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Tejedor M, Hjerde SN, Myhre JN, Godtliebsen F. Evaluating Deep Q-Learning Algorithms for Controlling Blood Glucose in In Silico Type 1 Diabetes. Diagnostics (Basel) 2023; 13:3150. [PMID: 37835893 PMCID: PMC10572616 DOI: 10.3390/diagnostics13193150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Patients with type 1 diabetes must continually decide how much insulin to inject before each meal to maintain blood glucose levels within a healthy range. Recent research has worked on a solution for this burden, showing the potential of reinforcement learning as an emerging approach for the task of controlling blood glucose levels. In this paper, we test and evaluate several deep Q-learning algorithms for automated and personalized blood glucose regulation in an in silico type 1 diabetes patient with the goal of estimating and delivering proper insulin doses. The proposed algorithms are model-free approaches with no prior information about the patient. We used the Hovorka model with meal variation and carbohydrate counting errors to simulate the patient included in this work. Our experiments compare different deep Q-learning extensions showing promising results controlling blood glucose levels, with some of the proposed algorithms outperforming standard baseline treatment.
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Affiliation(s)
- Miguel Tejedor
- Norwegian Centre for E-Health Research, P.O. Box 35, N-9038 Tromsø, Norway;
| | - Sigurd Nordtveit Hjerde
- Faculty of Science and Technology, Norwegian University of Life Sciences, Postboks 5003 NMBU, 1432 Ås, Norway;
| | - Jonas Nordhaug Myhre
- NORCE Norwegian Research Centre, Postboks 22, Nygårdstangen, 5838 Bergen, Norway;
| | - Fred Godtliebsen
- Department of Mathematics and Statistics, UiT—The Arctic University of Norway, P.O. Box 6050 Langnes, N-9037 Tromsø, Norway
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2
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Sujatha DV. Investigation on Modelling and Identification of Glucose Management system for normal individual and diabetic patient. Comput Chem Eng 2022. [DOI: 10.1016/j.compchemeng.2022.108077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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A simulator with realistic and challenging scenarios for virtual T1D patients undergoing CSII and MDI therapy. J Biomed Inform 2022; 132:104141. [PMID: 35835439 DOI: 10.1016/j.jbi.2022.104141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
In silico simulations have become essential for the development of diabetes treatments. However, currently available simulators are not challenging enough and often suffer from limitations in insulin and meal absorption variability, which is unable to realistically reflect the dynamics of people with type 1 diabetes (T1D). Additionally, T1D simulators are mainly designed for the testing of continuous subcutaneous insulin infusion (CSII) therapies. In this work, a simulator is presented that includes a generated virtual patient (VP) cohort and both fast- and long-acting Glargine-100 U/ml (Gla-100), Glargine-300 U/ml (Gla-300), and Degludec-100 U/ml (Deg-100) insulin models. Therefore, in addition to CSII therapies, multiple daily injections (MDI) therapies can also be tested. The Hovorka model and its published parameter probability distributions were used to generate cohorts of VPs that represent a T1D population. Valid patients are filtered through restrictions that guarantee that they are physiologically acceptable. To obtain more realistic scenarios, basal insulin profile patterns from the literature have been used to identify variability in insulin sensitivity. A library of mixed meals identified from real data has also been included. This work presents and validates a methodology for the creation of realistic VP cohorts that include physiological variability and a simulator that includes challenging and realistic scenarios for in silico testing. A cohort of 47 VPs has been generated and in silico simulations of both CSII and MDI therapies were performed in open-loop. The simulation outcome metrics were contrasted with literature results.
