Linear parameter-varying model to design control laws for an artificial pancreas

Optimized nonlinear robust controller along with model-parameter estimation for blood glucose regulation in type-1 diabetes

Glucose acts as a fundamental energy source for cells and plays a pivotal role in various physiological processes, including metabolism, signaling, and cellular control. Maintaining precise regulation of blood glucose levels is crucial for overall health and equilibrium. To achieve this balance, insulin is administered either orally or through an artificial pancreas (AP) during sleep, utilizing control algorithms based on mathematical models to regulate blood glucose concentration (BGC). The extended Bergman minimal model (EBMM) is an advanced mathematical framework that incorporates a state variable to accommodate disturbances in insulin levels triggered by factors such as meal intake or exercise-induced sugar burning. In our study, we propose robust nonlinear controllers: adaptive backstepping sliding mode control (AB-SMC), and adaptive backstepping integral super twisting sliding mode control (ABIST-SMC) and compare these with the backstepping sliding mode control (B-SMC) for stabilizing BGC in type 1 diabetic patients. These controllers aim to regulate blood glucose levels in type 1 diabetic patients by providing robust and adaptive control strategies that mitigate disturbances and ensure stability, ultimately enhancing health outcomes and quality of life. Moreover, adaptive parameter estimation is incorporated to eliminate the need for exact model parameter values for control design. The controller gains are meticulously fine-tuned using improved grey wolf optimization, with the integral time absolute error serving as the objective function. Notably, the ABIST-SMC controller emerges as the most efficient, achieving the desired reduction level in less than 1.92 min. The stability of the proposed controllers is rigorously analyzed using the Lyapunov control theory, demonstrating their capability to achieve asymptotic stability. Simulations are conducted to evaluate and compare the performance of the suggested controllers. Additionally, hardware validation is executed using a hardware-in-loop experimental setup.

Predictor-Based Output Feedback Control of Tumour Growth With Positive Input: Application to Antiangiogenic Therapy

Controlling tumour growth systems presents significant challenges due to the inherent restriction of positive input in biological systems, along with delays in system output and input measurements. Traditional control methods struggle to address these issues effectively, as they rely heavily on real-time feedback from system outputs. The delays in output measurements can lead to instability in closed-loop systems, whereas the inability of conventional approaches to manage the positive input constraint often results in ineffective control. In this study, the authors propose a novel control system designed to overcome these challenges. First, a system state prediction observer that utilises delayed output measurements was developed. Next, a backstepping technique was utilized to develop a feedback controller that ensures the control input stays positive, thereby guaranteeing the system's asymptotic stability. Furthermore, numerical comparisons with previous research validate the effectiveness of the proposed strategy. Overall, the approach offers a promising solution to the issues of delays and positive input constraints in tumour growth control systems.

Hardware design for blood glucose control based on the Sorensen diabetic patient model using a robust evolving cloud-based controller

Diabetes Mellitus (DM) is the most hazardous public health challenge requiring engineering study to prevent disease complications. In this paper, a Sorensen-based diabetic model is presented in which the insulin-glucose process of a Type 1 patient is maintained by considering other factors such as physical characteristics and changes in mental aspects of the diabetic patient. The purpose of the research is to include a non-linear model of a patient with diabetes who is affected by stress, meals, exercise, and Insulin Sensitivity (IS), and a suitable RECCo controller is designed as a notable recent innovation that implements the concept of ANYA fuzzy rule-based system, which is an online adaptive type of controller that is used in this research work with an uncertainty case of the condition, where the blood glucose must be regulated. To ensure the performance of the proposed controller, a simple insulin pump is designed in a practical case, and a hardware experiment is conducted. The result of the hardware is analyzed and shows the success of the implementation of the controller in blood glucose regulation, thereby preventing complications such as hypoglycemia and hyperglycemia. The comparison analysis of RECCo was performed with other types of controllers, such as MPC and MRAC. The accuracy of the model was validated using the N-BEATS algorithm with a data-set collected from the simulated model, which is around 98%.

