Adaptive control strategy for regulation of blood glucose levels in patients with type 1 diabetes

Abstract Current insulin therapy for patients with type 1 diabetes often results in high variability in blood glucose concentrations and may cause hyperglycemic/hypoglycemic episodes. Closing the glucose control loop with a fully automated electro-mechanical pancreas will improve the quality of life for insulin-dependent patients. An adaptive control algorithm is proposed to keep glucose concentrations within normoglycemic range and dynamically respond to glycemic challenges. A model-based control strategy is used to calculate the required insulin infusion rate, while the model parameters are recursively tuned. The algorithm handles delays associated with insulin absorption, time-lag between subcutaneous and blood glucose concentrations, and variations in inter/intra-subject glucose–insulin dynamics. Simulation results for simultaneous meal and physiological disturbances are demonstrated for subcutaneous insulin infusion.

[1]  B. Bequette A critical assessment of algorithms and challenges in the development of a closed-loop artificial pancreas. , 2005, Diabetes technology & therapeutics.

[2]  C. Saudek,et al.  Timing of changes in interstitial and venous blood glucose measured with a continuous subcutaneous glucose sensor. , 2003, Diabetes.

[3]  Giuseppe De Nicolao,et al.  Adaptive controllers for intelligent monitoring , 1995, Artif. Intell. Medicine.

[4]  D. Gough,et al.  Is blood glucose predictable from previous values? A solicitation for data. , 1999, Diabetes.

[5]  John J Mastrototaro,et al.  Subcutaneous glucose predicts plasma glucose independent of insulin: implications for continuous monitoring. , 1999, American journal of physiology. Endocrinology and metabolism.

[6]  Srinivas Karra,et al.  PREDICTIVE CONTROL OF BLOOD GLUCOSE CONCENTRATION IN TYPE-I DIABETIC PATIENTS USING LINEAR INPUT-OUTPUT MODELS , 2007 .

[7]  S Andreassen,et al.  Model predictive glycaemic regulation in critical illness using insulin and nutrition input: a pilot study. , 2006, Medical engineering & physics.

[8]  Ali Cinar,et al.  ADAPTIVE CONTROL STRATEGY FOR GLUCOSE REGULATION USING RECURSIVE LINEAR MODELS , 2007 .

[9]  G M Steil,et al.  Can interstitial glucose assessment replace blood glucose measurements? , 2000, Diabetes technology & therapeutics.

[10]  Claudio Cobelli,et al.  An integrated mathematical model of the dynamics of blood glucose and its hormonal control , 1982 .

[11]  Howard Zisser,et al.  Closed-Loop Control and Advisory Mode Evaluation of an Artificial Pancreatic β Cell: Use of Proportional-Integral-Derivative Equivalent Model-Based Controllers , 2008, Journal of diabetes science and technology.

[12]  L. Quinn,et al.  Estimation of future glucose concentrations with subject-specific recursive linear models. , 2009, Diabetes technology & therapeutics.

[13]  A. Fuller Optimal nonlinear control of systems with pure delay , 1968 .

[14]  Roman Hovorka,et al.  Multicentric, randomized, controlled trial to evaluate blood glucose control by the model predictive control algorithm versus routine glucose management protocols in intensive care unit patients. , 2006, Diabetes care.

[15]  Howard C. Zisser,et al.  A Feedforward-Feedback Glucose Control Strategy for Type 1 Diabetes Mellitus. , 2008, Journal of process control.

[16]  G. Steil,et al.  Determination of plasma glucose during rapid glucose excursions with a subcutaneous glucose sensor. , 2003, Diabetes technology & therapeutics.

[17]  R.S. Parker,et al.  A model-based algorithm for blood glucose control in Type I diabetic patients , 1999, IEEE Transactions on Biomedical Engineering.

[18]  R. Hovorka,et al.  Nonlinear model predictive control of glucose concentration in subjects with type 1 diabetes. , 2004, Physiological measurement.

[19]  Eric Renard,et al.  Closed loop insulin delivery using implanted insulin pumps and sensors in type 1 diabetic patients , 2006 .

[20]  B. Schneider,et al.  Myocardial infarction and stroke in early years after diagnosis of type 2 diabetes: risk factors and relation to self-monitoring of blood glucose. , 2009, Diabetes technology & therapeutics.