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Fakhroleslam M, Bozorgmehry Boozarjomehry R. A multi‐objective optimal insulin bolus advisor for type 1 diabetes based on personalized model and daily diet. ASIA-PAC J CHEM ENG 2021. [DOI: 10.1002/apj.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mohammad Fakhroleslam
- Process Engineering Department, Faculty of Chemical Engineering Tarbiat Modares University Tehran Iran
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5
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Camerlingo N, Vettoretti M, Del Favero S, Facchinetti A, Sparacino G. Mathematical Models of Meal Amount and Timing Variability With Implementation in the Type-1 Diabetes Patient Decision Simulator. J Diabetes Sci Technol 2021; 15:346-359. [PMID: 32940087 PMCID: PMC7925444 DOI: 10.1177/1932296820952123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In type 1 diabetes (T1D) research, in-silico clinical trials (ISCTs) have proven effective in accelerating the development of new therapies. However, published simulators lack a realistic description of some aspects of patient lifestyle which can remarkably affect glucose control. In this paper, we develop a mathematical description of meal carbohydrates (CHO) amount and timing, with the aim to improve the meal generation module in the T1D Patient Decision Simulator (T1D-PDS) published in Vettoretti et al. METHODS Data of 32 T1D subjects under free-living conditions for 4874 days were used. Univariate probability density function (PDF) parametric models with different candidate shapes were fitted, individually, against sample distributions of: CHO amounts of breakfast (CHOB), lunch (CHOL), dinner (CHOD), and snack (CHOS); breakfast timing (TB); and time between breakfast-lunch (TBL) and between lunch-dinner (TLD). Furthermore, a support vector machine (SVM) classifier was developed to predict the occurrence of a snack in future fixed-length time windows. Once embedded inside the T1D-PDS, an ISCT was performed. RESULTS Resulting PDF models were: gamma (CHOB, CHOS), lognormal (CHOL, TB), loglogistic (CHOD), and generalized-extreme-values (TBL, TLD). The SVM showed a classification accuracy of 0.8 over the test set. The distributions of simulated meal data were not statistically different from the distributions of the real data used to develop the models (α = 0.05). CONCLUSIONS The models of meal amount and timing variability developed are suitable for describing real data. Their inclusion in modules that describe patient behavior in the T1D-PDS can permit investigators to perform more realistic, reliable, and insightful ISCTs.
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Affiliation(s)
- Nunzio Camerlingo
- Department of Information Engineering,
University of Padova, Padova, Italy
| | - Martina Vettoretti
- Department of Information Engineering,
University of Padova, Padova, Italy
| | - Simone Del Favero
- Department of Information Engineering,
University of Padova, Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering,
University of Padova, Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering,
University of Padova, Padova, Italy
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6
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In-Silico Evaluation of Glucose Regulation Using Policy Gradient Reinforcement Learning for Patients with Type 1 Diabetes Mellitus. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this paper, we test and evaluate policy gradient reinforcement learning for automated blood glucose control in patients with Type 1 Diabetes Mellitus. Recent research has shown that reinforcement learning is a promising approach to accommodate the need for individualized blood glucose level control algorithms. The motivation for using policy gradient algorithms comes from the fact that adaptively administering insulin is an inherently continuous task. Policy gradient algorithms are known to be superior in continuous high-dimensional control tasks. Previously, most of the approaches for automated blood glucose control using reinforcement learning has used a finite set of actions. We use the Trust-Region Policy Optimization algorithm in this work. It represents the state of the art for deep policy gradient algorithms. The experiments are carried out in-silico using the Hovorka model, and stochastic behavior is modeled through simulated carbohydrate counting errors to illustrate the full potential of the framework. Furthermore, we use a model-free approach where no prior information about the patient is given to the algorithm. Our experiments show that the reinforcement learning agent is able to compete with and sometimes outperform state-of-the-art model predictive control in blood glucose regulation.
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7
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Sánchez OD, Ruiz-Velázquez E, Alanís AY, Quiroz G, Torres-Treviño L. Parameter estimation of a meal glucose-insulin model for TIDM patients from therapy historical data. IET Syst Biol 2019; 13:8-15. [PMID: 30774111 DOI: 10.1049/iet-syb.2018.5038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The effect of meal on blood glucose concentration is a key issue in diabetes mellitus because its estimation could be very useful in therapy decisions. In the case of type 1 diabetes mellitus (T1DM), the therapy based on automatic insulin delivery requires a closed-loop control system to maintain euglycaemia even in the postprandial state. Thus, the mathematical modelling of glucose metabolism is relevant to predict the metabolic state of a patient. Moreover, the eating habits are characteristic of each person, so it is of interest that the mathematical models of meal intake allow to personalise the glycaemic state of the patient using therapy historical data, that is, daily measurements of glucose and records of carbohydrate intake and insulin supply. Thus, here, a model of glucose metabolism that includes the effects of meal is analysed in order to establish criteria for data-based personalisation. The analysis includes the sensitivity and identifiability of the parameters, and the parameter estimation problem was resolved via two algorithms: particle swarm optimisation and evonorm. The results show that the mathematical model can be a useful tool to estimate the glycaemic status of a patient and personalise it according to her/his historical data.
