Toward a Run-to-Run Adaptive Artificial Pancreas: In Silico Results.

Objective: Contemporary and future outpatient long-term artificial pancreas (AP) studies need to cope with the well-known large intra- and interday glucose variability occurring in type 1 diabetic (T1D) subjects. Here, we propose an adaptive model predictive control (MPC) strategy to account for it and test it in silico.
Methods: A run-to-run (R2R) approach adapts the subcutaneous basal insulin delivery during the night and the carbohydrate-to-insulin ratio (CR) during the day, based on some performance indices calculated from subcutaneous continuous glucose sensor data. In particular, R2R aims, first, to reduce the percentage of time in hypoglycemia and, secondarily, to improve the percentage of time in euglycemia and average glucose. In silico simulations are performed by using the University of Virginia/Padova T1D simulator enriched by incorporating three novel features: intra- and interday variability of insulin sensitivity, different distributions of CR at breakfast, lunch, and dinner, and dawn phenomenon.
Results: After about two months, using the R2R approach with a scenario characterized by a random 30% variation of the nominal insulin sensitivity the time in range and the time in tight range are increased by 11.39% and 44.87%, respectively, and the time spent above 180 mg/dl is reduced by 48.74%.
Conclusions: An adaptive MPC algorithm based on R2R shows in silico great potential to capture intra- and interday glucose variability by improving both overnight and postprandial glucose control without increasing hypoglycemia.
Significance: Making an AP adaptive is key for long-term real-life outpatient studies. These good in silico results are very encouraging and worth testing in vivo.