Specification
0001] Diabetes mellitus is a chronic metabolic disorder caused by an inability of the pancreas
to produce sufficient amounts of the hormone insulin, resulting in the decreased ability of the
body to metabolize glucose. This failure leads to hyperglycemia, i.e. the presence of an
excessive amount of glucose in the blood plasma. Persistent hyperglycemia and/or
hypoinsulinemia has been associated with a variety of serious symptoms and life threatening
long term complications such as dehydration, ketoacidosis, diabetic coma, cardiovascular
diseases, chronic renal failure, retinal damage and nerve damages with the risk of amputation
of extremities. Because restoration of endogenous insulin production is not yet possible, a
permanent therapy is necessary which provides constant glycemic control in order to always
maintain the level of blood glucose within normal limits. Such glycemic control is achieved
by regularly supplying external insulin to the body of the patient to thereby reduce the elevated
levels of blood glucose.
[0002] External biologic such as insulin was commonly administered by means of multiple
daily injections of a mixture of rapid and intermediate acting drug via a hypodermic syringe. It
has been found that the degree of glycemic control achievable in this way is suboptimal
because the delivery is unlike physiological hormone production, according to which hormone
enters the bloodstream at a lower rate and over a more extended period of time. Improved
glycemic control may be achieved by the so-called intensive hormone therapy which is based
on multiple daily injections, including one or two injections per day of long acting hormone for
providing basal hormone and additional injections of rapidly acting hormone before each meal
in an amount proportional to the size of the meal. Although traditional syringes have at least
partly been replaced by insulin pens, the frequent injections are nevertheless very inconvenient
for the patient, particularly those who are incapable of reliably self-administering injections.
[0003] Substantial improvements in diabetes therapy have been achieved by the development
of the drug delivery device, relieving the patient of the need for syringes or drug pens and the
administration of multiple daily injections. The drug delivery device allows for the delivery of
drug in a manner that bears greater similarity to the naturally occurring physiological processes
and can be controlled to follow standard or individually modified protocols to give the patient
better glycemic control.
[0004] In addition, delivery directly into the intraperitoneal space or intravenously can be
achieved by drug delivery devices. Drug delivery devices can be constructed as an implantable
device for subcutaneous arrangement or can be constructed as an external device with an
infusion set for subcutaneous infusion to the patient via the transcutaneous insertion of a
catheter, cannula or a transdermal drug transport such as through a patch. External drug
delivery devices are mounted on clothing, hidden beneath or inside clothing, or mounted on the
body and are generally controlled via a user interface built-in to the device or on a separate
remote device.
[0005] Blood or interstitial analyte monitoring is required to achieve acceptable glycemic
control. For example, delivery of suitable amounts of insulin by the drug delivery device
requires that the patient frequently determines his or her blood analyte level and manually
input this value into a user interface for the external pumps, which then calculates a suitable
modification to the default or currently in-use insulin delivery protocol, i.e. dosage and timing,
and subsequently communicates with the drug delivery device to adjust its operation
accordingly. The determination of blood analyte concentration is typically performed by
means of an episodic measuring device such as a hand-held electronic meter which receives
blood samples via enzyme-based test strips and calculates the blood analyte value based on the
enzymatic reaction.
[0006] Continuous analyte monitoring (CGM) has also been utilized over the last twenty years
with drug delivery devices to allow for closed loop control of the insulin(s) being infused into
the diabetic patients. To allow for closed-loop control of the infused insulins, proportionalintegral-
derivative (PID) controllers have been utilized with mathematical model of the
metabolic interactions between glucose and insulin in a person. The PID controllers can be
tuned based on simple rules of the metabolic models. However, when the PID controllers are
tuned or configured to aggressively regulate the blood glucose levels of a subject, overshooting
of the set level can occur, which is often followed by oscillations, which is highly undesirable
in the context of regulation of blood glucose. Alternative controllers were investigated. It was
determined that a model predictive controller (MPC) used in the petrochemical industries
where processes involved large time delays and system responses, was the most suitable for the
complex interplay between insulin, glucagon, and blood glucose. The MPC controller has
been demonstrated to be more robust than PID because MPC considers the near future effects
of control changes and constraints in determining the output of the MPC whereas PID typically
involves only past outputs in determining future changes. Constraints can be implemented in
the MPC controller such that MPC prevents the system from running away when the limit has
already been reached. Another benefit of MPC controllers is that the model in the MPC can, in
some cases, theoretically compensate for dynamic system changes whereas a feedback control,
such as PID control, such dynamic compensation would not be possible.
