Development of AIDA v4.3b Diabetes Simulator: Technical Upgrade to Support Incorporation of Lispro, Aspart, and Glargine Insulin Analogues

Table 1

Comparison of features in current release of AIDA v4 diabetes simulator (on left) with planned features in future versions of the software (v4.5) and later (on right). IDDM: insulin-dependent (type 1) diabetes mellitus. NIDDM: non-insulin-dependent (type 2) diabetes mellitus.

AIDA v4 current version	AIDA v4.5 (and later) future versions
Model building/structure	New features
(i) Interconnected insulin-glucose submodels	(i) Comprehensive insulin/glucose model built from unit processes (diabetes “lego”-land)
(ii) Empirical models for insulin/glucose dynamics and control	(ii) Physiologically based model of insulin absorption (generic) and kinetics
(iii) Linear insulin disposition/elimination (superposition principle applies)	(iii) Fewer (only necessary and realistic) assumptions
(iv) Use of fictive compartment (“active” insulin)	(iv) Patient specification with minimal number of identifiable parameters
(v) Over parameterisation of patients (use of nonidentifiable parameters such as separate hepatic and peripheral insulin sensitivities)	(v) Specification of typical patient types (insulin sensitive versus resistant, etc.) parameterised accordingly
Limitations	Overcoming limitations
(i) IDDM only	(i) Both IDDM and NIDDM
(ii) No insulin analogues	(ii) Both rapidly acting and very long-acting insulin analogues added
(iii) Insulin dose ≤40 units	(iii) Insulin dose ≤60 units
(iv) Carbohydrate intake/meal ≤80 g	(iv) Carbohydrate intake/meal ≤120 g
(v) Oral hypoglycaemic drugs not incorporated	(v) Different types of oral hypoglycaemic drugs included
(vi) Lifestyle events/effects not included (stress, physical activity, menstrual cycle, etc.)	(vi) Lifestyle events (stress, physical activity, menstrual cycle, etc.) included
Technical	New features
(i) Menu driven data entry (nongraphical)	(i) Intuitive graphical user interface