Automated control of an adaptive bihormonal, dual-sensor artificial pancreas and evaluation during inpatient studies.
Automated control of an adaptive bihormonal, dual-sensor artificial pancreas and evaluation during inpatient studies.
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DOI：
10.1109/tbme.2014.2323248
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Ward WK
中科院分区：
文献类型：
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作者：
Jacobs PG;El Youssef J;Castle J;Bakhtiani P;Branigan D;Breen M;Bauer D;Preiser N;Leonard G;Stonex T;Ward WK
1型糖尿病患者的血糖自动控制尚未完全实施。这项研究的目的是设计和临床评估一种系统，该系统将控制算法与现成的皮下传感器和泵集成在一起，以响应连续的血糖传感器测量，自动递送激素胰高血糖素和胰岛素。该系统的自动化组件运行自适应比例导数控制算法，该算法根据检测到的血糖测量和患者的饮食通知确定激素释放速率。我们提供了详细的系统设计和控制算法，其中包括一个衰落记忆比例导数控制器(FMPD)和一个基于胰岛素作用的血糖调节模型来估计胰岛素敏感性变化的自适应系统。在一项使用Dexcom 7 Plus传感器在8名受试者中进行的住院研究中，研究前的HbA1c平均为7.6，这意味着估计的平均血糖为171 mg/dL。相比之下，在使用自动化系统期间，在最初稳定后，血糖平均为145 mg/dL，受试者有73.1%的时间保持在正常血糖范围(70至180 mg/dL)，这表明血糖控制有所改善。在对另外五个受试者的进一步研究中，我们使用了更新、更可靠的血糖传感器(Dexcom G4铂金)，并对胰岛素和胰升糖素泵通讯系统进行了改进，从而消除了低血糖事件。在这项G4研究中，该系统能够在71.6%的研究持续时间内将受试者的血糖水平维持在接近正常血糖的范围内，平均静脉血糖水平为151毫克/分升。
Automated control of blood glucose in patients with type 1 diabetes has not yet been fully implemented. The aim of this study was to design and clinically evaluate a system that integrates a control algorithm with off-the-shelf subcutaneous sensors and pumps to automate the delivery of the hormones glucagon and insulin in response to continuous glucose sensor measurements. The automated component of the system runs an adaptive proportional derivative control algorithm which determines hormone delivery rates based on the sensed glucose measurements and the meal announcements by the patient. We provide details about the system design and the control algorithm, which incorporates both a fading memory proportional derivative controller (FMPD) and an adaptive system for estimating changing sensitivity to insulin based on a glucoregulatory model of insulin action. For an inpatient study carried out in eight subjects using Dexcom SEVEN PLUS sensors, pre-study HbA1c averaged 7.6, which translates to an estimated average glucose of 171 mg/dL. In contrast, during use of the automated system, after initial stabilization, glucose averaged 145 mg/dL and subjects were kept within the euglycemic range (between 70 and 180 mg/dL) for 73.1% of the time, indicating improved glycemic control. A further study on five additional subjects in which we used a newer and more reliable glucose sensor (Dexcom G4 PLATINUM) and made improvements to the insulin and glucagon pump communication system resulted in elimination of hypoglycemic events. For this G4 study, the system was able to maintain subjects’ glucose levels within the near-euglycemic range for 71.6% of the study duration and the mean venous glucose level was 151 mg/dL.