[0007] MPC can be viewed therefore as a combination of feedback and feed forward control.
MPC, however, typically requires a metabolic model to mimic as closely as possible to the
interaction between insulin and glucose in a biological system. As such, due to person-toperson
biological variations, MPC models continue to be further refined and developed and
details of the MPC controllers, variations on the MPC and mathematical models representing
the complex interaction of glucose and insulin are shown and described in the following
documents:
[0008] US Patent No. 7,060,059;
[0009] US Patent Application Nos. 2011/0313680 and 201 1/0257627,
[0010] International Publication WO 2012/051344,
[001 1] Percival et ah, "Closed-Loop Control and Advisory Mode Evaluation of an Artificial
Pancreatic b Cell: Use of Proportional-Integral-Derivative Equivalent Model-Based
Controllers' Journal of Diabetes Science and Technology, Vol. 2, Issue 4, July 2008.
[0012] Paola Soru et al.., "MPC Based Artificial Pancreas; Strategies for Individualization
and Meal Compensation" Annual Reviews in Control 36, p.118-128 (2012),
[0013] Cobelli et al, "Artificial Pancreas: Past, Present, Future" Diabetes Vol. 60, Nov.
201 1;
[0014] Magni et al., "Run-to-Run Tuning of Model Predictive Controlfor Type 1 Diabetes
Subjects: In Silico Trial" Journal of Diabetes Science and Technology, Vol. 3, Issue 5,
September 2009.
[0015] Lee et al., "A Closed-Loop Artificial Pancreas Using Model Predictive Control and a
Sliding Meal Size Estimator" Journal of Diabetes Science and Technology, Vol. 3, Issue 5,
September 2009;
[0016] Lee et al., "A Closed-Loop Artificial Pancreas based on MPC: Human Friendly
Identification and Automatic Meal Disturbance Rejection" Proceedings of the 17th World
Congress, The International Federation of Automatic Control, Seoul Korea July 6-11, 2008;
[0017] Magni et al., "Model Predictive Control of Type 1 Diabetes: An in Silico Trial" Journal
of Diabetes Science and Technology, Vol. 1, Issue 6, November 2007;
[0018] Wang et al., "Automatic Bolus and Adaptive Basal Algorithm for the Artificial
Pancreatic b-Cell" Diabetes Technology and Therapeutics, Vol. 12, No. 11, 2010; and
[0019] Percival et al.., "Closed-Loop Control of an Artificial Pancreatic b-Cell Using Multi-
Parametric Model Predictive Control" Diabetes Research 2008.
[0020] All articles or documents cited in this application are hereby incorporated by reference
into this application as if fully set forth herein.
SUMMARY OF THE DISCLOSURE
[0021] Applicant has identified a counterproductive effect of some realizations of model-based
control (including MPC) that fail to account for the effects of meals or a combination of meals
and manual boluses. In such a scenario, the model in the MPC may predict a quiescent, steady
glucose trend for the near future, even immediately after the subject or patient ingested a snack
or meal containing a substantial amount of carbohydrates. In this scenario, it is likely that the
model's prediction of future glucose is erroneous due to the model's failure to account for
effects of the snack. Applicant has also identified that the model's failure may be further
exacerbated in the same scenario but with the subject giving a self-delivered or manual bolus
to account for the snack. Because the manual bolus can be recognized by the model (due to
pump configuration) but the snack cannot, the controller may reduce or even suspend insulin
infusion after the manual bolus. This post-bolus attenuation of insulin infusion by the
controller is believed to be counterproductive because it effectively negates a portion of the
manual bolus. From an identification of the shortcoming of such closed-loop control, applicant
has devised a solution to mitigate such counterproductive effect of the closed-loop (e.g., MPC)
control.
[0022] In one aspect of the solution, applicant has provided a diabetes management system
that includes an infusion pump, glucose sensor and controller. The infusion pump is
configured to deliver insulin to a subject. The glucose sensor is configured to sense glucose
levels in the subject and provide output signals representative of the glucose levels in the
subject.
[0023] The controller receives signals from at least one of the glucose sensor and the pump,
and configured to issue signals to the pump to deliver an amount of insulin determined by a
feedback controller that utilizes a model predictive control of the subject based on desired
glucose levels, insulin amount delivered and measured glucose levels of the subject. The
controller is configured to deliver at least the basal amount of insulin whenever the subject has
initiated a manual bolus of insulin and a sensed or measured glucose level of is at least a first
threshold within a first duration of time.
