Insulin Replacement Across the Menstrual Cycle in Women with Type 1 Diabetes: An In Silico Assessment of the Need for Ad Hoc Technology
Abstract
Background: Women with type 1 diabetes (T1D) of fertile age may experience fluctuations in insulin needs across the menstrual cycle. When present, these fluctuations complicate glucose management and oftentimes worsen glycemic control. In this work, an in silico analysis was conducted to assess whether current technology is sufficient to handle changes in insulin needs due to the menstrual cycle in women with T1D. Methods: Euglycemic clamp studies were performed in 16 women with T1D in the follicular phase (FP) and luteal phase (LP) of the menstrual cycle. Interphase insulin sensitivity (IS) variability observed in the data was modeled and introduced in the University of Virginia/Padova T1D Simulator. Open-loop and closed-loop insulin delivery was tested in two in silico studies, without ( nominal study ) and with ( informed study ) a priori knowledge on cycle-related IS variability informing insulin therapy. Glycemic metrics were computed on the obtained glucose traces. Results: In the pool of studied women, the glucose infusion rate area under the curve significantly decreased from FP to LP ( P = 0.0107), indicating an average decrease of IS in LP. When introduced in the simulator, this pattern led to increased time spent >180 and >250 mg/dL during LP versus FP in the nominal studies, irrespective of the insulin delivery strategy. In the informed studies, glycemic metrics stabilized across the cycle. Conclusion: This work suggests that current insulin delivery technology ma…
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Fourteen studies were included in the systematic review.
“We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients.”
From Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review (2023) · cites this paper as [20]
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- Authors
- Diaz C., J. L., Fabris, C., Breton, M. D., & Cengiz, E.
- Affiliations
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.
- University of Virginia (US)
- University of California, San Francisco (US)
- Corresponding author
- Fabris, Chiara
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2022-10-31
- Volume
- 24
- Issue
- 11
- Pages
- 832-841
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- OpenAlex
- W4283076334
- Cited by
- 19
- References
- 27
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 2 · 2023: 2
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, menstrual cycle, insulin replacement therapy, artificial pancreas, euglycemic clamp, luteal phase, follicular phase, glycemic control, insulin dosing algorithms, in silico modeling
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 1, Female, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Insulin Resistance, Menstrual Cycle, Technology, Insulin, Regular, Human
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