (1110), retrospective validation of data used
in metric calculation is performed (1120), which includes one or
more metric calculation parameters (1130). Referring to FIG. 11, in
one aspect, the metric calculation parameters (1130) may be used in
the metric calculation (1140) which, as shown, may be performed
after the data to be used in the metric calculation are
retrospectively validated.
[0131] In one aspect, the metrics may be determined or recalculated
after each received analyte sensor data and thereafter, displayed
or provided to the user or the patient upon request, or
alternatively, automatically, for example, by refreshing the
display screen of the user interface device in the therapy
management system 100 (FIG. 1), or otherwise providing an audible
or vibratory indication to the patient or the user.
[0132] FIG. 12 is illustrates metric analysis in accordance with
yet another embodiment of the present disclosure. Referring to FIG.
12, upon detection of display activation (1210), the user interface
device may be configured to activate a home screen or main menu
configuration or setup function based on detected display element
selection (1220). That is, in one aspect, the user or the patient
may call a configuration function to customize the displayed menu
associated with the display or output indication of the
metrics.
[0133] Referring to FIG. 12, from the configuration menu on the
user interface device, the user or patient selection of one or more
metrics to be displayed or output on the main menu or home screen
on the user interface device is detected (1230). After storing the
user defined or selected metrics related configuration, the user
interface device is configured to display or output the selected
one or more metrics on the home screen or the main menu each time
the user interface device is activated (1240). In this manner, in
one aspect, the user or the patient may be provided with an option
to display or output a particular subset of available metrics on
the main display screen of the user interface device. In another
aspect, the user interface device in the therapy management system
100 may be configured to include a default set of metrics to
displayed and/or updated, either in real time, or substantially in
real time, or based in response to another related event such as an
alarm condition, or a monitored glucose level. The system may be
configured to not output any metrics.
[0134] FIG. 13 illustrates metric analysis in accordance with a
further embodiment of the present disclosure. Referring to FIG. 13,
upon detection of the display or user interface device activation
(1310), metric calculation setup function is called based on
detection of a display selection to activate the same (1320), and
detection of a selection from a list of metrics that allow the
calculations to be modified (or alarms associated) (1330). The
configuration options including metric calculation parameters, for
example, are displayed (1340) in one embodiment, and the selected
metric may be calculated, with one or more parameters modified or
otherwise programmed, and optionally with one or more alarm
conditions or settings associated with the selected metric (1
350).
[0135] In this manner, the patient or the user may in one
embodiment interact with the user interface device to customize or
program the determination or calculation of the particular one or
more metrics for display, and further, to modify the parameters
associated with the calculation of the various metrics.
Accordingly, in one aspect of the present disclosure, therapy
related information may be configured for output to the user to,
among others, provide the patient or the user of the associated
physiological condition and the related therapy compliance
state.
[0136] In accordance with still another aspect of the present
disclosure, the therapy management system 100 (FIG. 1) may be
configured to monitor potential adverse conditions related to the
patient's physiological conditions. For example, a prevalence of
glucose levels for a predetermined time period, pre-prandial, may
be analyzed to determine if the prevalence exceeds a predefined
threshold, with some consistency. Upon detection of the predefined
adverse condition, the user interface device may be configured to
provide a notification (visual or otherwise) to the patient or the
user, and varying degrees of detailed information associated with
the detected adverse condition may be provided to the patient or
the user. Such notification may include text information such as,
for example "Your pre-meal glucose tends to be high", or
graphically by use of an arrow icon or other suitable visual
indication, or a combination of text and graphics.
[0137] Adverse conditions that are not related to the monitored
analyte level, such as insulin delivery data that is consistent
with insulin stacking may be detected. Other examples include mean
bolus event that appear to occur too late relative to the meal
related glucose increases may be detected, or excessive use of
temporary basal or bolus dosage or other modes of enhanced insulin
delivery beyond the basal delivery profiles. Also device problems
such as excessive signal dropouts from the analyte sensor may be
detected and reported to the user.
[0138] In one aspect, the user interface device may be configured
to customize or program the visual output indication such as icon
appearance, such as enabling or disabling the icon appearance or
one or more alarms associated with the detection of the adverse
conditions. The notification to the user may be real time, active
or passive, such that portions of the user interface device is
updated to provide real time detection of the adverse conditions.
Moreover, the adverse condition detection thresholds may be
configured to be more or less sensitive to the triggering event,
and further, parameters associated with the adverse condition
detection determination may be adjusted--for example, the time
period for calculating a metric.
[0139] In a further aspect, the user interface device may provide
indication of a single adverse detection condition, based on a
priority list of possible adverse conditions, a list of detected
adverse conditions, optionally sorted by priority, or prior
detection of adverse conditions. Also, the user interface device
may provide treatment recommendation related to the detected
adverse condition, displayed concurrently, or options to resolve
the detected adverse condition along with the detected adverse
condition. In still another aspect, the notification of the
detected adverse condition may be transmitted to another device,
for example, that the user or the patient is carrying or using such
as, for example, mobile telephone, a pager device, a personal
digital assistant, or to a remote device over a data network such
as a personal computer, server terminal or the like.
