Automated closed-loop control of diabetes: the artificial pancreas

Abstract

The incidence of Diabetes Mellitus is on the rise worldwide, which exerts enormous health toll on the population and enormous pressure on the healthcare systems. Now, almost hundred years after the discovery of insulin in 1921, the optimization problem of diabetes is well formulated as maintenance of strict glycemic control without increasing the risk for hypoglycemia. External insulin administration is mandatory for people with type 1 diabetes; various medications, as well as basal and prandial insulin, are included in the daily treatment of type 2 diabetes. This review follows the development of the Diabetes Technology field which, since the 1970s, progressed remarkably through continuous subcutaneous insulin infusion (CSII), mathematical models and computer simulation of the human metabolic system, real-time continuous glucose monitoring (CGM), and control algorithms driving closed-loop control systems known as the "artificial pancreas" (AP). All of these developments included significant engineering advances and substantial bioelectronics progress in the sensing of blood glucose levels, insulin delivery, and control design. The key technologies that enabled contemporary AP systems are CSII and CGM, both of which became available and sufficiently portable in the beginning of this century. This powered the quest for wearable home-use AP, which is now under way with prototypes tested in outpatient studies during the past 6 years. Pivotal trials of new AP technologies are ongoing, and the first hybrid closed-loop system has been approved by the FDA for clinical use. Thus, the closedloop AP is well on its way to become the digital-age treatment of diabetes.

Predicting Quality of Overnight Glycaemic Control in Type 1 Diabetes Using Binary Classifiers

“…In particular, people with T1D measure capillary blood glucose several times a day and administer exogenous insulin via multiple daily injections (MDI) or A. Güemes, P. Georgiou, P. Herrero continuous subcutaneous insulin infusion (CSII). Continuous glucose monitoring (CGM) technology [2] has enabled more advanced technologies to support self-management such as sensor-augmented insulin pumps with low-glucose insulin suspend [3], the artificial pancreas [4], and decision support systems (DSS) for insulin dosing [5]. Although the artificial pancreas might be, a priori, the holy grail of the technological solutions for glucose management, slow market adoption, elevated cost, and some unmet customer expectations [6], may limit uptake and emphasize the importance of research focused on DSS [7].…”

Bioelectronic Medicine: From Preclinical Studies on the Inflammatory Reflex to New Approaches in Disease Diagnosis and Treatment

“…In addition to the vagus nerve, studies on the regulatory role of other peripheral and CNS circuitries and the therapeutic usage of their modulation are considerably adding to progress in bioelectronic medicine ( Fig. 3; Talbot et al 2015;Guduru et al 2018;Güemes and Georgiou 2018;Jiman et al 2018;Kibleur and David 2018;Kovatchev 2018;Zhang et al 2018;Pavlov and Tracey 2019). These studies use methodological advances in material science, bioengineering, neuroscience, data analytics, computer modeling and mathematics, immunology, molecular biology, and other disciplines ( Fig.…”

The Bio-inspired Artificial Pancreas for Type 1 Diabetes Control in the Home: System Architecture and Preliminary Results

“…In the last two decades, technological progress in the field of diabetes management, especially in continuous glucose monitoring (CGM) [1], has enabled the development of automated insulin delivery systems, the so-called artificial pancreas (AP). The most common configuration of an AP consists of a CGM sensor and a subcutaneous infusion pump that delivers insulin at a rate decided by a computer program (control algorithm) [2,3].…”