A Dual-Hormone Multicontroller for Artificial Pancreas Systems.

Artificial pancreas (AP) algorithms can be divided into single-hormone (SH) and dual-hormone (DH). SH algorithms regulate glycemia using insulin as their control input. On the other hand, DH algorithms also use glucagon to counteract insulin. While SH-AP systems are already commercially available, DH-AP systems are still in an earlier research phase. DH-AP systems have been questioned since the added complexity of glucagon infusion does not always guarantee hypoglycemia prevention and might significantly raise insulin delivery. In this work, a DH multicontroller is proposed based on a SH linear quadratic gaussian (LQG) algorithm with an additional LQG controller to deliver glucagon. This strategy has a switched structure that allows activating one of the following three controllers when necessary: a conservative insulin LQG controller to modulate basal delivery ( K), an aggressive insulin LQG controller to counteract meals ( K), or a glucagon LQG controller to avoid imminent hypoglycemia ( K). Here, an in silico study of the benefits of incorporating controller K is carried out. Intra-patient variability and mixed meals are considered. Results indicate that the proposed switched, dual-hormone strategy yields to a reduction in hypoglycemia without increasing hyperglycemia, with no significant rise in insulin delivery.