Auto adaptation of closed-loop insulin delivery system using continuous reward functions and incremental discretization

Several closed or hybrid loop controllers for Blood Glucose (BG) regulation, which are also known as Artificial Pancreas (AP) Systems or Automated Insulin Delivery systems (AIDs), are in development worldwide. Most AIDs are designed and evaluated for short-term performance, with a particular emphasis on the post-meal period. However, if controllers are not adapted properly to account for variations in physiology that affect Insulin Sensitivity (IS), the AIDs may perform inadequately. In this work, the performance of two Reinforcement Learning (RL) agents trained under both piecewise and continuous reward functions is evaluated in-silico for long-term adaptation of a Fully Automated Insulin Delivery (fAID) system. An automatic adaptive discretization scheme that expands the state space as needed is also implemented to avoid disproportionate state space exploration. The proposed agents are evaluated for long-term adaptation of the Automatic Regulation of Glucose (ARG) algorithm, considering variations in IS. Results show that both RL agents have improved performance compared to a rule-based decision-making approach and the baseline controller for the majority of the adult population. Moreover, the use of a continuous shaped reward function proves to enhance the performance of the agents further than a piecewise one.

Automated blood glucose regulation for nonlinear model of type-1 diabetic patient under uncertainties: GWOCS type-2 fuzzy approach

Regulating blood glucose level (BGL) for type-1 diabetic patient (T1DP) accurately is very important issue, an uncontrolled BGL outside the standard safe range between 70 and 180 mg/dl results in dire consequences for health and can significantly increase the chance of death. So the purpose of this study is to design an optimized controller that infuses appropriate amounts of exogenous insulin into the blood stream of T1DP proportional to the amount of obtained glucose from food. The nonlinear extended Bergman minimal model is used to present glucose-insulin physiological system, an interval type-2 fuzzy logic controller (IT2FLC) is utilized to infuse the proper amount of exogenous insulin. Superiority of IT2FLC in minimizing the effect of uncertainties in the system depends primarily on the best choice of footprint of uncertainty (FOU) of IT2FLC. So a comparison includes four different optimization methods for tuning FOU including hybrid grey wolf optimizer-cuckoo search (GWOCS) and fuzzy logic controller (FLC) method is constructed to select the best controller approach. The effectiveness of the proposed controller was evaluated under six different scenarios of T1DP using Matlab/Simulink platform. A 24-h scenario close to real for 100 virtual T1DPs subjected to parametric uncertainty, uncertain meal disturbance and random initial condition showed that IT2FLC accurately regulate BGL for all T1DPs within the standard safe range. The results indicated that IT2FLC using GWOCS can prevent side effect of treatment with blood-sugar-lowering medication. Also stability analysis for the system indicated that the system operates within the stability region of nonlinear system.

Robust positive control of tumour growth using angiogenic inhibition

In practice, many physical systems, including physiological ones, can be considered whose input can take only positive quantities. However, most of the conventional control methods do not support the positivity of the main input data to the system. Furthermore, the parameters of these systems, similar to other non-linear systems, are either not accurately identified or may change over time. Therefore, it is reasonable to design a controller that is robust against system uncertainties. A robust positive-input control method is proposed for the automatic treatment of targeted anti-angiogenic therapy implementing a recently published tumour growth model based on experiments conducted on mouse models. The backstepping (BS) approach is applied to design the positive input controller using sensory data of tumour volume as feedback. Unlike previous studies, the proposed controller only requires the measurement of tumour volume and does not require the measurement of inhibitor level. The exponential stability of the controlled system is proved mathematically using the Lyapunov theorem. As a result, the convergence rate of the tumour volume can be controlled, which is an important issue in cancer treatment. Moreover, the robustness of the system against parametric uncertainties is verified mathematically using the Lyapunov theorem. The real-time simulation results-based (OPAL-RT) and comparisons with previous studies confirm the theoretical findings and effectiveness of the proposed method.