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Affiliation(s)
- Oscar D Sánchez
- CUCEI, Universidad de Guadalajara, Av. Revolución 1500, Col. Universitaria, 44430 Guadalajara, Jal., México
| | - Eduardo Ruiz-Velázquez
- CUCEI, Universidad de Guadalajara, Av. Revolución 1500, Col. Universitaria, 44430 Guadalajara, Jal., México.
| | - Alma Y Alanís
- CUCEI, Universidad de Guadalajara, Av. Revolución 1500, Col. Universitaria, 44430 Guadalajara, Jal., México
| | - Griselda Quiroz
- FIME, Universidad Autónoma de Nuevo León, Av. Universidad S/N, Ciudad Universitaria, 66455 San Nicolás de los Garza, Nuevo León, N.L., México
| | - Luis Torres-Treviño
- FIME, Universidad Autónoma de Nuevo León, Av. Universidad S/N, Ciudad Universitaria, 66455 San Nicolás de los Garza, Nuevo León, N.L., México
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Rashid M, Samadi S, Sevil M, Hajizadeh I, Kolodziej P, Hobbs N, Maloney Z, Brandt R, Feng J, Park M, Quinn L, Cinar A. Simulation Software for Assessment of Nonlinear and Adaptive Multivariable Control Algorithms: Glucose - Insulin Dynamics in Type 1 Diabetes. Comput Chem Eng 2019; 130. [PMID: 32863472 DOI: 10.1016/j.compchemeng.2019.106565] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A simulator for testing automatic control algorithms for nonlinear systems with time-varying parameters, variable time delays, and uncertainties is developed. It is based on simulation of virtual patients with Type 1 diabetes (T1D). Nonlinear models are developed to describe glucose concentration (GC) variations based on user-defined scenarios for meal consumption, insulin administration, and physical activity. They compute GC values and physiological variables, such as heart rate, skin temperature, accelerometer, and energy expenditure, that are indicative of physical activities affecting GC dynamics. This is the first simulator designed for assessment of multivariable controllers that consider supplemental physiological variables in addition to GC measurements to improve glycemic control. Virtual patients are generated from distributions of identified model parameters using clinical data. The simulator will enable testing and evaluation of new control algorithms proposed for automated insulin delivery as well as various control algorithms for nonlinear systems with uncertainties, time-varying parameters and delays.
