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- Silber, Hanna E., et al.
(författare)
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Optimization of the intravenous glucose tolerance test in T2DM patients using optimal experimental design
- 2009
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Ingår i: Journal of Pharmacokinetics and Pharmacodynamics. - : Springer Science and Business Media LLC. - 1567-567X .- 1573-8744. ; 36:3, s. 281-295
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Tidskriftsartikel (refereegranskat)abstract
- Intravenous glucose tolerance test (IVGTT) provocations are informative, but complex and laborious, for studying the glucose-insulin system. The objective of this study was to evaluate, through optimal design methodology, the possibilities of more informative and/or less laborious study design of the insulin modified IVGTT in type 2 diabetic patients. A previously developed model for glucose and insulin regulation was implemented in the optimal design software PopED 2.0. The following aspects of the study design of the insulin modified IVGTT were evaluated; (1) glucose dose, (2) insulin infusion, (3) combination of (1) and (2), (4) sampling times, (5) exclusion of labeled glucose. Constraints were incorporated to avoid prolonged hyper- and/or hypoglycemia and a reduced design was used to decrease run times. Design efficiency was calculated as a measure of the improvement with an optimal design compared to the basic design. The results showed that the design of the insulin modified IVGTT could be substantially improved by the use of an optimized design compared to the standard design and that it was possible to use a reduced number of samples. Optimization of sample times gave the largest improvement followed by insulin dose. The results further showed that it was possible to reduce the total sample time with only a minor loss in efficiency. Simulations confirmed the predictions from PopED. The predicted uncertainty of parameter estimates (CV) was low in all tested cases, despite the reduction in the number of samples/subject. The best design had a predicted average CV of parameter estimates of 19.5%. We conclude that improvement can be made to the design of the insulin modified IVGTT and that the most important design factor was the placement of sample times followed by the use of an optimal insulin dose. This paper illustrates how complex provocation experiments can be improved by sequential modeling and optimal design.
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| 2. |
- Silber, Hanna E, 1977-, et al.
(författare)
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The impact of misspecification of residual error or correlation structure on the type I error rate for covariate inclusion
- 2009
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Ingår i: Journal of Pharmacokinetics and Pharmacodynamics. - : Springer Science and Business Media LLC. - 1567-567X .- 1573-8744. ; 36:1, s. 81-99
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Tidskriftsartikel (refereegranskat)abstract
- It has been shown that when using the FOCE method in NONMEM, the likelihood ratio test (LRT) can be sensitive to the use of an inappropriate estimation method in that ignoring an existing eta-epsilon interaction leads to actual significance levels for type I errors being higher than the nominal levels. The objective of this study was to assess through simulations the LRT sensitivity to various types of residual error model misspecifications in both continuous and categorical data. The study contained two parts, simulations based on continuous and categorical data. Data sets containing 250 individuals with up to 24 observations per individual were simulated multiple times (1000) with different types of residual error models for the continuous data and different strength of correlation between observations for the categorical data. The data sets were analyzed using either the correct or a simpler (incorrect) model with or without addition of a covariate. The type I error rate of inclusion of the non-informative covariate on the 5% level was calculated as the number of runs where the drop in the objective function value (OFV) was larger than 3.84 when the covariate relationship was included in the model using the correct or the incorrect model. The difference in OFV between the model with the correct and the incorrect structure was also calculated as a measure of the residual error model misspecification. For continuous data the FOCE method was used in most cases (with interaction when appropriate). The Laplacian estimation method was used for one of the continuous models and for categorical data. The results showed that the residual error model misspecifications when the erroneous model was used were pronounced, as indicated by the OFV being substantially higher than for the corresponding correct models. The significance levels of the LRT with the incorrect model were appropriate in all cases but ignoring (serial) correlations between observations (continuous and categorical data) as well as when the eta-epsilon interaction was ignored (which has previously been shown, continuous data). When ignoring correlation, the type I error rates were shown to be sensitive to the correlation strength, the number of observations per individual and the magnitude of the inter-individual variability on clearance. We conclude that the LRT appears robust towards all tested cases, but ignoring (serial) correlations between observations and eta-epsilon interaction.
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