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Background: Advanced decision support systems for type 1 diabetes (T1D) management often embed prediction modules, which allow T1D people to take preventive actions to avoid critical episodes like hypoglycemia. Real-time prediction of blood glucose (BG) concentration relies on a subject-specific model of glucose-insulin dynamics. Model parameter identification is usually based on the mean square error (MSE) cost function, and the model is usually used to predict BG at a single prediction horizon (PH). Finally, a hypo-alarm is raised if the predicted BG crosses a threshold. This work aims to show that real-time hypoglycemia forecasting can be improved by leveraging: a glucose-specific mean square error (gMSE) cost function in model’s parameters identification, and a “prediction-funnel,” that is, confidence intervals (CIs) for multiple PHs, within the hypo-alarm-raising strategy. Methods: Autoregressive integrated moving average with exogenous input (ARIMAX) models are selected to illustrate the proposed solution (use of gMSE and prediction-funnel) and its assessment against the conventional approach (MSE and single PH). The gMSE penalizes the model misfit in unsafe BG ranges (e.g., hypoglycemia), and the prediction-funnel allows raising an alarm by monitoring if the CIs cross a suitable threshold. The algorithms were evaluated by measuring precision ( P), recall ( R), F1-score ( F1), false positive per day (FP/day), and time gain (TG) on a real dataset collected in 11 T1D individuals. Results: The best performance is achieved exploiting both the gMSE and the prediction-funnel: P = 65%, R = 88%, F1 = 75%, FP/day = 0.29, and mean TG = 15 minutes. Conclusions: The combined use of a glucose-specific metric and an alarm-raising strategy based on the prediction-funnel allows achieving a more effective and reliable hypoglycemia prediction algorithm.

Accurate blood glucose (BG) forecasting is key in diabetes management, as it allows preventive actions to mitigate harmful hypoglycemic/hyperglycemic episodes. Considering the encouraging results obtained by seasonal stochastic models in proof-of-concept studies, this work assesses the methodology in two datasets (open-loop and closed-loop) recorded in free-living conditions. First, similar postprandial glycemic profiles are grouped together with fuzzy C-means clustering. Then, a seasonal stochastic model is identified for each cluster. Finally, real-time BG forecasting is performed by weighting each model’s prediction. The proposed methodology (named C-SARIMA) is compared to other linear and nonlinear black-box methods: autoregressive integrated moving average (ARIMA), its variant with input (ARIMAX), a feed-forward neural network (NN), and its modified version (NN-X) fed by BG, insulin, and carbohydrates (timing and dosing) information for several prediction horizons (PHs). In the open-loop dataset, C-SARIMA grants a median root-mean-squared error (RMSE) of 20.13 mg/dL (PH = 30) and 27.23 mg/dL (PH = 45), not significantly different from ARIMA and NN. Over a longer PH, C-SARIMA achieves an RMSE = 31.96 mg/dL (PH = 60) and RMSE = 33.91 mg/dL (PH = 75), significantly outperforming the ARIMA and NN, without significant differences from the ARIMAX for PH ≥ 45 and the NN-X for PH ≥ 60. Similar results hold on the closed-loop dataset: for PH = 30 and 45 min, the C-SARIMA achieves an RMSE = 21.63 mg/dL and RMSE = 29.67 mg/dL, not significantly different from the ARIMA and NN. On longer PH, the C-SARIMA outperforms the ARIMA for PH > 45 and the NN for PH > 60 without significant differences from the ARIMAX for PH ≥ 45. Although using less input information, the C-SARIMA achieves similar performance to other prediction methods such as the ARIMAX and NN-X and outperforming the CGM-only approaches on PH > 45min.

In type 1 diabetes management, the availability of algorithms capable of accurately forecasting future blood glucose (BG) concentrations and hypoglycemic episodes could enable proactive therapeutic actions, e.g., the consumption of carbohydrates to mitigate, or even avoid, an impending critical event. The only input of this kind of algorithm is often continuous glucose monitoring (CGM) sensor data, because other signals (such as injected insulin, ingested carbs, and physical activity) are frequently unavailable. Several predictive algorithms fed by CGM data only have been proposed in the literature, but they were assessed using datasets originated by different experimental protocols, making a comparison of their relative merits difficult. The aim of the present work was to perform a head-to-head comparison of thirty different linear and nonlinear predictive algorithms using the same dataset, given by 124 CGM traces collected over 10 days with the newest Dexcom G6 sensor available on the market and considering a 30-min prediction horizon. We considered the state-of-the art methods, investigating, in particular, linear black-box methods (autoregressive, autoregressive moving-average, and autoregressive integrated moving-average, ARIMA) and nonlinear machine-learning methods (support vector regression, SVR, regression random forest, feed-forward neural network, fNN, and long short-term memory neural network). For each method, the prediction accuracy and hypoglycemia detection capabilities were assessed using either population or individualized model parameters. As far as prediction accuracy is concerned, the results show that the best linear algorithm (individualized ARIMA) provides accuracy comparable to that of the best nonlinear algorithm (individualized fNN), with root mean square errors of 22.15 and 21.52 mg/dL, respectively. As far as hypoglycemia detection is concerned, the best linear algorithm (individualized ARIMA) provided precision = 64%, recall = 82%, and one false alarm/day, comparable to the best nonlinear technique (population SVR): precision = 63%, recall = 69%, and 0.5 false alarms/day. In general, the head-to-head comparison of the thirty algorithms fed by CGM data only made using a wide dataset shows that individualized linear models are more effective than population ones, while no significant advantages seem to emerge when employing nonlinear methodologies.