Model for Simulating Fasting Glucose in Type 2 Diabetes and the Effect of Adherence to Treatment

The primary goal of this paper is to predict fasting glucose levels in type 2 diabetes (T2D) in long-acting insulin treatment. The paper presents a model for simulating insulinglucose dynamics in T2D patients. The model combines a physiological model of type 1 diabetes (T1D) and an endogenous insulin production model in T2D. We include a review of sources of variance in fasting glucose values in long-acting insulin treatment, with respect to dose guidance algorithms. We use the model to simulate fasting glucose levels in T2D long-acting insulin treatment and compare the results with clinical trial results where a dose guidance algorithm was used. We investigate sources of variance and through simulations evaluate the contribution of adherence to variance and dose guidance quality. The results suggest that the model for simulation of T2D patients is sufficient for simulating fasting glucose levels during titration in a clinical trial. Adherence to insulin injections plays an important role considering variance in fasting glucose. For adherence levels 100%, 70% and 50%, the coefficient of variation of simulated fasting glucose levels were similar to observed variances in insulin treatment. The dose guidance algorithm suggested too large doses in 0.0%, 5.3% and 24.4% of cases, respectively. Adherence to treatment is an important source of variance in long-acting insulin titration.