Positive input observer-based controller design for blood glucose regulation for type 1 diabetic patients: A backstepping approach

In practice, there are many physical systems that can have only positive inputs, such as physiological systems. Most conventional control methods cannot ensure that the main system input is positive. A positive input observer-based controller is designed for an intravenous glucose tolerance test model of type 1 diabetes mellitus (T1DM). The backstepping (BS) approach is employed to design the feedback controller for artificial pancreas (AP) systems, based on the Extended Bergman's Minimal Model (EBMM). The EBMM represents the T1DM in terms of the blood glucose concentration (BGC), insulin concentration, and plasma level and the disturbance of insulin during medication due to either meal intake or burning sugar by doing some physical exercise. The insulin concentration and plasma level are estimated using observers, and these estimations are applied as feedback to the controller. The asymptotic stability of the observer-based controller is proved using the Lyapunov theorem. Moreover, it is proved that the system is bounded input-bounded output (BIBO) stable in the presence of uncertainties generated by uncertain parameters and external disturbance. For realistic situations, we consider only the BGC to be available for measurement and additionally inter-and intra-patient variability of system parameters is considered.

Towards the Integration of an Islet-Based Biosensor in Closed-Loop Therapies for Patients With Type 1 Diabetes

In diabetes mellitus (DM) treatment, Continuous Glucose Monitoring (CGM) linked with insulin delivery becomes the main strategy to improve therapeutic outcomes and quality of patients' lives. However, Blood Glucose (BG) regulation with CGM is still hampered by limitations of algorithms and glucose sensors. Regarding sensor technology, current electrochemical glucose sensors do not capture the full spectrum of other physiological signals, i.e., lipids, amino acids or hormones, relaying the general body status. Regarding algorithms, variability between and within patients remains the main challenge for optimal BG regulation in closed-loop therapies. This work highlights the simulation benefits to test new sensing and control paradigms which address the previous shortcomings for Type 1 Diabetes (T1D) closed-loop therapies. The UVA/Padova T1DM Simulator is the core element here, which is a computer model of the human metabolic system based on glucose-insulin dynamics in T1D patients. That simulator is approved by the US Food and Drug Administration (FDA) as an alternative for pre-clinical testing of new devices and closed-loop algorithms. To overcome the limitation of standard glucose sensors, the concept of an islet-based biosensor, which could integrate multiple physiological signals through electrical activity measurement, is assessed here in a closed-loop insulin therapy. This investigation has been addressed by an interdisciplinary consortium, from endocrinology to biology, electrophysiology, bio-electronics and control theory. In parallel to the development of an islet-based closed-loop, it also investigates the benefits of robust control theory against the natural variability within a patient population. Using 4 meal scenarios, numerous simulation campaigns were conducted. The analysis of their results then introduces a discussion on the potential benefits of an Artificial Pancreas (AP) system associating the islet-based biosensor with robust algorithms.

Sliding-mode-based controllers for automation of blood glucose concentration for type 1 diabetes

Destruction of β-cells in pancreas causes deficiency in insulin production that leads to diabetes in the human body. To cope with this problem, insulin is either taken orally during the day or injected into the patient's body using artificial pancreas (AP) during sleeping hours. Some mathematical models indicate that AP uses control algorithms to regulate blood glucose concentration (BGC). The extended Bergman minimal model (EBMM) incorporates, as a state variable, the disturbance in insulin level during medication due to either meal intake or burning sugar by engaging in physical exercise. In this research work, EBMM and proposed finite time robust controllers are used, including the sliding mode controller (SMC), backstepping SMC (BSMC) and supertwisting SMC (second-order SMC or SOSMC) for automatic stabilisation of BGC in type 1 diabetic patients. The proposed SOSMC diminishes the chattering phenomenon which appears in the conventional SMC. The proposed BSMC is a recursive technique which becomes robust by the addition of the SMC. Lyapunov theory has been used to prove the asymptotic stability of the proposed controllers. Simulations have been carried out in MATLAB/Simulink for the comparative study of the proposed controllers under varying data of six different type 1 diabetic patients available in the literature.