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Affiliation(s)
- Mudassir Rashid
- Dept of Chemical and Biological Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 60616
| | - Sediqeh Samadi
- Dept of Chemical and Biological Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 60616
| | - Mert Sevil
- Dept of Biomedical Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 606016
| | - Iman Hajizadeh
- Dept of Chemical and Biological Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 60616
| | - Paul Kolodziej
- Dept of Chemical and Biological Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 60616
| | - Nicole Hobbs
- Dept of Biomedical Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 606016
| | - Zacharie Maloney
- Dept of Biomedical Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 606016
| | - Rachel Brandt
- Dept of Biomedical Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 606016
| | - Jianyuan Feng
- Dept of Chemical and Biological Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 60616
| | - Minsun Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA, 60612
| | - Laurie Quinn
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA, 60612
| | - Ali Cinar
- Dept of Chemical and Biological Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 60616.,Dept of Biomedical Engineering, Illinois Institute of Technology, 10 W 33rd Street, Chicago, IL, USA, 606016
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Townsend C, Seron MM, Goodwin GC, King BR. Control Limitations in Models of T1DM and the Robustness of Optimal Insulin Delivery. J Diabetes Sci Technol 2018; 12:926-936. [PMID: 30060692 PMCID: PMC6134626 DOI: 10.1177/1932296818789950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In insulin therapy, the blood glucose level is constrained from below by the hypoglycemic threshold, that is, the blood glucose level must remain above this threshold. It has been shown that this constraint fundamentally limits the ability to lower the maxima of the blood glucose level predicted by many mathematical models of glucose metabolism. However, it is desirable to minimize hyperglycemia as well. Hence, a desirable insulin input is one that minimizes the maximum glucose concentration while causing it to remain above the hypoglycemic, or higher, threshold. It has been shown that this input, which we call optimal, is characterized by glucose profiles for which either each maximum of the glucose concentration is followed by a minimum or each minimum is followed by a maximum. METHODS We discuss the implication of this inherent control limitation for clinical practice and test, through simulation, the robustness of the optimal input to a number of different model and parameter uncertainties. We further develop guidelines on how to design an optimal insulin input that is robust to such uncertainties. RESULTS The optimal input is in general not robust to uncertainties. However, a number of strategies may be used to ensure the blood glucose level remains above the hypoglycemic threshold and the maximum blood glucose level achieved is less than that achieved by standard therapy. CONCLUSIONS An understanding of the limitations on the controllability of the blood glucose level is important for future treatment improvements and the development of artificial pancreas systems.
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Affiliation(s)
- Christopher Townsend
- Priority Research Centre for Complex Dynamic Systems and Control, School of Electrical Engineering and Computing, University of Newcastle, Callaghan, New South Wales, Australia
- Christopher Townsend, Priority Research Centre for Complex Dynamic Systems and Control, School of Electrical Engineering and Computing, University of Newcastle, 2308, Australia.
| | - Maria M. Seron
- Priority Research Centre for Complex Dynamic Systems and Control, School of Electrical Engineering and Computing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Graham C. Goodwin
- Priority Research Centre for Complex Dynamic Systems and Control, School of Electrical Engineering and Computing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Bruce R. King
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia
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10
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Maghoul P, Boulet B, Tardif A, Haidar A. Computer Simulation Model to Train Medical Personnel on Glucose Clamp Procedures. Can J Diabetes 2017; 41:485-490. [PMID: 28863979 DOI: 10.1016/j.jcjd.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A glucose clamp procedure is the most reliable way to quantify insulin pharmacokinetics and pharmacodynamics, but skilled and trained research personnel are required to frequently adjust the glucose infusion rate. A computer environment that simulates glucose clamp experiments can be used for efficient personnel training and development and testing of algorithms for automated glucose clamps. METHODS We built 17 virtual healthy subjects (mean age, 25±6 years; mean body mass index, 22.2±3 kg/m2), each comprising a mathematical model of glucose regulation and a unique set of parameters. Each virtual subject simulates plasma glucose and insulin concentrations in response to intravenous insulin and glucose infusions. Each virtual subject provides a unique response, and its parameters were estimated from combined intravenous glucose tolerance test-hyperinsulinemic-euglycemic clamp data using the Bayesian approach. The virtual subjects were validated by comparing their simulated predictions against data from 12 healthy individuals who underwent a hyperglycemic glucose clamp procedure. RESULTS Plasma glucose and insulin concentrations were predicted by the virtual subjects in response to glucose infusions determined by a trained research staff performing a simulated hyperglycemic clamp experiment. The total amount of glucose infusion was indifferent between the simulated and the real subjects (85±18 g vs. 83±23 g; p=NS) as well as plasma insulin levels (63±20 mU/L vs. 58±16 mU/L; p=NS). CONCLUSIONS The virtual subjects can reliably predict glucose needs and plasma insulin profiles during hyperglycemic glucose clamp conditions. These virtual subjects can be used to train personnel to make glucose infusion adjustments during clamp experiments.