[0140] In still another embodiment, some or all aspects of the
adverse condition detection and analysis may be performed by a data
management system, for example, by the remote terminal 140 (FIG. 1)
or a server terminal coupled to the therapy management system 100.
In this case, the analysis, detection and display of the adverse
condition may be initiated upon the initial upload of data from the
one or more analyte monitoring system 110 or the fluid delivery
device 120, or both. Additionally, the adverse condition process
may also account for potential measurement anomalies such as
analyte sensor attenuation conditions or dropouts, or sensor
calibration failures.
[0141] FIG. 14 illustrates condition detection or notification
analysis in accordance with one embodiment of the present
disclosure. Referring to FIG. 14, upon user interface device
activation detection (1410) such as activation of a display device
in the therapy management system 100 (FIG. 1), preprogrammed or
predefined adverse condition is detected (1420), and displayed
(1430) on the home screen of the user interface device using, for
example, a problem icon. When the selection of the icon display
element associated with the adverse condition is detected (1440),
for example, indicating that the patient or the user desires
additional information associated with the detected adverse
condition, additional detailed information associated with the
adverse condition is determined, as appropriate (1450), and
thereafter, the additional detailed information is displayed to the
user (1460).
[0142] FIG. 15 illustrates condition detection or notification
analysis in accordance with another embodiment of the present
disclosure. Referring to FIG. 15, current and prior stored analyte
sensor data and blood glucose data are retrieved (1510) and
retrospective validation of the data for use in the adverse
condition detection process is performed (1530), based also, at
least in part, on the detection calculation parameters (1520) which
may be user input or preprogrammed and stored. Thereafter, the
adverse condition detection process is performed (1540), for
example, the parameters associated with the programmed adverse
conditions are monitored and upon detection, notified to the
patient or the user.
[0143] In accordance with yet a further aspect of the present
disclosure, therapy analysis system is provided. In one aspect, the
therapy management system 100 (FIG. 1) may be used to collect and
store patient related data for analysis to optimizing therapy
profiles and associated parameters for providing treatment to the
patients. More specifically, FIG. 16 illustrates therapy parameter
analysis in accordance with one embodiment of the present
disclosure. As shown, data from a continuous glucose monitoring
system (CGM) such as an analyte monitoring system 110 (FIG. 1) and
an insulin pump such as, for example, fluid delivery device 120
(FIG. 1) are collected or stored over a predetermined time period.
In addition, during this time period, meal intake information may
be stored, along with other relevant data such as, exercise
information, and other health related information. All data are
stored with a corresponding date and time stamp and are
synchronized.
[0144] After the predetermined time period, the stored data
including, for example, time synchronized analyte sensor data
(CGM), blood glucose (BG) data, insulin delivery information, meal
intake information and pump therapy settings, among others, are
uploaded to a personal computer, for example, such as the remote
terminal 140 (FIG. 1) for further analysis (1601). The received
data are used as input data including, for example, actual glucose
data (CGM), actual blood glucose data (BG), actual insulin amount
delivered, actual pump settings including carbohydrate ratio,
insulin sensitivity, and basal rate, among other (1607), as well as
actual meal information (1608), to perform a system identification
process (1602).
[0145] More specifically, the system identification process (1602)
in one embodiment is configured to fit the received input data to a
generic physiological model that dynamically describes the
interrelationship between the glucose levels and the delivered
insulin level as well as meal intake. In this manner, in one
aspect, the system identification process (1602) is configured to
predict or determine glucose levels that closely matches the actual
glucose level (CGM) received as one of the input parameters.
[0146] Referring to FIG. 16, as shown the parameters of the generic
physiological model are adjusted so that the model output (glucose
level) closely matches the actual monitored glucose level when the
measured inputs are applied (1610). That is, a newly identified
model is generated based, at least in part, on meal dynamics,
insulin absorption dynamics, and glucose response dynamics.
Thereafter, based on the newly identified model (1610), actual meal
information representing carbohydrate intake data (1608), and the
glucose profile target(s) as well as any other constraints such as
insulin delivery limits, low glucose limits, for example (1609), to
determine the optimal pump setting to obtain the target glucose
profile(s) (1603). That is, in one aspect, based on a predefined
cost function such as minimizing the area about a preferred glucose
level, or some other boundaries, predicted glucose levels are
determined based on optimal pump therapy settings, and optimal
insulin delivery information (1611).
[0147] Based on the analysis performed as described above, a report
may be generated which show modal day results, with median and
quartile traces, and illustrating the actual glucose levels and
glucose levels predicted based on the identified model parameters,
actual insulin delivery information and optimal insulin delivery
information, actual mean intake information, and actual and optimal
insulin therapy settings (1604). Other report types can be
generated as desired. In one aspect, a physician or a treatment
provider may modify one or more parameters to view a corresponding
change in the predicted glucose values, for example, that may be
more conservative to reduce the possibility of hypoglycemia.