[21]  Eduardo F. Camacho,et al.  Multivariable generalised predictive controller based on the Smith predictor , 2000 .

[22]  R. Hovorka,et al.  Partitioning glucose distribution/transport, disposal, and endogenous production during IVGTT. , 2002, American journal of physiology. Endocrinology and metabolism.

[23]  T Lotz,et al.  A novel, model-based insulin and nutrition delivery controller for glycemic regulation in critically ill patients. , 2006, Diabetes technology & therapeutics.

[24]  David W. Clarke,et al.  Generalized predictive control - Part I. The basic algorithm , 1987, Autom..

[25]  O. J. M. Smith,et al.  A controller to overcome dead time , 1959 .

[26]  W. Schenk,et al.  Does Physiological Blood Glucose Control Require an Adaptive Control Strategy? , 1987, IEEE Transactions on Biomedical Engineering.

[27]  E.R. Carson,et al.  A spectrum of approaches for controlling diabetes , 1992, IEEE Control Systems.

[28]  Dale E. Seborg,et al.  IDENTIFICATION OF LINEAR DYNAMIC MODELS FOR TYPE 1 DIABETES: A SIMULATION STUDY , 2006 .

[29]  Joost B L Hoekstra,et al.  Relationship between interstitial and blood glucose in type 1 diabetes patients: delay and the push-pull phenomenon revisited. , 2007, Diabetes technology & therapeutics.

[30]  Katsuhiko Ogata,et al.  Discrete-time control systems , 1987 .

[31]  F. Hariri,et al.  Interstitial fluid glucose dynamics during insulin-induced hypoglycaemia , 2005, Diabetologia.

[32]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[33]  A. Cinar,et al.  Glucosim: Educational Software for Virtual Experiments with Patients with Type 1 Diabetes , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[34]  Giovanni Sparacino,et al.  Glucose Concentration can be Predicted Ahead in Time From Continuous Glucose Monitoring Sensor Time-Series , 2007, IEEE Transactions on Biomedical Engineering.

[35]  Howard Wolpert,et al.  Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group , 2008 .

[36]  R. Bonnecaze,et al.  Measurement and modeling of the transient difference between blood and subcutaneous glucose concentrations in the rat after injection of insulin. , 1998, Proceedings of the National Academy of Sciences of the United States of America.

[37]  F. Doyle,et al.  Detection of a Meal Using Continuous Glucose Monitoring , 2008, Diabetes Care.

[38]  G. Steil,et al.  Feasibility of Automating Insulin Delivery for the Treatment of Type 1 Diabetes , 2006, Diabetes.

[39]  D. Klonoff Continuous glucose monitoring: roadmap for 21st century diabetes therapy. , 2005, Diabetes care.

[40]  C Cobelli,et al.  A Simulation Study on a Self-Tuning Portable Controller of Blood Glucose , 1993, The International journal of artificial organs.

[41]  John Thomas Sorensen,et al.  A physiologic model of glucose metabolism in man and its use to design and assess improved insulin therapies for diabetes , 1985 .

[42]  V. Wertz,et al.  Adaptive Optimal Control: The Thinking Man's G.P.C. , 1991 .

[43]  Francis J. Doyle,et al.  Glucose control design using nonlinearity assessment techniques , 2005 .

[44]  B.W. Bequette,et al.  Model predictive control of blood glucose in type I diabetics using subcutaneous glucose measurements , 2002, Proceedings of the 2002 American Control Conference (IEEE Cat. No.CH37301).

[45]  J. Mastrototaro,et al.  Continuous glucose monitoring used to adjust diabetes therapy improves glycosylated hemoglobin: a pilot study. , 1999, Diabetes research and clinical practice.

[46]  D. H. Mee An extension of predictor control for systems with control time-delays , 1973 .

[47]  Roman Hovorka Management of diabetes using adaptive control , 2005 .

[48]  Julio E. Normey-Rico,et al.  Robustness effects of a prefilter in a Smith predictor-based generalised predictive controller , 1999 .

[49]  Justin A. Gantt,et al.  TYPE 1 DIABETIC PATIENT INSULIN DELIVERY USING ASYMMETRIC PI CONTROL , 2007 .