Overcoming Therapeutic Inertia in Type 2 Diabetes: Exploring Machine Learning-Based Scenario Simulation for Improving Short-Term Glycemic Control

Author:

Nicoletta Musacchio1,Zilich Rita2ORCID,Masi Davide3ORCID,Baccetti Fabio4ORCID,Nreu Besmir5,Giorda Carlo Bruno6ORCID,Guaita Giacomo7ORCID,Morviducci Lelio8,Muselli Marco9ORCID,Ozzello Alessandro10ORCID,Pisani Federico2,Ponzani Paola11,Rossi Antonio1213ORCID,Santin Pierluigi14,Verda Damiano9ORCID,Cianni Graziano Di15,Candido Riccardo16

Affiliation:

1. AMD-AI National Group Coordinator Coordinator, UOS Integrating Primary and Specialist Care, ASST Nord Milano, Via Filippo Carcano 17, 20149 Milan, Italy

2. Mix-x Partner, Via Circonvallazione 5, 10015 Ivrea, Italy

3. Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy

4. Diabetes and Endocrinology Unit, ASL Nord-West Tuscany, 54100 Massa Carrara, Italy

5. Diabetology Unit, Careggi Hospital, Largo G.A. Brambilla, 3, 50134 Florence, Italy

6. Diabetes and Endocrinology Unit, ASL TO5, 10023 Chieri, Italy

7. Diabetes and Endocrinology Unit, ASL SULCIS, 09016 Sulcis, Italy

8. Diabates and Nutrition UOC, S. Spirito Hospital—ASL Roma 1, 00913 Rome 00913, Italy

9. Rulex Innovation Labs, Rulex Inc., Via Felice Romani 9/2, 16122 Genoa, Italy

10. AMD Regional Past President, AI AMD National Group, 10090 Bruino, Italy

11. Diabetes and Metabolic Disease Unit ASL 4 Liguria, 16043 Chiavari, Italy

12. IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20149 Milan, Italy

13. Department of Biomedical and Clinical Sciencies, University of Milan, 20157 Milan, Italy

14. Data Scientist Deimos, 33100 Udine, Italy

15. AMD Past President, Diabetes and Metabolic Diseases Unit, Nord-West Tuscany, Livorno Hospital, Viale Alfieri 36, 57124 Livorno, Italy

16. AMD New President, Azienda Sanitaria Universitaria Giuliano Isontina, 34128 Trieste, Italy

Abstract

Background: International guidelines for diabetes care emphasize the urgency of promptly achieving and sustaining adequate glycemic control to reduce the occurrence of micro/macrovascular complications in patients with type 2 diabetes mellitus (T2DM). However, data from the Italian Association of Medical Diabetologists (AMD) Annals reveal that only 47% of T2DM patients reach appropriate glycemic targets, with approximately 30% relying on insulin therapy, either solely or in combination. This artificial intelligence analysis seeks to assess the potential impact of timely insulin initiation in all eligible patients via a “what-if” scenario simulation, leveraging real-world data. Methods: This retrospective cohort study utilized the AMD Annals database, comprising 1,186,247 T2DM patients from 2005 to 2019. Employing the Logic Learning Machine (LLM), we simulated timely insulin use for all eligible patients, estimating its effect on glycemic control after 12 months within a cohort of 85,239 patients. Of these, 20,015 were employed for the machine learning phase and 65,224 for simulation. Results: Within the simulated scenario, the introduction of appropriate insulin therapy led to a noteworthy projected 17% increase in patients meeting the metabolic target after 12 months from therapy initiation within the cohort of 65,224 individuals. The LLM’s projection envisages 32,851 potential patients achieving the target (hemoglobin glycated < 7.5%) after 12 months, compared to 21,453 patients observed in real-world cases. The receiver operating characteristic (ROC) curve analysis for this model demonstrated modest performance, with an area under the curve (AUC) value of 70.4%. Conclusions: This study reaffirms the significance of combatting therapeutic inertia in managing T2DM patients. Early insulinization, when clinically appropriate, markedly enhances patients’ metabolic goals at the 12-month follow-up.

Funder

Sanofi SpA

Publisher

MDPI AG

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3