[0148] Referring again to FIG. 16, a new predicted glucose and
insulin delivery information based on the adjusted setting are
determined (1605). The predicted glucose values and insulin
delivery information are added to the plot displayed and in one
aspect, configured to dynamically change, in real time, in response
to the parameter adjustments. Upon determination of an acceptable
therapy profile, the settings and/or parameters associated with the
insulin delivery, including, for example, modified basal profiles,
for the insulin pump, may be downloaded (1606) to the pump
controller from the computer terminal (for example, the remote
terminal 140) for execution by the insulin pump, for example, the
fluid delivery device 120 (FIG. 1).
[0149] FIG. 17 is a flowchart illustrating dynamic physiological
profile simulation routine in accordance with one embodiment of the
present disclosure. Referring to FIG. 17, in one aspect of the
present disclosure, the physiological profile of a patient or user
based on data collected or received from one or more of the analyte
monitoring system 110 (FIG. 1) or the fluid delivery device (120)
for example, are retrieved (1710). For example, based on a
collection of data associated with monitored analyte levels of a
patient and/or the therapy information such as the actual or
programmed insulin delivery profiles, the profile of a patient
which represents the physiological condition of the patient is
retrieved (1720). Other relevant data could be collected, for
example, but not limited to, the patient's physical activities,
meal consumption information including the particular content of
the consumed meal, medication intake including programmed and
executed basal and/or bolus profiles, other medication ingested
during the relevant time period of interest.
[0150] Thereafter, a simulation of a physiological model based on
the retrieved physiological condition is generated. In one aspect,
the generated physiological model includes one or more parameters
associated with the patient's physiological condition including,
for example, insulin sensitivity, carbohydrate ratio and basal
insulin needs. In one aspect, the relevant time period of interest
for physiological simulation may be selected by the patient,
physician or the care provider as may be desired. In one aspect,
there may be a threshold time period which is necessary to generate
the physiological model, and thus a selection of a time period
shorter than the threshold time period may not result in accurate
physiological modeling. For example, in one aspect, the data
processing system or device may be configured to establish a seven
day period as the minimum number of days based on which, the
physiological modeling may be achieved.
[0151] Referring to FIG. 17, with the generated physiological model
based on the patient's profile, one or more patient condition
parameters may be modified (1730). For example, the basal profile
for the infusion device of the patient may be modified and entered
into the simulation module. Alternatively or in addition, the
patient's profile may be modified. For example, the type or amount
of food to be ingested may be provided into the simulation module.
Within the scope of the present disclosure, the patient, the
physician or the care provider may modify one or more of the
condition parameters to determine the simulated effect of the
modified condition parameter or profile component to the
physiological model generated. More specifically, referring back to
FIG. 17, when one or more patient condition parameters or one or
more profiles components is modified, the simulated physiological
model is modified or altered in response to the modified condition
parameter(s) (1740).
[0152] That is, in one aspect, the simulation of the initial
physiological profile of a patient may be generated based on
collected/monitored data. Thereafter, one or more parameters may be
modified to show the resulting effect of such modified one or more
patient condition parameters on the simulation of the patient's
physiological model. In this manner, in one aspect, the patient,
physician or the healthcare provider may be provided with a
simulation tool to assist in the therapy management of the patient,
where a model based on the patient's condition is first built, and
thereafter, with adjustment or modification of one or more
parameters, the simulation model provides the resulting effect of
the adjustment or modification so as to allow the patient,
physician or the healthcare provider to take appropriate actions to
improve the therapy management of the patient's physiological
condition.
[0153] FIG. 18 is a flowchart illustrating dynamic physiological
profile simulation routine in accordance with another embodiment of
the present disclosure. Referring to FIG. 18, in another
embodiment, a user selects, using one or more user input devices of
a personal computer or other computing or data processing device,
the desired physiological profile (1810), and thereafter, one or
more condition parameters displayed to the user may be selected as
desired. For example, the user may be prompted to select an insulin
level adjustment setting, to view a simulation of the physiological
profile model responding to such insulin level adjustment
setting.
[0154] In another aspect, the user may select an activity
adjustment setting to view the effect of the selected activity on
the physiological profile model. For example, the user may select
to exercise for 30 minutes before dinner every day. With this
adjustment to the condition parameter, the physiological profile
model simulation module may be configured to modify the generated
physiological model to show the resulting effect of the exercise to
the glucose level of the patient in view of the existing insulin
delivery profile, for example. In this manner, one or more
parameters associated with the patient's physiological condition
may be modified as a condition parameter and provided to the model
simulation module to determine the resulting effect of such
modified condition parameter (1820). Indeed, referring back to FIG.
18, with the entered condition parameter(s) selected by the
patient, physician or the healthcare provider, the simulation
module in one aspect may be configured to generate a modified
physiological profile model which is received or output to the
user, patient, physician or the healthcare provider, visually,
graphically, in text form, or one or more combinations thereof
(1830).
[0155] FIG. 19 is a flowchart illustrating dynamic physiological
profile simulation routine in accordance with still another
embodiment of the present disclosure. Referring to FIG. 19, in one
aspect, when the physiological profile model is selected (1910) and
the desired modified parameter(s) is selected for the condition(s)
associated with the physiological profile model (1920), a modified
physiological model is received (1930) or output to the user on a
display device of the data processing terminal or computer.