[0024] That is, the controller is provided with constraints to deliver at least the basal quantity
of insulin whenever the subject has initiated a manual bolus of insulin and a sensed or
measured glucose level of is at least a first threshold within a first duration of time. In this
aspect, the first threshold may be about 120 milligrams of glucose per deciliter of blood and
the first duration may be from about 15 minutes to about 240 minutes. Further, the glucose
sensor may include at least one of an episodic glucose sensor and a continuous glucose sensor.
[0025] In yet another aspect of the solution devised by applicant, a method to manage diabetes
for a subject with an infusion pump, controller, and glucose sensor is provided. The method
can be achieved by: measuring glucose level in the subject from the glucose sensor to provide
a plurality of glucose measurements; calculating insulin amount by the controller for delivery
based on a model predictive controller that utilizes the plurality of glucose measurements to
predict a trend of the glucose level from estimates of a metabolic state of the subject so as to
provide a calculated insulin amount to be delivered to the subject over a predetermined
interval; determining whether the subject initiated a manual bolus while the glucose level is at
least a first glucose threshold within a first time period; and in the event the determining step is
true, constraining insulin delivery to be at least the basal amount. In the above aspects, the
first glucose threshold may include a glucose concentration of any concentration from about 80
mg of glucose per deciliter of blood to about 180 mg of glucose per deciliter of blood; the first
time period may include a duration of any value from about 15 minutes to two hours; the
predetermined interval may include an interval selected from a group consisting essentially of
1 minute, 3, minutes, 5 minutes, 10 minutes, 15 minutes, 20 minutes, 30 minutes and
combinations thereof. In this method, the glucose sensor may include at least one of an
episodic glucose sensor and a continuous glucose sensor. In this aspect, the calculating further
may include recursively determining an estimate of a metabolic state of the subject from
approximately real-time measurements of the glucose levels in the subject.
[0026] In a further aspect, a method to manage diabetes for a subject with an infusion pump,
controller, and glucose sensor is provided. The method can be achieved by: measuring
glucose level in the subject from the glucose sensor to provide a plurality of glucose
measurements; calculate a basal rate for delivery to the subject; determining whether the
subject initiated a manual bolus with the glucose level being at a level of at least a first glucose
threshold within a first time period; in the event the determining is true, constraining the
infusion pump to deliver insulin at the basal rate; in the event the determining is false, limiting
the infusion pump to deliver at approximately zero rate; calculating insulin dosing based on the
constraining and limiting steps; and commanding the pump to deliver insulin dosing calculated
by the calculating step. In the above aspects, the first glucose threshold may include a glucose
concentration of any concentration from about 80 mg of glucose per deciliter of blood to about
180 mg of glucose per deciliter of blood; the first time period may include a duration of any
value from about 15 minutes to two hours; the predetermined interval may include an interval
selected from a group consisting essentially of 1 minute, 3, minutes, 5 minutes, 10 minutes, 15
minutes, 20 minutes, 30 minutes and combinations thereof. In this method, the glucose sensor
may include at least one of an episodic glucose sensor and a continuous glucose sensor.
Additionally, the calculating further may include recursively determining an estimate of a
metabolic state of the subject from approximately real-time measurements of the glucose levels
in the subject.
[0027] In the aforementioned aspects of the disclosure, the steps of determining, estimating,
calculating, computing, deriving and/or utilizing (possibly in conjunction with an equation)
may be performed be an electronic circuit or a processor. These steps may also be
implemented as executable instructions stored on a computer readable medium; the
instructions, when executed by a computer may perform the steps of any one of the
aforementioned methods.
[0028] In additional aspects of the disclosure, there are computer readable media, each
medium comprising executable instructions, which, when executed by a computer, perform the
steps of any one of the aforementioned methods.
[0029] These and other embodiments, features and advantages will become apparent to those
skilled in the art when taken with reference to the following more detailed description of
various exemplary embodiments of the invention in conjunction with the accompanying
drawings that are first briefly described.
BRIEF DESCRIPTION OF THE DRAWINGS
[0030] The accompanying drawings, which are incorporated herein and constitute part of this
specification, illustrate presently preferred embodiments of the invention, and, together with
the general description given above and the detailed description given below, serve to explain
features of the invention (wherein like numerals represent like elements).
[0031] Figure 1 illustrates an exemplary embodiment of the diabetic management system in
schematic form.
[0032] Figure 2 illustrates the infusion set for the system of Figure 1 in which a controller for
the pump or glucose monitor(s) is separate from both the infusion pump and the glucose
monitor(s) and in which a network can be coupled to the controller to provide near real-time
monitoring.
[0033] Figure 3 illustrates the logic utilized in the controller of Figure 1 or Figure 2.
