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Evaluation of an Artificial Pancreas with Enhanced Model Predictive Control and a Glucose Prediction Trust Index with Unannounced Exercise.

ABSTRACT: BACKGROUND:We investigated the safety and efficacy of the addition of a trust index to enhanced Model Predictive Control (eMPC) Artificial Pancreas (AP) that works by adjusting the responsiveness of the controller's insulin delivery based on the confidence intervals around predictions of glucose trends. This constitutes a dynamic adaptation of the controller's parameters in contrast with the widespread AP implementation of individualized fixed controller tuning. MATERIALS AND METHODS:After 1 week of sensor-augmented pump (SAP) use, subjects completed a 48-h AP admission that included three meals/day (carbohydrate range 29-57?g/meal), a 1-h unannounced brisk walk, and two overnight periods. Endpoints included sensor glucose percentage time 70-180, <70, >180?mg/dL, number of hypoglycemic events, and assessment of the trust index versus standard eMPC glucose predictions. RESULTS:Baseline characteristics for the 15 subjects who completed the study (mean?±?SD) were age 46.1?±?17.8 years, HbA1c 7.2%?±?1.0%, diabetes duration 26.8?±?17.6 years, and total daily dose (TDD) 35.5?±?16.4?U/day. Mean sensor glucose percent time 70-180?mg/dL (88.0%?±?8.0% vs. 74.6%?±?9.4%), <70?mg/dL (1.5%?±?1.9% vs. 7.8%?±?6.0%), and number of hypoglycemic events (0.6?±?0.6 vs. 6.3?±?3.4), all showed statistically significant improvement during AP use compared with the SAP run-in (P?

SUBMITTER: Pinsker JE

PROVIDER: S-EPMC6049959 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Evaluation of an Artificial Pancreas with Enhanced Model Predictive Control and a Glucose Prediction Trust Index with Unannounced Exercise.

Pinsker Jordan E JE Laguna Sanz Alejandro J AJ Lee Joon Bok JB Church Mei Mei MM Andre Camille C Lindsey Laura E LE Doyle Francis J FJ Dassau Eyal E

Diabetes technology & therapeutics 20180701 7

<h4>Background</h4>We investigated the safety and efficacy of the addition of a trust index to enhanced Model Predictive Control (eMPC) Artificial Pancreas (AP) that works by adjusting the responsiveness of the controller's insulin delivery based on the confidence intervals around predictions of glucose trends. This constitutes a dynamic adaptation of the controller's parameters in contrast with the widespread AP implementation of individualized fixed controller tuning.<h4>Materials and methods< ...[more]

PMID: 29958023

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Project description:BackgroundExercise challenges people with type 1 diabetes in controlling their glucose concentration (GC). A multivariable adaptive artificial pancreas (MAAP) may lessen the burden.MethodsThe MAAP operates without any user input and computes insulin based on continuous glucose monitor and physical activity signals. To analyze performance, 18 60-h closed-loop experiments with 96 exercise sessions with three different protocols were completed. Each day, the subjects completed one resistance and one treadmill exercise (moderate continuous training [MCT] or high-intensity interval training [HIIT]). The primary outcome is time spent in each glycemic range during the exercise + recovery period. Secondary measures include average GC and average change in GC during each exercise modality.ResultsThe GC during exercise + recovery periods were within the euglycemic range (70-180?mg/dL) for 69.9% of the time and within a safe glycemic range for exercise (70-250?mg/dL) for 93.0% of the time. The exercise sessions are defined to begin 30?min before the start of exercise and end 2?h after start of exercise. The GC were within the severe hypoglycemia (<55?mg/dL), moderate hypoglycemia (55-70?mg/dL), moderate hyperglycemia (180-250?mg/dL), and severe hyperglycemia (>250?mg/dL) for 0.9%, 1.3%, 23.1%, and 4.8% of the time, respectively. The average GC decline during exercise differed with exercise type (P?=?0.0097) with a significant difference between the MCT and resistance (P?=?0.0075). To prevent large GC decreases leading to hypoglycemia, MAAP recommended carbohydrates in 59% of MCT, 50% of HIIT, and 39% of resistance sessions.ConclusionsA consistent GC decline occurred in exercise and recovery periods, which differed with exercise type. The average GC at the start of exercise was above target (185.5?±?56.6?mg/dL for MCT, 166.9?±?61.9?mg/dL for resistance training, and 171.7?±?41.4?mg/dL HIIT), making a small decrease desirable. Hypoglycemic events occurred in 14.6% of exercise sessions and represented only 2.22% of the exercise and recovery period.

Dataset Information

Evaluation of an Artificial Pancreas with Enhanced Model Predictive Control and a Glucose Prediction Trust Index with Unannounced Exercise.

Publications

Evaluation of an Artificial Pancreas with Enhanced Model Predictive Control and a Glucose Prediction Trust Index with Unannounced Exercise.

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