Thereafter, the simulation module may prompt the patient, the user,
physician or the healthcare provider to either enter additional or
different condition parameters to view the resulting effect on the
simulated physiological model, or alternatively, select the option
to indicate the completion of the modification to the condition
parameters (1940).
[0156] In this manner, an iteration may be provided such that the
patient, user, physician or the healthcare provider may modify one
or more conditions associated with the patient's physiological
condition, and in response, view or receive in real time, the
resulting effect of the modified one or more conditions to the
modeled physiological condition simulation. Thereafter, optionally,
the modified as well as the initial physiological profile model
(and including any intermediate modification to the physiological
profile model based on one or more parameter inputs) may be stored
in the memory or storage unit of the data processing terminal or
computer (1950).
[0157] In this manner, in one aspect, when the simulation module
has sufficient data associated with the patient's physiological
condition or state to define the simulation model parameters, the
patient, healthcare provider, physician or the user may model
different treatment scenarios to determine strategies for managing
the patient's condition such as the diabetic condition in an
interactive manner, for example. Thus, changes to the resulting
physiological model may be displayed or provided to the patient,
physician or the healthcare provider based on one or more potential
changes to the treatment regimen.
[0158] FIG. 20 is a flowchart illustrating visual medication
delivery profile programming in accordance with one embodiment of
the present disclosure. Referring to FIG. 20, medication delivery
profile such as a basal rate profile is retrieved (2010), for
example, from memory of the remote terminal 140 (FIG. 1) or
received from the fluid delivery device 120 (FIG. 1) such as an
insulin pump. Thereafter, a graphical representation of the
medication delivery profile is generated and displayed (2020) on
the display unit of the remote terminal 140. For example, the
graphical representation of the medication delivery profile may
include a line graph of the insulin level over a predetermined time
period for the corresponding medication delivery profile.
[0159] In one aspect, the graphically displayed medication delivery
profile may be configured to be manipulated using an input device
for the remote terminal 140 such as, for example, a computer mouse,
a pen type pointing device, or any other types of user input device
that is configured for manipulation of the displayed objects on the
display unit of the remote terminal 140. In addition to the
graphical display of the medication delivery profile, one or more
of a corresponding therapy or physiological profile for a
particular patient or user may be displayed. For example, in one
embodiment, based on data received from the analyte monitoring
system 110 and/or the fluid delivery device 120, the remote
terminal 140 may be configured to display the basal profile
programmed in the fluid delivery device 120 indicating the amount
of insulin that has been programmed to administer to the patient,
and the corresponding monitored analyte level of the patient,
insulin sensitivity, insulin to carbohydrate ratio, and any other
therapy or physiological related parameters.
[0160] Referring to FIG. 20, the patient or the user including a
physician or the healthcare provider may manipulate the user input
device such as the computer mouse coupled to the remote terminal
140 to select and modify one or more segments of the graphically
displayed medication delivery profile (2030). In response to the
display manipulation/modification, the corresponding displayed
therapy/physiological profile may be dynamically updated (2040).
For example, using one or more of the user input devices, the user
or the patient may select a portion or segment of the basal profile
line graph, and either move the selected portion or segment of the
line graph in vertical or horizontal direction (or at an angle), to
correspondingly modify the level of the medication segment for a
given time period as graphically displayed by the line graph.
[0161] In one aspect, the medication delivery profile in one aspect
may be displayed as a line graph with time of day represented along
the X-axis and the value or level of the medication on the Y-axis.
When the computer mouse is moved near a segment of the line graph,
the cursor displayed on the remote terminal 140 display unit may be
configured to change to indicate that the portion of the line graph
may be selected and dragged on the displayed screen. For example,
the horizontal portions of the line graph may be dragged in a
vertical direction to increase or decrease the setting or the
medication level for that selected time period, while the vertical
portions of the line graph may be dragged in the horizontal
direction to adjust the time associated with the particular
medication level selected.
[0162] Referring again to FIG. 20, in one aspect, the modified
medication delivery profile and the updated therapy/physiological
profile are stored (2050) in a storage unit such as a memory of the
remote terminal 140, and thereafter, may be transmitted to one or
more of the fluid delivery device 120 or the analyte monitoring
system 110 (2060). In this manner, in one aspect, the patient or
the user may be provided with an intuitive and graphical therapy
management tool which allows manipulation of one or more parameters
associated with the patient's condition such as diabetes, and
receive real time visual feedback of based on the manipulation of
the one or more parameters to determine the appropriate therapy
regimen.
[0163] For example, when the user or the patient wishes to maintain
his or her blood glucose level within a predetermined range, the
user may manipulate the line graph associated with the insulin
delivery rate, for example, to receive feedback on the effect of
the change to the insulin amount on the blood glucose level. The
modeling of the physiological parameters associated with the
patient in one aspect may be generated using computer algorithms
that provide simulated model of the patient's physiological
condition based on the monitored physiological condition,
medication delivery rate, patient specific conditions such as
exercise and meal events (and the types of exercise and meal for
the particular times), which may be stored and later retrieved for
constructing or modeling the patient's physiological
conditions.
