Automating Glucose Control in Type 1 Diabetes

Type 1 diabetes (T1D) is a chronic metabolic disease characterised by an autoimmune destruction of the beta cells in the pancreas, responsible of insulin secretion which promotes glucose transport into the cells. The resulting absolute insulin deficiency results in high blood glucose levels (hyperglycaemia). Therefore, people with T1D require exogenous delivery of insulin in order to survive. Sustained elevated glucose levels can lead to long-term complications (retinopathy, nephropathy, heart disease), which place a heavy burden to the healthcare system. Due to the complexity of glucoseinsulin metabolism, achieving good glucose control is often a very difficult task. The development of continuous glucose monitoring (CGM) have opened the door to the development of automatic insulin delivery systems, the so-called artificial pancreas (AP). In the past 10 years there has been an intensive research effort from different players in the artificial pancreas development, which has translated into a first system reaching the market in 2017, although patient intervention for meal control is still needed (this is referred as 'hybrid artificial pancreas'). This has been thanks to important contributions from modelling and control engineering, in combination with technological and pharmacological achievements.