Frequent and long-term exposure to hyperglycemia (i.e., high blood glucose) increases the risk of chronic complications such as neuropathy, nephropathy, and cardiovascular disease. Current technologies like continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) primarily model specific aspects of glycemic control-like hypoglycemia prediction or insulin delivery. Similarly, most digital twin approaches in diabetes management simulate only physiological processes. These systems lack the ability to offer alternative treatment scenarios that support proactive behavioral interventions. To address this, we propose GlyTwin, a novel digital twin framework that uses counterfactual explanations to simulate optimal treatments for glucose regulation. Our approach helps patients and caregivers modify behaviors like carbohydrate intake and insulin dosing to avoid abnormal glucose events. GlyTwin generates behavioral treatment suggestions that proactively prevent hyperglycemia by recommending small adjustments to daily choices, reducing both frequency and duration of these events. Additionally, it incorporates stakeholder preferences into the intervention design, making recommendations patient-centric and tailored. We evaluate GlyTwin on AZT1D, a newly constructed dataset with longitudinal data from 21 type 1 diabetes (T1D) patients on automated insulin delivery systems over 26 days. Results show GlyTwin outperforms state-of-the-art counterfactual methods, generating 76.6% valid and 86% effective interventions. These findings demonstrate the promise of counterfactual-driven digital twins in delivering personalized healthcare.

The growing worldwide incidence of diabetes requires more effective approaches for managing blood glucose levels. Insulin delivery systems have advanced significantly, with artificial intelligence (AI) playing a key role in improving their precision and adaptability. AI algorithms, particularly those based on reinforcement learning, allow for personalised insulin dosing by continuously adapting to an individual's responses. Despite these advancements, challenges such as data privacy, algorithm transparency, and accessibility still need to be addressed. Continued progress and validation in AI-driven insulin delivery systems promise to improve therapy outcomes further, offering people more effective and individualised management of their diabetes. This paper presents an overview of current strategies, key challenges, and future directions.

This paper presents a novel multi-agent reinforcement learning (RL) approach for personalized glucose control in individuals with type 1 diabetes (T1D). The method employs a closed-loop system consisting of a blood glucose (BG) metabolic model and a multi-agent soft actor-critic RL model acting as the basal-bolus advisor. Performance evaluation is conducted in three scenarios, comparing the RL agents to conventional therapy. Evaluation metrics include glucose levels (minimum, maximum, and mean), time spent in different BG ranges, and average daily bolus and basal insulin dosages. Results demonstrate that the RL-based basal-bolus advisor significantly improves glucose control, reducing glycemic variability and increasing time spent within the target range (70-180 mg/dL). Hypoglycemia events are effectively prevented, and severe hyperglycemia events are reduced. The RL approach also leads to a statistically significant reduction in average daily basal insulin dosage compared to conventional therapy. These findings highlight the effectiveness of the multi-agent RL approach in achieving better glucose control and mitigating the risk of severe hyperglycemia in individuals with T1D.

Objective: The artificial pancreas (AP) has shown promising potential in achieving closed-loop glucose control for individuals with type 1 diabetes mellitus (T1DM). However, designing an effective control policy for the AP remains challenging due to the complex physiological processes, delayed insulin response, and inaccurate glucose measurements. While model predictive control (MPC) offers safety and stability through the dynamic model and safety constraints, it lacks individualization and is adversely affected by unannounced meals. Conversely, deep reinforcement learning (DRL) provides personalized and adaptive strategies but faces challenges with distribution shifts and substantial data requirements. Methods: We propose a hybrid control policy for the artificial pancreas (HyCPAP) to address the above challenges. HyCPAP combines an MPC policy with an ensemble DRL policy, leveraging the strengths of both policies while compensating for their respective limitations. To facilitate faster deployment of AP systems in real-world settings, we further incorporate meta-learning techniques into HyCPAP, leveraging previous experience and patient-shared knowledge to enable fast adaptation to new patients with limited available data. Results: We conduct extensive experiments using the FDA-accepted UVA/Padova T1DM simulator across three scenarios. Our approaches achieve the highest percentage of time spent in the desired euglycemic range and the lowest occurrences of hypoglycemia. Conclusion: The results clearly demonstrate the superiority of our methods for closed-loop glucose management in individuals with T1DM. Significance: The study presents novel control policies for AP systems, affirming the great potential of proposed methods for efficient closed-loop glucose control.