[0164] FIG. 21 is a flowchart illustrating visual medication
delivery profile programming in accordance with another embodiment
of the present disclosure. Referring to FIG. 21, medication
delivery profile for a particular patient may be graphically
displayed (2110), and thereafter, upon detection of an input
command to modify the displayed medication delivery profile (2120),
the corresponding displayed therapy physiological profile is
modified (2130). As discussed above, the input command may be
received from an input device such as a computer mouse executing
select and drag functions, for example, on the display screen of
the remote terminal 140. In one aspect, in response to the input
command, the displayed medication delivery profile as well as the
corresponding displayed therapy/physiological profile may be
graphically updated to provide visual feedback to the patient or
the user of the effect resulting from the input command modifying
the medication delivery profile.
[0165] Referring to FIG. 21, when the confirmation of the modified
medication delivery profile is received (2140), for example, via
the user input device, the modified medication delivery profile may
be transmitted (2150) and, the modified medication delivery profile
and the updated therapy/physiological profile are stored (2160).
That is, when the user or the patient confirms or accepts the
modification or update to the medication delivery profile based,
for example, on the visual feedback received corresponding to the
change to the therapy/physiological profile, in one aspect, the
modified medication delivery profile may be transmitted to the
fluid delivery device 120 to program the device for execution, for
example. The transmission may be wireless using RF communication,
infrared communication or any other suitable wireless communication
techniques, or alternatively, may include cabled connection using,
for example, USB or serial connection.
[0166] In this manner, in one aspect, there is provided an
intuitive and easy to use visual feedback mechanism to improve
treatment of a medical condition such as diabetes, by providing
visual modeling of the therapy regimen that can be dynamically
adjusted to show the effect of such adjustment to the physiological
condition.
[0167] FIG. 22 is an exemplary screen display of a medication
delivery profile. As can be seen, in one aspect, the basal rate,
insulin sensitivity and the insulin to carbohydrate ratio (CHO) are
shown on the Y-axis, while the X-axis represents the corresponding
time of day. For each of these therapy parameters, the existing
profile is shown 2320 and the optimal profile proposed by the
therapy calculator is shown 2330. FIG. 23 is an exemplary screen
display illustrating vertical modification of the proposed
medication delivery profile as shown by the directional arrow 2310,
while FIG. 24 illustrates an exemplary screen display with
horizontal modification of the proposed medication delivery profile
shown by the directional arrow 2410. Referring still to the
Figures, FIG. 25 illustrates addition of a transition 2510 in the
medication delivery profile, while FIG. 26 illustrates deletion
2610 of a transition in the medication delivery profile.
[0168] In this manner, in one aspect, the visual modeling and
dynamic feedback in therapy management provides immediate feedback
on the anticipated results or effect of a proposed modification to
the therapy profile such as increase or decrease of insulin
administration to the patient. Accordingly, the patient, the
physician or the healthcare provider may be provided with a
graphical treatment tool to assist in the treatment of the
patient's condition.
[0169] In another aspect, the visual modeling and dynamic feedback
in the therapy management includes illustration of a current
physiological profile such as the glucose level and one or more
time corresponding parameter values associated with the current
physiological profile such that, when the user, patient or
healthcare provider modifies the displayed one or more parameter
values (such as, but not limited to, the corresponding medication
level including basal profile, insulin sensitivity, and/or insulin
to carbohydrate ratio), the corresponding current physiological
profile is responsively modified and displayed in real time, while
leaving a trace (referring to herein as a phantom plot) of the
current physiological profile and the time corresponding one or
more parameter values associated with the current physiological
profile.
[0170] That is, by manipulating the display of the therapy related
parameter value to a modified level (for example, using a
conventional click and drag operation of an input device such as a
computer mouse), the displayed current physiological profile is
modified on the screen accordingly, while maintaining the display
of the current physiological profile as well as the initial or
current therapy related parameter value. In other words, in one
aspect, the display or screen is configured to represent both the
initial profile and the modified profile so that the user, patient
or healthcare provider can readily see the change to the plotted
physiological profile in response to the modification to the one or
more parameter values, for example, the initial profile or plot
shown as a lighter trace (phantom plot) or of a different color or
representation), while maintaining a darker color or thickness of
the plot for the modified profile/plot.
[0171] For example, with a plot of a glucose level information and
a corresponding basal profile on the screen, when the user, patient
or the healthcare provider selects the basal profile and moves or
modifies one or more sections of the basal profile, the initial
position of the glucose level remains displayed as a trace (phantom
plot), while displaying the new or modified glucose level. In
addition, both the initial and the modified basal profile of the
time corresponding basal profile are displayed on the same chart or
plot. In this manner, in one aspect, the display of the remote
terminal 140 (FIG. 1) and/or the display of the analyte monitoring
system 110 or the display of the fluid delivery device 120 may be
manipulated using, for example, user interface capabilities such as
input device (computer mouse for use with the remote terminal 140,
input/select buttons on the analyte monitoring system 110 or the
fluid delivery device 120 to provide visual indications of the
extent of adjustment to one or more parameters from the initial or
recommended settings or profiles and the corresponding modification
to the associated physiological or other monitored profile such as
glucose levels in addition to the initial displayed profile.
