Automated closed-loop insulin delivery: system components, performance, and limitations

Closed-loop control of glucose concentrations in type 1 diabetes mellitus has progressed significantly over the last decade. Automated insulin delivery systems, or artificial pancreas systems, have advanced to incorporate model-based predictive controllers developed on the basis of adaptive and personalized glucose-insulin models. This chapter reviews the advancements and the state of the art in control algorithms and modeling paradigms employed to develop the artificial pancreas systems. Recent technological breakthroughs in dual-hormone systems, run-to-run control approaches, and multivariable control architectures for improving glycemic control are discussed. A novel integrated physiological and metabolic simulation platform for multivariable glucose, insulin, and physiological variables simulation is used to demonstrate the ability of the artificial pancreas systems to counteract the diverse meal and exercise disturbances and maintain euglycemia.