Automatic glycemic regulation for the pediatric population based on switched control and time-varying IOB constraints: an in silico study

Artificial pancreas (AP) systems have shown to improve glucose regulation in type 1 diabetes (T1D) patients. However, full closed-loop performance remains a challenge particularly in children and adolescents, since these age groups often present the worst glycemic control. In this work, an algorithm based on switched control and time-varying IOB constraints is presented. The proposed control strategy is evaluated in silico using the FDA-approved UVA/ Padova simulator and its performance contrasted with the previously introduced Automatic Regulation of Glucose (ARG) algorithm in the pediatric population. The effect of unannounced meals is also explored. Results indicate that the proposed strategy achieves lower hypo- and hyperglycemia than the ARG for both announced and unannounced meals. Graphical Abstract Block diagram and illustrative example of insulin and glucose evolution over time for the proposed algorithm (ARGAE).

Control-Oriented Model With Intra-Patient Variations for an Artificial Pancreas

In this work, a low-order model designed for glucose regulation in Type 1 Diabetes Mellitus (T1DM) is obtained from the UVA/Padova metabolic simulator. It captures not only the nonlinear behavior of the glucose-insulin system, but also intra-patient variations related to daily insulin sensitivity ( S_I) changes. To overcome the large inter-subject variability, the model can also be personalized based on a priori patient information. The structure is amenable for linear parameter varying (LPV) controller design, and represents the dynamics from the subcutaneous insulin input to the subcutaneous glucose output. The efficacy of this model is evaluated in comparison with a previous control-oriented model which in turn is an improvement of previous models. Both models are compared in terms of their open- and closed-loop differences with respect to the UVA/Padova model. The proposed model outperforms previous T1DM control-oriented models, which could potentially lead to more robust and reliable controllers for glycemia regulation.

Chatteringfree hybrid adaptive neuro-fuzzy inference system-particle swarm optimisation data fusion-based BG-level control

In this study, a closed-loop control scheme is proposed for the glucose-insulin regulatory system in type-1 diabetic mellitus (T1DM) patients. Some innovative hybrid glucose-insulin regulators have combined artificial intelligence such as fuzzy logic and genetic algorithm with well known Palumbo model to regulate the blood glucose (BG) level in T1DM patients. However, most of these approaches have focused on the glucose reference tracking, and the qualitative of this tracking such as chattering reduction of insulin injection has not been well-studied. Higher-order sliding mode (HoSM) controllers have been employed to attenuate the effect of chattering. Owing to the delayed nature and non-linear property of glucose-insulin mechanism as well as various unmeasurable disturbances, even the HoSM methods are partly successful. In this study, data fusion of adaptive neuro-fuzzy inference systems optimised by particle swarm optimisation has been presented. The excellent performance of the proposed hybrid controller, i.e. desired BG-level tracking and chattering reduction in the presence of daily glucose-level disturbances is verified.

Artificial Pancreas: Clinical Study in Latin America Without Premeal Insulin Boluses

BACKGROUND

Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial.

METHODS

A 36-hour pilot study was performed on five T1DM subjects to validate the ARG algorithm. Subjects wore a subcutaneous continuous glucose monitor (CGM) and an insulin pump. Insulin delivery was solely commanded by the ARG algorithm, without premeal insulin boluses. This was the first clinical trial in Latin America to validate an AP controller.

RESULTS

For the total 36-hour period, results were as follows: average time of CGM readings in range 70-250 mg/dl: 88.6%, in range 70-180 mg/dl: 74.7%, <70 mg/dl: 5.8%, and <50 mg/dl: 0.8%. Results improved analyzing the final 15-hour period of this trial. In that case, the time spent in range was 70-250 mg/dl: 94.7%, in range 70-180 mg/dl: 82.6%, <70 mg/dl: 4.1%, and <50 mg/dl: 0.2%. During the last night the time spent in range was 70-250 mg/dl: 95%, in range 70-180 mg/dl: 87.7%, <70 mg/dl: 5.0%, and <50 mg/dl: 0.0%. No severe hypoglycemia occurred. No serious adverse events were reported.

CONCLUSIONS

The ARG algorithm was successfully validated in a pilot clinical trial, encouraging further tests with a larger number of patients and in outpatient settings.