MODES FOR CARRYING OUT THE INVENTION
[0034] The following detailed description should be read with reference to the drawings, in
which like elements in different drawings are identically numbered. The drawings, which are
not necessarily to scale, depict selected embodiments and are not intended to limit the scope of
the invention. The detailed description illustrates by way of example, not by way of limitation,
the principles of the invention. This description will clearly enable one skilled in the art to
make and use the invention, and describes several embodiments, adaptations, variations,
alternatives and uses of the invention, including what is presently believed to be the best mode
of carrying out the invention.
[0035] As used herein, the terms "about" or "approximately" for any numerical values or
ranges indicate a suitable dimensional tolerance that allows the part or collection of
components to function for its intended purpose as described herein. More specifically,
"about" or "approximately" may refer to the range of values ±10% of the recited value, e.g.,
"about 90%" may refer to the range of values from 81% to 99%. In addition, as used herein,
the terms "patient," "host," "user," and "subject" refer to any human or animal subject and are
not intended to limit the systems or methods to human use, although use of the subject
invention in a human patient represents a preferred embodiment. As used herein, "oscillating
signal" includes voltage signal(s) or current signal(s) that, respectively, change polarity or
alternate direction of current or are multi-directional. Also used herein, the phrase "electrical
signal" or "signal" is intended to include direct current signal, alternating signal or any signal
within the electromagnetic spectrum. The terms "processor"; "microprocessor"; or
"microcontroller" are intended to have the same meaning and are intended to be used
interchangeably. As used herein, the term "annunciated" and variations on its root term
indicate that an announcement may be provided via text, audio, visual or a combination of all
modes or mediums of communication to a user. The term "drug" may include hormone,
biologically active materials, pharmaceuticals or other chemicals that causes a biological
response (e.g., glycemic response) in the body of a user or patient.
[0036] Figure 1 illustrates a schematic diagram of a system programmed with the solution
devised by applicant to counteract a less than desirable effect of a closed-loop control system.
In particular, Figure 1 provides for a controller 10 that receives a desired glucose concentration
or range of glucose concentration 12 (along with any modification from an update filter 28).
The controller 10 is programmed with an appropriate MPC to maintain the output (i.e., glucose
level) of the subject within the desired range of levels.
[0037] Referring to Figure 1, the first output 14 of the MPC-enabled controller 10 can be a
control signal to an insulin pump 16 to deliver a desired quantity of insulin 18 into a live
subject 20 at predetermined time intervals. A second output in the form of a predicted glucose
value 15 can be utilized in control junction B. A glucose sensor 22 measures the glucose
levels in the subject 20 in order to provide signals 24 representative of the actual or measured
glucose levels to control junction B, which takes the difference between measured glucose
concentration 24 and the MPC predictions of that measured glucose concentration. This
difference provides input for the update filter 26 of state variables of the model. The
difference 26 is provided to an estimator (also known as an update filter 28) that provides for
estimate of state variables of the model that cannot be measured directly. The update filter 28
is preferably a recursive filter in the form of a Kalman filter with tuning parameters for the
model. The output of the update or recursive filter 28 is provided to control junction A whose
output is utilized by the MPC in the controller 10 to further refine the control signal 14 to the
pump 16. A brief overview of the MPC used in controller 10 is provided below.
[0038] The MPC of controller 10 incorporates an explicit model of human T1DM glucoseinsulin
dynamics. The model is used to predict future glucose values and to calculate future
controller moves that will bring the glucose profile to the desired range. MPC controllers can
be formulated for both discrete- and continuous-time systems; the controller is set in discrete
time, with the discrete time (stage) index k referring to the epoch of the k ' sample occurring
at continuous time t =k -T , where Ts = 5 min is the sampling period. Software constraints
ensure that insulin delivery rates are constrained between minimum (i.e., zero) and maximum
values. The first insulin infusion (out of N steps) is then implemented. At the next time
step, + 1 based on the new measured glucose value and the last insulin rate, the process is
repeated.
[0039] The MPC algorithm is formulated to control to a safe glucose zone, with the lower limit
of the zone varying between 80-100 mg/dL and the upper limit varying between about 140-180
mg/dL; the algorithm will henceforth be referred to as the "zone MPC" algorithm. Controlling
to a target zone is, in general, applied to controlled systems that lack a specific set point with
the controller goal to keep the controlled variable (CV) in a predefined zone. Control to zone
(i.e. a normaglycemic zone) is highly suitable for the artificial pancreas because of the absence
of a natural glycemic set point. Moreover, an inherent benefit of control to zone is limiting
pump actuation/activity in a way that if glucose levels are within the zone no extra correction
shall be suggested.