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Affiliation(s)
- Pooya Maghoul
- Department of Electrical and Computer Engineering, Faculty of Engineering, McGill University, Montreal, Quebec, Canada
| | - Benoit Boulet
- Department of Electrical and Computer Engineering, Faculty of Engineering, McGill University, Montreal, Quebec, Canada
| | - Annie Tardif
- Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada
| | - Ahmad Haidar
- Department of Biomedical Engineering, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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11
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Colmegna P, Sanchez Pena RS, Gondhalekar R, Dassau E, Doyle Iii FJ. Reducing risks in type 1 diabetes using H∞ control. IEEE Trans Biomed Eng 2014; 61:2939-47. [PMID: 25020013 DOI: 10.1109/tbme.2014.2336772] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A control scheme was designed in order to reduce the risks of hyperglycemia and hypoglycemia in type 1 diabetes mellitus (T1DM). This structure is composed of three main components: an H∞ robust controller, an insulin feedback loop (IFL), and a safety mechanism (SM). A control-relevant model that is employed to design the robust controller is identified. The identification procedure is based on the distribution version of the UVA/Padova metabolic simulator using the simulation adult cohort. The SM prevents dangerous scenarios by acting upon a prediction of future glucose levels, and the IFL modifies the loop gain in order to reduce postprandial hypoglycemia risks. The procedure is tested on the complete alic>in silico adult cohort of the UVA/Padova metabolic simulator, which has been accepted by the Food and Drug Administration (FDA) in lieu of animal trials.
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Ajmera I, Swat M, Laibe C, Le Novère N, Chelliah V. The impact of mathematical modeling on the understanding of diabetes and related complications. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2013; 2:e54. [PMID: 23842097 PMCID: PMC3731829 DOI: 10.1038/psp.2013.30] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 04/18/2013] [Indexed: 12/20/2022]
Abstract
Diabetes is a chronic and complex multifactorial disease caused by persistent hyperglycemia and for which underlying pathogenesis is still not completely understood. The mathematical modeling of glucose homeostasis, diabetic condition, and its associated complications is rapidly growing and provides new insights into the underlying mechanisms involved. Here, we discuss contributions to the diabetes modeling field over the past five decades, highlighting the areas where more focused research is required.
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Affiliation(s)
- I Ajmera
- 1] BioModels Group, EMBL - European Bioinformatics Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK [2] Multidiscipinary Centre for Integrative Biology (MyCIB), School of Biosciences, University of Nottingham, Loughborough, UK
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Abbes IB, Richard PY, Lefebvre MA, Guilhem I, Poirier JY. A closed-loop artificial pancreas using a proportional integral derivative with double phase lead controller based on a new nonlinear model of glucose metabolism. J Diabetes Sci Technol 2013; 7:699-707. [PMID: 23759403 PMCID: PMC3869138 DOI: 10.1177/193229681300700315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most closed-loop insulin delivery systems rely on model-based controllers to control the blood glucose (BG) level. Simple models of glucose metabolism, which allow easy design of the control law, are limited in their parametric identification from raw data. New control models and controllers issued from them are needed. METHODS A proportional integral derivative with double phase lead controller was proposed. Its design was based on a linearization of a new nonlinear control model of the glucose-insulin system in type 1 diabetes mellitus (T1DM) patients validated with the University of Virginia/Padova T1DM metabolic simulator. A 36 h scenario, including six unannounced meals, was tested in nine virtual adults. A previous trial database has been used to compare the performance of our controller with their previous results. The scenario was repeated 25 times for each adult in order to take continuous glucose monitoring noise into account. The primary outcome was the time BG levels were in target (70-180 mg/dl). RESULTS Blood glucose values were in the target range for 77% of the time and below 50 mg/dl and above 250 mg/dl for 0.8% and 0.3% of the time, respectively. The low blood glucose index and high blood glucose index were 1.65 and 3.33, respectively. CONCLUSION The linear controller presented, based on the linearization of a new easily identifiable nonlinear model, achieves good glucose control with low exposure to hypoglycemia and hyperglycemia.
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Affiliation(s)
- Ilham Ben Abbes
- Supelec/I.E.T.R., Avenue de la Boulaie, Cesson-Sévigné Cedex, France.