[0172] FIG. 27 is an exemplary display illustrating an initial
glucose level and a corresponding parameter value, and FIGS. 28-29
are exemplary displays illustrating response to the manipulation of
the parameter plot or value segment of FIG. 27 and corresponding
modification to the displayed glucose profile as a function of time
in one embodiment. Referring to FIGS. 27-29, an initial display of
one parameter value 2720 (FIG. 27) is plotted along with a time
corresponding plot of the glucose level 2710 (FIG. 27). In one
aspect, the user, patient or the healthcare provider may move the
computer mouse to position the cursor over and select a segment of
the plotted parameter value 2720 (for example, between two
displayed dots at each transition point in the displayed plot).
With the selected segment of the plotted parameter, the user,
patient or the healthcare provider may move the selected segment in
a vertical direction as shown in FIG. 28, in a horizontal
direction, or in both a horizontal and vertical direction as shown
in FIG. 29.
[0173] Referring back to FIG. 28, when the selected segment of the
displayed parameter 2840 is moved in an upward vertical direction
to a new position 2830 as shown, the corresponding initial glucose
profile 2810 is updated to the modified glucose profile 2820. As
shown in FIG. 28, it can be seen that both the initial position and
the modified position of the parameter plot and those of the
glucose levels are shown. In particular, in one embodiment, when a
modification to the parameter value is effected, the segment of the
initial position or plot of the parameter value (and the
corresponding initial display of the glucose level) is displayed as
a lighter trace or of a different color (for example, the initial
parameter segment 2840 and the initial glucose profile 2810) to be
distinguishable with the modified parameter segment 2830 and the
corresponding modified glucose profile 2820. In one aspect, the
particular type of display modes (different color, thickness,
legend indicating the initial and modified chart or profile
segment) may be user definable or configurable.
[0174] Referring to FIG. 29, when a segment 2940 of the parameter
displayed is modified in both the vertical and the horizontal
direction to the modified position 2930 as shown, the corresponding
displayed initial glucose level display 2910 is updated to a
modified profile 2920 in the direction shown by the arrow
illustrating a movement from the initial display 2910 to the
modified display 2920 in addition to the display of the initial
glucose profile 2910 and the initial parameter value 2940.
[0175] In this manner, in one aspect, proposed or recommended
modification to therapy profiles such as basal profiles may be
displayed including the initial and modified profiles, and the
corresponding initial and modified physiological profiles
recalculated or determined in response to the proposed or
recommended modification to the therapy profiles may be visually
output to the user, patient or the healthcare provider to enhance
visual representation of the proposed or recommended modification
to the therapy profiles in the course of the treatment and therapy
of physiological conditions such as diabetes. In this manner, the
user, patient or the healthcare provider may easily and visually
understand the degree of parameter change and effect of the change
on the output values such as insulin delivery and glucose
level.
[0176] While a single parameter plot is shown in conjunction with
the discussion above and FIGS. 27-29, in accordance with the
embodiments of the present disclosure, multiple parameter values or
profiles may be displayed and modified by the user, patient, or the
healthcare provider. In such cases, for each parameter displayed,
when a modification to the parameter is performed, both the initial
and the modified profile or plot may be displayed. Moreover, while
glucose level is discussed above in the physiological profile
displayed, embodiments of the present disclosure may be used to
display other physiological profiles and associated parameters that
affects the physiological profile, such as blood pressure level or
other physiological conditions.
[0177] In accordance with the embodiments of the present
disclosure, other variations of the embodiments discussed above are
contemplated. For example, the phantom plots may be associated with
the plots that are adjusted rather than the plots that stay in the
same position. Also, as discussed above, the phantom plots may be
represented other than as a thinner line (compared to the
non-phantom or the modified profile), including, such as, for
example, with different colors, line types, icon indication,
legends, labels and the like. In addition, the modification to the
initial profile or parameter may be represented in tabular form
with numeric value entries, with some table elements associated
with the original or initial values and other table elements
representing the adjusted/modified values.
[0178] In a further embodiment, for multiple adjustments or
modifications, the phantom (original) plot may be updated or
modified after each adjustment, relative to the immediately prior
modification position. In this case, optionally, multiple phantom
plots may be displayed (using different indications such as
gradually increasing thickness of the plotted line, or different
color or legend, for example) such that the modifications may be
visually represented in a graphically sweeping manner, illustrating
each modification to the parameter(s) and the corresponding
modification to the physiological profile in, for example, a single
chart or display.
[0179] Moreover, other mechanisms may be contemplated to allow the
user, patient or the healthcare provider to make the adjustments to
the parameters. For example, a table may be provided and displayed
with numeric values associated with parameter segments, and the
user, patient or the healthcare provider may edit the numeric
values in the table. After the adjustment or modification to the
numeric value in the table, the corresponding plots may be modified
as described above, in a similar manner as when the graphical
segment is modified using, for example, the computer mouse by click
and drag operation.