Scientists at the University of Bristol have shown that reinforcement learning, a type of machine learning in which a computer program learns to make decisions by trying different actions, significantly outperforms commercial blood glucose controllers in terms of safety and effectiveness. By using offline reinforcement learning, where the algorithm learns from patient records, the researchers improve on prior work, showing that good blood glucose control can be achieved by learning from the decisions of the patient rather than by trial and error. Type 1 diabetes is one of the most prevalent auto-immune conditions in the UK and is characterised by an insufficiency of the hormone insulin, which is responsible for blood glucose regulation. Many factors affect a person's blood glucose and therefore it can be a challenging and burdensome task to select the correct insulin dose for a given scenario. Current artificial pancreas devices provide automated insulin dosing but are limited by their simplistic decision-making algorithms.

The widespread adoption of effective hybrid closed loop systems would represent an important milestone of care for people living with type 1 diabetes (T1D). These devices typically utilise simple control algorithms to select the optimal insulin dose for maintaining blood glucose levels within a healthy range. Online reinforcement learning (RL) has been utilised as a method for further enhancing glucose control in these devices. Previous approaches have been shown to reduce patient risk and improve time spent in the target range when compared to classical control algorithms, but are prone to instability in the learning process, often resulting in the selection of unsafe actions. This work presents an evaluation of offline RL for developing effective dosing policies without the need for potentially dangerous patient interaction during training. This paper examines the utility of BCQ, CQL and TD3-BC in managing the blood glucose of the 30 virtual patients available within the FDA-approved UVA/Padova glucose dynamics simulator. When trained on less than a tenth of the total training samples required by online RL to achieve stable performance, this work shows that offline RL can significantly increase time in the healthy blood glucose range from 61.6 +\- 0.3% to 65.3 +/- 0.5% when compared to the strongest state-of-art baseline (p < 0.001). This is achieved without any associated increase in low blood glucose events. Offline RL is also shown to be able to correct for common and challenging control scenarios such as incorrect bolus dosing, irregular meal timings and compression errors.

Neural network training entails heavy computation with obvious bottlenecks. The Compute Unified Device Architecture (CUDA) programming model allows us to accelerate computation by passing the processing workload from the CPU to the graphics processing unit (GPU). In this paper, we leveraged the power of Nvidia GPUs to parallelize all of the computation involved in training, to accelerate a backpropagation feed-forward neural network with one hidden layer using CUDA and C++. This optimized neural network was tasked with predicting the level of glycated hemoglobin (HbA1c) from non-invasive markers. The rate of increase in the prevalence of Diabetes Mellitus has resulted in an urgent need for early detection and accurate diagnosis. However, due to the invasiveness and limitations of conventional tests, alternate means are being considered. Limited Joint Mobility (LJM) has been reported as an indicator for poor glycemic control. LJM of the fingers is quantified and its link to HbA1c is investigated along with other potential non-invasive markers of HbA1c. We collected readings of 33 potential markers from 120 participants at a clinic in south Trinidad. Our neural network achieved 95.65% accuracy on the training and 86.67% accuracy on the testing set for male participants and 97.73% and 66.67% accuracy on the training and testing sets for female participants. Using 960 CUDA cores from a Nvidia GeForce GTX 660, our parallelized neural network was trained 50 times faster on both subsets, than its corresponding CPU implementation on an Intel Core (TM) i7-3630QM 2.40 GHz CPU.