Cited by 34Diabetes Management and ResearchAdvanced Control Systems OptimizationPancreatic function and diabetes

Design of a dual-hormone model predictive control for artificial pancreas with exercise model

Open access
Resalat, Navid, El Youssef, Joseph, Reddy, Ravi, Jacobs, Peter G.·2016·2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

Abstract

The Artificial Pancreas (AP) is a new technology for helping people with type 1 diabetes to better control their glucose levels through automated delivery of insulin and optionally glucagon in response to sensed glucose levels. In a dual hormone AP, insulin and glucagon are delivered automatically to the body based on glucose sensor measurements using a control algorithm that calculates the amount of hormones to be infused. A dual-hormone MPC may deliver insulin continuously; however, it must avoid continuous delivery of glucagon because nausea can occur from too much glucagon. In this paper, we propose a novel dual-hormone (DH) switching model predictive control and compare it with a single-hormone (SH) MPC. We extended both MPCs by integrating an exercise model and compared performance with and without the exercise model included. Results were obtained on a virtual patient population undergoing a simulated exercise event using a mathematical glucoregulatory model that includes exercise. Time spent in hypoglycemia is significantly less with the DH-MPC than the SH-MPC (p=0.0022). Additionally, including the exercise model in the DH-MPC can help prevent hypoglycemia (p <; 0.001).

AI snapshot

Written from the paper’s full text.

TL;DR

A dual-hormone switching model predictive controller (DH-MPC) with an integrated exercise model reduced hypoglycemia compared with single-hormone MPC in simulated type 1 diabetes. Including the exercise model in the controller was critical for preventing exercise-induced hypoglycemia.

Key findings

  • Time spent in hypoglycemia was significantly less with DH-MPC than SH-MPC (p=0.0022); only the lower 2.5% of DH subjects went hypoglycemic, whereas some SH subjects within the 25%–75% interquartile range crossed the hypoglycemia threshold.
  • Including the exercise model in the DH-MPC significantly reduced time spent in hypoglycemia (p<0.001).
  • DH-Thr (switch based on fixed 85 mg/dl threshold) was optimal for controlling glucose during exercise; DH-Pred (switch based on predicted drop below 70 mg/dl) resulted in significantly higher time in hyperglycemia and median blood glucose (p<0.001), with hypoglycemia difference reported at p=0.011.

Methods

  • In-silico study using a virtual patient population: 163 of 400 virtual subjects passed physiologic feasibility criteria and were simulated.
  • Scenario: glucose brought to steady state 160 mg/dl at t=0, then 45 minutes of exercise starting at t=10 minutes at 60% PVO2max and 80% PAMM.
  • Compared SH-MPC, DH-MPC, DH-Thr, and DH-Pred, with and without the exercise model; used Student’s t-test and Wilcoxon rank-sum test at 95% significance. MPC used a 300-minute prediction horizon, 20-minute control horizon, and constraints of 15 units/hour insulin and 50 micrograms glucagon.

Limitations

  • Stated: the exercise model only models aerobic exercise; anaerobic exercise can cause a less significant glucose drop, and the exercise model was static for all subjects.
  • Stated future work: no meal model was included (uG was zero in equation 1), and the approach was not evaluated in human subjects.
  • Evident from the text: all results are from in-silico simulations, not clinical trials.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1109/embc.2016.7591182

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 1 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The DH-Pred strategy led to some hyperglycemia after exercise.

    “DH-Pred resulted in some post-exercise hyperglycemia.”
    Quote in the paperSubstantial claim
  • Findingown data

    Adding the exercise model to the dual-hormone MPC significantly shortened the time spent in hypoglycemia (p<0.001).

    “Additionally, including the exercise model in the DH-MPC can help prevent hypoglycemia (p < 0.001).”
    • Also stated in: § III. Results and Discussion · plain
      “The time spent in hypoglycemia was significantly less when exercise was included (p-value < 0.001).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exercise can cause rapid glucose drops and hypoglycemia when insulin dosing is not adjusted.
  • Findingown data

    In virtual subjects, the dual-hormone MPC yielded a significantly shorter duration of hypoglycemia than the single-hormone MPC (p=0.0022).

    “Time spent in hypoglycemia is significantly less with the DH-MPC than the SH-MPC (p=0.0022).”
    • Also stated in: § III. Results and Discussion · plain
      “The time the virtual subjects spent in hypoglycemia was significantly less for the DH (p-value = 0.0022).”
    Quote in the paperSubstantial claim
  • Findingown data

    The time in hypoglycemia did not differ significantly between DH-Pred and DH-Thr (p=0.011).

    “While time spent in hypoglycemia with the DH-Pred approach did not change significantly in comparison to the DH-Thr approach (p-value = 0.011)”
    Quote in the paperSubstantial claim
  • Interpretationown data

    The dual-hormone MPC that used a threshold and included exercise in its process model gave better results than the other tested controllers.

    “In conclusion, the threshold-based dual-hormone MPC with exercise in the process model outperformed the other controlling approaches.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exercise can cause rapid glucose drops and hypoglycemia when insulin dosing is not adjusted.
  • May combine two claims. 6
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 1
  • May combine two claims.