[0180] In addition, adjustment or modification to the parameters
may be performed in other manner. For example, segments of the
parameter plots may be predefined, for instance, at a segment of 15
minutes or other time periods. Alternatively, the segments may be
defined by changes in time for the original parameter value.
Additionally, new segments may be defined by the user using for
example, the computer mouse by clicking the mouse button with a
cursor near a point on the parameter plot, where the selected or
clicked point representing the end of a segment with the beginning
of a segment already defined on the plot (as indicated by a dot on
the plot). Also, a segment may be defined by the user with a mouse
click once near one point on a plot and again near a second point,
where the points define a segment. In this aspect, the segment may
be visually highlighted (for example, made thicker) to indicate to
the user that it can be dragged or otherwise adjusted or modified.
Furthermore, these defined segments may be limited to a predefined
time resolution as defined by the insulin delivery device, for
example. That is, fluid delivery device 120 (FIG. 1) may be limited
to a 15 minute resolution of parameter changes, in which case, the
plotting routine may locate the 15 minute point on the plot closest
to where the user selected with the mouse.
[0181] In another aspect, the display discussed above may include
one or more error indication. For example, the glucose display may
show, along with the median glucose profile, the upper and lower
glucose quartiles. This information may be useful to the user when
making corresponding adjustments to the therapy profile. For
example, if the user, patient or the healthcare provider desires to
make parameter adjustments in order to lower the median glucose
profile, they may understand from the lower quartile plot that
there is a high degree of glucose variation and that it may not be
safe or desirable to lower the median profile as much as they
intended or desired. In one aspect, the phantom plots discussed
above may be associated with these types of displayed error
indications.
[0182] As described above, the profile modification and the
corresponding displays may be based on data organized around
time-of-day information. In another aspect, the modifications or
determinations and the corresponding display plots may be based on
meals markers or meal bolus events recorded in time. These events
may be entered into the system manually (for instance a meal event
may be entered into the system by the user) or automatically (the
system may record a meal bolus when it is delivered, using, for
example, the fluid delivery device 120). The parameter, insulin
delivery and glucose data may be organized in data sets, with time
relative to the meal bolus event. A resulting data set for each may
be generated using a median calculation or average calculation, or
other appropriate calculation, to generate a profile in time
relative to the meal bolus event. For example, each data set may be
defined one hour prior to and 5 hours after when meals bolus event
occurs. Adjustments, as described above for plots over time-of-day,
may be made similarly for plots over time-relative-to-meal-events.
Also, determination and display of parameters, insulin delivery and
glucose profiles may be made for data sets generated relative to
correction bolus events.
[0183] In one aspect, the user may select from a list of possible
parameters to adjust or modify based on one or more indications
presenting the parameters available for modification. For example,
if the basal parameter adjustment is selected, then the
determination or modification and display may be associated with
time-of-day. In this case, when the user adjusts the glucose
values, the basal profile parameter may be adjusted to correlate
with glucose level adjustments. As a further example, if the
carbohydrate ratio parameter is selected, the modification and
display may be associated with time relative to meal bolus or meal
events. As yet a further example, when the insulin sensitivity
parameter adjustment is selected, the modification and display may
be associated with time relative to a correction bolus.
[0184] Additionally, when modifications and displays are associated
with time relative to an event, they may be restricted to time of
day periods. For example, the profile modification determination
may be restricted to one or more meal bolus that occur in a morning
period, for instance, between 6 am and 11 am. This restriction may
be used to associate a single carbohydrate ratio parameter for this
time period. Also, the resulting modified parameters may be
constrained by resolution restrictions imposed by the insulin
delivery device 120 discussed above.
[0185] In an alternative embodiment, the parameter and/or
physiological profile display may include both actual and
recommended glucose traces, insulin traces and therapy parameter
traces, in addition to the modified traces, and further, user
definable or configurable.
[0186] Within the scope of the present disclosure, data mining
techniques may be used to generate and/or modify the physiological
profile models based on the patient's data as well as data from
other patient's that have similar physiological characteristics.
Such data mining techniques may be used to filter and extract
physiological profile models that meet a predetermined number of
criteria and ranked in a hierarchy of relevance or applicability to
the particular patient's physiological condition. The simulation
module may be implemented by computer software with algorithm that
defines the parameters associated with the patient's physiological
conditions, and may be configured to model the various different
conditions of the patient's physiology.
[0187] Within the scope of the present disclosure, the therapy
analysis system described above may be implemented in a database
management system and used for treatment of diabetic patients by
general practitioner. Additionally, the therapy analysis system may
be implemented based on multiple daily doses of insulin (using, for
example, syringe type insulin injector, or inhalable insulin
dispenser) rather than based on an insulin pump, where the insulin
related information may be recorded by the patient and uploaded or
transferred to the data management system (for example, the remote
terminal 140 (FIG. 1)). Also, some or all of the data analysis and
display described above may be performed by the analyte monitoring
system 110 (FIG. 1) or the fluid delivery device (120), or by a
separate controller configured for communication with the therapy
management system 100.
