Model-Free Machine Learning in Biomedicine: Feasibility Study in Type 1 Diabetes

Type 1 diabetes (T1D) is a metabolic disease characterised by uncontrolled blood glucose levels, due to the absence or malfunction of insulin. The Artificial Pancreas (AP) system aims to simulate the function of the physiological pancreas and serve as an external automatic glucose regulation system. AP combines a continuous glucose monitor (CGM), a continuous subcutaneous insulin infusion (CSII) pump and a control algorithm which closes the loop between the two devices and optimises the insulin infusion rate. An important challenge in the design of efficient control algorithms for AP is the use of the subcutaneous route both for glucose measurement and insulin infusion (sc-sc route); this introduces delays of up to 30 minutes for sc glucose measurement and up to 20 minutes for insulin absorption. Thus, a total delay of almost one hour restricts both monitoring and intervention in real time. Moreover, glucose is affected by multiple factors, which may be genetic, lifestyle and environmental. With the improvement in sensor technology, more information can be provided to the control algorithm (e.g. more accurate glucose readings and physical activity levels); however, the level of uncertainty remains very high. Last but not least, one of the most important challenges emerges from the high inter- and intra-patient variability, which dictate personalised insulin treatment. Along with hardware improvements, the challenges of the AP are gradually being addressed with the development of advanced algorithmic strategies; the strategies most investigated clinically are the Proportional Integral Derivative (PID) [1], the Model Predictive Controller (MPC) [2]-[7] and fuzzy logic (e.g.