    Findingown data

    Under the single-hormone MPC, some subjects in the 25-75% interquartile range crossed the hypoglycemia threshold, while under the dual-hormone MPC only the lowest 2.5% became hypoglycemic.

    “Some subjects within the 25%–75% interquartile range using the SH process model crossed the hypoglycemia threshold interquartile range, whereas subjects using the DH model generally did not go hypoglycemic (only the lower 2.5% of subjects went hypoglycemic under DH).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingreasoning

    When the exercise model was left out, hypoglycemia occurred; when it was included, hypoglycemia was generally avoided.

    “When the exercise model is not included, hypoglycemia occurs, whereas when it is included, hypoglycemia is generally avoided.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exercise can cause rapid glucose drops and hypoglycemia when insulin dosing is not adjusted.
  • May combine two claims.

    Findingown data

    Within the dual-hormone MPC, glucagon delivery both prevented more subjects from becoming hypoglycemic and raised the median blood glucose across subjects.

    “In DH, the glucagon delivery not only prevented more subjects from becoming hypoglycemic, but also increased the median blood glucose across the subjects.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    DH-Pred had significantly more time in hyperglycemia and a higher median blood glucose than DH-Thr (p<0.001).

    “the time spent in hyperglycemia, as well as the median blood glucose, were significantly higher for DH-Pred (p-value < 0.001).”
    Quote in the paperSubstantial claim
  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    Virtual subjects were retained only if they passed four physiological feasibility tests; 163 of 400 did so.

    “A total of 163 out of 400 virtual subjects passed the above criteria and were selected for our in-silico simulations.”
    • Also stated in: § D. Virtual patient population · plain
      “Each parameter set was then subjected to a battery of tests to determine the physiologic feasibility. If a virtual subject did not pass each of the following 4 criteria, they were excluded from further testing.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The exercise model was the same for all subjects, even though individuals can vary in their response to exercise.

    “Furthermore, the exercise model was static for all subjects, whereas different people can respond differently to exercise.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Individuals can respond differently to exercise.
  • May combine two claims.

    Interpretationown data

    Without the exercise model, the controller could not foresee exercise-induced hypoglycemia and therefore did not stop insulin or raise glucagon delivery.

    “When the exercise model is not included, the algorithm cannot anticipate forthcoming exercise-induced hypoglycemia and thereby turn off insulin and increase glucagon dosing as shown in the insulin and glucagon delivery panels of Figure 3.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exercise can cause rapid glucose drops and hypoglycemia when insulin dosing is not adjusted.
7 of 7
  • The paper relies on this without support.

    Exercise can cause rapid glucose drops and hypoglycemia when insulin dosing is not adjusted.

    “Exercise can have profound effects on glucose levels in a person with type 1 diabetes, causing hypoglycemia if dosing is not adjusted.”
    “Aerobic exercise can cause rapid drops in glucose levels because of increased glucose uptake during exercise.”
  • The paper relies on this without support.

    Continuous glucagon delivery can cause nausea, so a dual-hormone MPC must avoid it.

    “A dual-hormone MPC may deliver insulin continuously; however, it must avoid continuous delivery of glucagon because nausea can occur from too much glucagon.”
  • The paper relies on this without support.

    No earlier group had put exercise directly into the process model of a dual-hormone MPC.

    “To the best of our knowledge, no prior groups have incorporated exercise directly into the process model of a DH-MPC.”
  • The paper relies on this without support.

    Individuals can respond differently to exercise.

    “whereas different people can respond differently to exercise.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • A p-value of 0.011 is described as not significant

    Major

    At the stated 95% significance level, p = 0.011 is statistically significant, contrary to the claim that the difference did not change significantly.

  • Listed state variables total 14, not 13

    Minor

    The listed groups contain 2 + 4 + 3 + 3 + 2 = 14 state variables, one more than the stated total.

    Reported 13 · recomputed 14

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. wang, 2009, Model Predictove Control System Design and Implementation Using Matlab, Advances in Industrial Control, 1

Cited by

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Authors
Resalat, N., El Youssef, J., Reddy, R., & Jacobs, P. G.
Affiliations
  • Oregon Health & Science University (US)
  • Dept. of Biomedical Engineering, Oregon Health &amp; Science University, Portland, OR, 97239
Venue
2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)
Publisher
IEEE
Published
2016-08
Volume
2016
Pages
2270-2273
ISSN
2375-7477 (ISSN-L)
OpenAlex
W2535260790
Cited by
34
References
14
Citations by year
2025: 5 · 2024: 1 · 2023: 7 · 2021: 3 · 2020: 7 · 2019: 8 · 2018: 1 · 2017: 2
FWCI
30.89
Type
conference paper
Language
en
Open access
Locations
  • Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK101044)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Physical Sciences › Engineering › Control and Systems Engineering › Advanced Control Systems Optimization
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Keywords
artificial pancreas, type 1 diabetes, exercise model, hypoglycemia prevention, glycemic control, switching control
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 1, Glucagon, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Models, Biological, Pancreas, Artificial

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