Modeling the effect of glucagon on endogenous glucose production in type 1 diabetes: On the role of glucagon receptor dynamics

This paper validates a glucoregulatory model including glucagon receptors dynamics in the description of endogenous glucose production (EGP). A set of models from literature are selected for a head-to-head comparison in order to evaluate the role of glucagon receptors. Each EGP model is incorporated into an existing glucoregulatory model and validated using a set of clinical data, where both insulin and glucagon are administered. The parameters of each EGP model are identified in the same optimization problem, minimizing the root mean square error (RMSE) between the simulation and the clinical data. The results show that the RMSE for the proposed receptors-based EGP model was lower when compared to each of the considered models (Receptors approach: 7.13 +/- 1.71 mg/dl vs. 7.76 +/- 1.45 mg/dl (P = 0.066), 8.45 +/- 1.38 mg/dl (P = 0.011) and 8.99 +/- 1.62 mg/dl (P = 0.007)). This raises the possibility of considering glucagon receptors dynamics in type 1 diabetes simulators.