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García-Jaramillo M, Calm R, Bondia J, Vehí J. Prediction of postprandial blood glucose under uncertainty and intra-patient variability in type 1 diabetes: a comparative study of three interval models. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 108:224-233. [PMID: 22677264 DOI: 10.1016/j.cmpb.2012.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 04/04/2012] [Accepted: 04/11/2012] [Indexed: 06/01/2023]
Abstract
The behavior of three insulin action and glucose kinetics models was assessed for an insulin therapy regime in the presence of patient variability. For this purpose, postprandial glucose in patients with type 1 diabetes was predicted by considering intra- and inter-patient variability using modal interval analysis. Equations to achieve optimal prediction are presented for models 1, 2 and 3, which are of increasing complexity. The model parameters were adjusted to reflect the "same" patient in the presence of variability. The glucose response envelope for model 1, the simplest insulin-glucose model assessed, included the responses of the other two models when a good fit of the model parameters was achieved. Thus, under variability, simple glucose-insulin models may be sufficient to describe patient dynamics in most situations.
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Affiliation(s)
- M García-Jaramillo
- Institut d'Informatica i Aplicacions, University of Girona, Campus de Montilivi, Edifici P4, 17071 Girona, Spain.
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Wilinska ME, Blaha J, Chassin LJ, Cordingley JJ, Dormand NC, Ellmerer M, Haluzik M, Plank J, Vlasselaers D, Wouters PJ, Hovorka R. Evaluating glycemic control algorithms by computer simulations. Diabetes Technol Ther 2011; 13:713-22. [PMID: 21488803 DOI: 10.1089/dia.2011.0016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Numerous guidelines and algorithms exist to achieve glycemic control. Their strengths and weaknesses are difficult to assess without head-to-head comparison in time-consuming clinical trials. We hypothesized that computer simulations may be useful. METHODS Two open-label randomized clinical trials were replicated using computer simulations. One study compared performance of the enhanced model predictive control (eMPC) algorithm at two intensive care units in the United Kingdom and Belgium. The other study compared three glucose control algorithms-eMPC, Matias (the absolute glucose protocol), and Bath (the relative glucose change protocol)-in a single intensive care unit. Computer simulations utilized a virtual population of 56 critically ill subjects derived from routine data collected at four European surgical and medical intensive care units. RESULTS In agreement with the first clinical study, computer simulations reproduced the main finding and discriminated between the two intensive care units in terms of the sampling interval (1.3 h vs. 1.8 h, United Kingdom vs. Belgium; P < 0.01). Other glucose control metrics were comparable between simulations and clinical results. The principal outcome of the second study was also reproduced. The eMPC demonstrated better performance compared with the Matias and Bath algorithms as assessed by the time when plasma glucose was in the target range between 4.4 and 6.1 mmol/L (65% vs. 43% vs. 42% [P < 0.001], eMPC vs. Matias vs. Bath) without increasing the risk of severe hypoglycemia. CONCLUSIONS Computer simulations may provide resource-efficient means for preclinical evaluation of algorithms for glycemic control in the critically ill.
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Abstract
Automated closed-loop insulin delivery, also referred to as the 'artificial pancreas', has been an important but elusive goal of diabetes treatment for many decades. Research milestones include the conception of continuous glucose monitoring in the early 1960s, followed by the production of the first commercial hospital-based artificial pancreas in the late 1970s that combined intravenous glucose sensing and insulin delivery. In the past 10 years, research into the artificial pancreas has gained substantial momentum and focused on the subcutaneous route for glucose measurement and insulin delivery, which reflects technological advances in interstitial glucose monitoring and the increasing use of the continuous subcutaneous insulin infusion. This Review discusses the design of an artificial pancreas, its components and clinical results, as well as the advantages and disadvantages of different types of automated closed-loop systems and potential future advances. The introduction of the artificial pancreas into clinical practice will probably occur gradually, starting with simpler approaches, such as overnight control of blood glucose concentration and temporary pump shut-off, that are adapted to more complex situations, such as glycemic control during meals and exercise.
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Affiliation(s)
- Roman Hovorka
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK.
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