title: Development of a fully automated closed loop artificial pancreas control system with dual pump delivery of insulin and glucagon.
abstract: Patients with diabetes have difficulty controlling their blood sugar and suffer from acute effects of hypoglycemia and long-term effects of hyperglycemia, which include disease of the eyes, kidneys and nerves/feet. In this paper, we describe a new system that is used to automatically control blood sugar in people with diabetes through the fully automated measurement of blood glucose levels and the delivery of insulin and glucagon via the subcutaneous route. When a patient's blood sugar goes too high, insulin is given to the patient to bring his/her blood sugar back to a normal level. To prevent a patient's blood sugar from going too low, the patient is given a hormone called glucagon which raises the patient's blood sugar. While other groups have described methods for automatically delivering insulin and glucagon, many of these systems still require human interaction to enter the venous blood sugar levels into the control system. This paper describes the development of a fully automated closed-loop dual sensor bi-hormonal artificial pancreas system that does not require human interaction. The system described in this paper is comprised of two sensors for measuring glucose, two pumps for independent delivery of insulin and glucagon, and a laptop computer running a custom software application that controls the sensor acquisition and insulin and glucagon delivery based on the glucose values recorded. Two control algorithms are designed into the software: (1) an algorithm that delivers insulin and glucagon according to their proportional and derivative errors and proportional and derivative gains and (2) an adaptive algorithm that adjusts the gain factors based on the patient's current insulin sensitivity as determined using a mathematical model. Results from this work may ultimately lead to development of a portable, easy to use, artificial pancreas device that can enable far better glycemic control in patients with diabetes.
authors.affiliation: Portland VA Medical Center and the Oregon Health & Sciences University, Portland, OR 97239, USA. peter.jacobs@va.gov
authors.forename: Peter G
authors.initials: PG
authors.lastname: Jacobs
authors.forename: Joseph
authors.initials: J
authors.lastname: El Youssef
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Castle
authors.forename: Julia M
authors.initials: JM
authors.lastname: Engle
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Branigan
authors.forename: Phillip
authors.initials: P
authors.lastname: Johnson
authors.forename: Ryan
authors.initials: R
authors.lastname: Massoud
authors.forename: Apurv
authors.initials: A
authors.lastname: Kamath
authors.forename: W Kenneth
authors.initials: WK
authors.lastname: Ward
mesh_terms: D003198:Computer Simulation; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004360:Drug Therapy, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D025461:Feedback, Physiological; D005934:Glucagon / Q000008:administration & dosage*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008954:Models, Biological; D019397:Pancreas, Artificial; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D007328:Insulin; D005934:Glucagon