Multilevel model of type 1 diabetes mellitus patients for model-based glucose controllers.

BACKGROUND: Glucose homeostasis is the result of complex interactions across different biological levels. This multilevel characteristic should be considered when analyzing and designing closed-loop glucose control algorithms. Classic control schemes use only a pharmacokinetic-pharmacodynamic (PKPD) perspective to describe the gluco-regulatory system.
METHODS: A multilevel model combining a PKPD model with an insulin signaling model is proposed for patients with type 1 diabetes mellitus T1DM (T1DM). The PKPD Dalla Man model for T1DM is expanded to include an intracellular level involving insulin signaling to control glucose uptake through glucose transporter type 4 (GLUT4) translocation. A model-based controller is then designed and used as an example to illustrate the feasibility of the proposal.
RESULTS: Two significant results were obtained for the controller explicitly utilizing multilevel information. No hypo-glycemic events were registered and an excellent performance for interpatient variability was achieved. Controller performance was evaluated using two indexes. The glucose was kept inside the range (70-180) mg/dl more than 99% of the time, and the intrapatient variability measured using control variability grid analysis was solid with 90% of the population inside the target zone.
CONCLUSIONS: Multilevel models open new possibilities for designing glucose control algorithms. They allow controllers to take into account variables that have a strong influence on glucose homeostasis. A model-based controller was used for demonstrating how improved knowledge of the multilevel nature of diabetes increases the robustness and performance of glucose control algorithms. Using the proposed multi-level approach, a reduction of the hypoglycemic risk and robust behaviour for intrapatient variability was demonstrated.