[0188] In one embodiment, a method may comprise displaying a first
representation of a medication treatment parameter profile,
displaying a first representation of a physiological profile
associated with the medication treatment parameter profile,
detecting a modification to a segment of the medication treatment
parameter profile, displaying a modified representation of the
medication treatment parameter profile and the physiological
profile based on the detected modification to the segment of the
medication treatment parameter profile, modifying an attribute of
the first representation of the medication treatment parameter
profile, and modifying an attribute of the first representation of
the physiological profile.
[0189] In one aspect modifying the attribute of the first
representation of the medication treatment parameter profile may
include modifying a visual attribute without modifying the
underlying value associated with the profile.
[0190] Moreover, the visual attribute may include one or more of a
color representation, a line representation, visual contrast
representation.
[0191] In another aspect, the modified representation and the first
representation of the medication treatment parameter profile may
include at least an overlapping displayed segment.
[0192] In yet another aspect the modified representation and the
first representation of the physiological profile may be
substantially non-overlapping.
[0193] In one aspect, the medication treatment parameter profile
may include one or more of a basal rate profile, an insulin
sensitivity profile, an insulin to carbohydrate ratio, an meal
event, a bolus event, or an insulin type profile.
[0194] In another aspect, the physiological profile may include a
glucose level profile, an oxygen level profile, or a blood pressure
level profile.
[0195] In yet another aspect, modifying the attribute of the first
representation of the physiological profile may include modifying a
visual attribute without modifying the underlying value associated
with the profile.
[0196] Moreover, when the attribute of the first representation of
the medication treatment parameter profile is modified, the
displayed position of the first representation of the medication
treatment parameter profile is not changed.
[0197] Moreover, when the attribute of the first representation of
the physiological profile is modified, the displayed position of
the first representation of the physiological profile is not
changed.
[0198] Furthermore, the displayed first representation of the
medication treatment parameter profile and the physiological
profile respectively may include one or more of a line graph, a bar
graph, a 2-dimensional graph, or a 3-dimensional graph.
[0199] In another embodiment, an apparatus may comprise, a display
unit, one or more processing units coupled to the display unit, and
a memory for storing instructions which, when executed by the one
or more processing units, may cause the one or more processing
units to display a first representation of a medication treatment
parameter profile, display a first representation of a
physiological profile associated with the medication treatment
parameter profile, detect a modification to a segment of the
medication treatment parameter profile, display a modified
representation of the medication treatment parameter profile and
the physiological profile based on the detected modification to the
segment of the medication treatment parameter profile, modify an
attribute of the first representation of the medication treatment
parameter profile, and modify an attribute of the first
representation of the physiological profile.
[0200] In one aspect, the memory for storing instructions which,
when executed by the one or more processing units, may cause the
one or more processing units to modify a visual attribute
associated with the physiological profile without modifying the
underlying value associated with the first representation of the
physiological profile, and to modify a visual attribute associated
with the first representation of the medication treatment parameter
profile without modifying the underlying value associated with the
medication treatment parameter profile.
[0201] Moreover, the visual attribute may include one or more of a
color representation, a line representation, visual contrast
representation.
[0202] In another aspect, the modified representation and the first
representation of the medication treatment parameter profile may
include at least an overlapping displayed segment.
[0203] Furthermore, the modified representation and the first
representation of the physiological profile may be substantially
non-overlapping.
[0204] In yet another aspect, the medication treatment parameter
profile may include one or more of a basal rate profile, an insulin
sensitivity profile, an insulin to carbohydrate ratio, an meal
event, a bolus event, or an insulin type profile.
[0205] Moreover, the physiological profile may include a glucose
level profile, an oxygen level profile, or a blood pressure level
profile.
[0206] In yet another aspect, when the attribute of the first
representation of the medication treatment parameter profile is
modified, the displayed position of the first representation of the
medication treatment parameter profile may not be changed, and
further, when the attribute of the first representation of the
physiological profile is modified, the displayed position of the
first representation of the physiological profile may not be
changed.
[0207] The various processes described above including the
processes performed by the processor 210 (FIG. 2) in the software
application execution environment in the fluid delivery device 120
(FIG. 1) as well as any other suitable or similar processing units
embodied in the analyte monitoring system 110, the fluid delivery
device 120, and/or the remote terminal 140, including the processes
and routines described in conjunction with FIGS. 3-16, may be
embodied as computer programs developed using an object oriented
language that allows the modeling of complex systems with modular
objects to create abstractions that are representative of real
world, physical objects and their interrelationships. The software
required to carry out the inventive process, which may be stored in
the memory unit 240 (or similar storage devices in the analyte
monitoring system 110 and the remote terminal 140) and executed by
the processor 210, may be developed by a person of ordinary skill
in the art and may include one or more computer program
products.
[0208] Various other modifications and alterations in the structure
and method of operation of this disclosure will be apparent to
those skilled in the art without departing from the scope and
spirit of the disclosure. Although the present disclosure has been
described in connection with specific preferred embodiments, it
should be understood that the present disclosure as claimed should
not be unduly limited to such specific embodiments. It is intended
that the following claims define the scope of the present
disclosure and that structures and methods within the scope of
these claims and their equivalents be covered thereby.
* * * * *