Nonlinear Model Predictive Control and System Identification for a Dual-hormone Artificial Pancreas

Reenberg, Asbjørn Thode; Ritschel, Tobias; Lindkvist, Emilie Bundgaard; Laugesen, Christian; Svensson, Jannet; Ranjan, Ajenthen; Nørgaard, Kirsten; Jørgensen, John Bagterp

doi:10.1016/j.ifacol.2022.07.561

Cited by 7 publications

(9 citation statements)

References 20 publications

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“…During the DH arm some participants were administered glucagon right before dinner announcement, resulting in inadequate meal bolus insulin, and subsequent hyperglycemia. Due to restrictions in the DiaCon AP around meals this led to insulin corrections being administered in the night hours ( 14 ). Another possible explanation could be the occurrence of pressure induced sensor augmentations.…”

Section: Discussionmentioning

confidence: 99%

“…We used our DiaCon system consisting of two Dana Diabecare RS insulin pumps (one for insulin and one for glucagon/saline), a Dexcom G6 sensor (Dexcom, San Diego, CA) and a smartphone (Samsung Galaxy A5 2017 Android phone) containing the DiaCon algorithm ( 14 ) to adjust the pump deliveries based on the CGM values. One pump was filled with insulin aspart (Fiasp ® , Novo Nordisk, Bagsværd, Denmark) and the other with either glucagon (GlucaGen ® , Novo Nordisk, Bagsværd, Denmark) or isotonic saline (sodium chloride 9 mg/dL).…”

Section: Methodsmentioning

confidence: 99%

“…The algorithm computed the insulin and glucagon administration based on predictions obtained with a mathematical model of the blood glucose response to CHO, insulin, and glucagon, i.e., based on nonlinear model predictive control (NMPC). Safety constraints on bolus and basal insulin were based on participants’ insulin pump settings and the glucagon algorithm was constrained to deliver maximally 300 µg glucagon over a two hour period ( 14 ). Meals and exercise were announced to the DiaCon AP.…”

Section: Methodsmentioning

confidence: 99%

“…Exercise mode increased target glucose from 6 to 7 mmol/L and the limit for when glucagon could be administered was increased from 4.5 to 7.0 mmol/L. If SG was ≤7.0 mmol/L at exercise announcement 100 µg glucagon was administered ( 14 ).…”

Section: Methodsmentioning

confidence: 99%

“…Our group has developed the DiaCon AP ( 14 ) which can run in two configurations; SH and DH. A previous version of the system was tested among adults with T1D showing improvements in TIR during exercise and a lesser need for hypoglycemic-CHO treatments when using the DH configuration ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Performance of a dual-hormone closed-loop system versus insulin-only closed-loop system in adolescents with type 1 diabetes. A single-blind, randomized, controlled, crossover trial

et al. 2023

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ObjectiveTo assess the efficacy and safety of a dual-hormone (DH [insulin and glucagon]) closed-loop system compared to a single-hormone (SH [insulin only]) closed-loop system in adolescents with type 1 diabetes.MethodsThis was a 26-hour, two-period, randomized, crossover, inpatient study involving 11 adolescents with type 1 diabetes (nine males [82%], mean ± SD age 14.8 ± 1.4 years, diabetes duration 5.7 ± 2.3 years). Except for the treatment configuration of the DiaCon Artificial Pancreas: DH or SH, experimental visits were identical consisting of: an overnight stay (10:00 pm until 7:30 am), several meals/snacks, and a 45-minute bout of moderate intensity continuous exercise. The primary endpoint was percentage of time spent with sensor glucose values below range (TBR [<3.9 mmol/L]) during closed-loop control over the 26-h period (5:00 pm, day 1 to 7:00 pm, day 2).ResultsOverall, there were no differences between DH and SH for the following glycemic outcomes (median [IQR]): TBR 1.6 [0.0, 2.4] vs. 1.28 [0.16, 3.19]%, p=1.00; time in range (TIR [3.9-10.0 mmol/L]) 68.4 [48.7, 76.8] vs. 75.7 [69.8, 87.1]%, p=0.08; and time above range (TAR [>10.0 mmol/L]) 28.1 [18.1, 49.8] vs. 23.3 [12.3, 27.2]%, p=0.10. Mean ( ± SD) glucose was higher during DH than SH (8.7 ( ± 3.2) vs. 8.1 ( ± 3.0) mmol/L, p<0.001) but coefficient of variation was similar (34.8 ( ± 6.8) vs. 37.3 ( ± 8.6)%, p=0.20). The average amount of rescue carbohydrates was similar between DH and SH (6.8 ( ± 12.3) vs. 9.5 ( ± 15.4) grams/participant/visit, p=0.78). Overnight, TIR was higher, TAR was lower during the SH visit compared to DH. During and after exercise (4:30 pm until 7 pm) the SH configuration produced higher TIR, but similar TAR and TBR compared to the DH configuration.ConclusionsDH and SH performed similarly in adolescents with type 1 diabetes during a 26-hour inpatient monitoring period involving several metabolic challenges including feeding and exercise. However, during the night and around exercise, the SH configuration outperformed DH.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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