[0040] In real-time, the insulin delivery rate ID from the zone MPC law is calculated by an on
line optimization, which evaluates at each sampling time the next insulin delivery rate. The
optimization at each sampling time is based on the estimated metabolic state (plasma glucose,
subcutaneous insulin) obtained from the dynamic model.
[0041] Using the FDA (US Food and Drug Administration) accepted UVa (University of
Virginia)/Padova metabolic simulator a reduced linear difference model was obtained which
relates the effects of insulin infusion rate (ID), and CHO ingestion input (Meal) on plasma
glucose. The model represents a single average model for the total population of subjects. The
model and its parameters are fixed.
[0042] The model includes second-order input transfer functions that are used to generate an
artificial input memory in the zone MPC schema to prevent insulin over-dosing, and as a result
hypoglycemia. In order to avoid over-delivery of insulin, the evaluation of any sequential insulin
delivery must take into consideration the past administered insulin against the length of the
insulin action. However, a one-state linear difference model with a relatively low order uses the
output (glycemia) as the main source of past administered input (insulin) "memory." In the face
of the model mismatch, noise, or change in the subject's insulin sensitivity, this may result in
under- or over-delivery of insulin. This is mitigated by adding two additional states for the
mapped insulin and meal inputs that carry a longer insulin memory. In this system, the insulin
delivery rates ID are adjusted over a finite horizon of M control moves, with the predicted
outputs G given by the model over a control horizon of P samples, assuming the insulin
delivery rate stays constant after time M until time P. Deviations in the estimated plasma
glucose outside the target zone and insulin delivery rates from the basal rate (for that time of
day) are penalized by the parameters Q and R, respectively.
[0043] Zone MPC is applied when the specific set point value of a controlled variable (CV) is
of low relevance compared to a zone that is defined by upper and lower boundaries.
Moreover, in the presence of noise and model mismatch there is no practical value using a
fixed set point. A related derivation of zone MPC was presented in Maciejowski JM.
Predictive control with constraints. Harlow, UK: Prentice-Hall, Pearson Education Limited,
2002.
[0044] The zone MPC is implemented by defining fixed upper and lower bounds as soft
constraints by letting the optimization weights switch between zero and some final values
when the predicted CVs are in or out of the desired zone, respectively. The predicted residuals
are generally defined as the difference between the CV that is out of the desired zone and the
nearest bound. Zone MPC is typically divided into three different zones. The permitted range
is the control target and it is defined by upper and lower bounds. The upper zone represents
undesirable high predicted glycemic values. The lower zone represents undesirable low
predicted glycemic values that represent hypoglycemic zone or a pre-hypoglycemic protective
area that is a low alarm zone. The zone MPC optimizes the predicted glycemia by
manipulating the near-future insulin control moves to stay in the permitted zone under
specified constrains.
[0045] The core of zone MPC lies in its cost function formulation that holds the zone
formulation. Zone MPC, like any other forms of MPC, predicts the future output by an explicit
model using past input/output records and future input moves that need to be optimized.
However, instead of driving to a specific fixed set point, the optimization attempts to keep or
move the predicted outputs into a zone that is defined by upper and lower bounds. Using a
linear difference model, the glycemic dynamics are predicted and the optimization reduces
future glycemic excursions from the zone under constraints and weights defined in its cost
function.
[0046] A suitable technical computing software (e.g., MATLAB 'fmincon.m') is used to solve
the optimization problem described above and the following hard constraints are implemented
on the manipulated variables (ID ) - basal
Documents
Application Documents
| # |
Name |
Date |
| 1 |
9378-DELNP-2014-FER.pdf |
2021-10-17 |
| 1 |
PCT-IB-304.pdf |
2014-11-14 |
| 2 |
9378-DELNP-2014-FORM 4(ii) [30-12-2020(online)].pdf |
2020-12-30 |
| 2 |
OTHER RELEVANT DOCUMENT.pdf |
2014-11-14 |
| 3 |
FORM 5.pdf |
2014-11-14 |
| 3 |
Form 18 [17-06-2016(online)].pdf |
2016-06-17 |
| 4 |
FORM 3.pdf |
2014-11-14 |
| 4 |
9378-delnp-2014-Assignment-(08-01-2015).pdf |
2015-01-08 |
| 5 |
9378-delnp-2014-Correspondence Others-(08-01-2015).pdf |
2015-01-08 |
| 5 |
FORM 2 + SPECIFICATION.pdf |
2014-11-14 |
| 6 |
9378-DELNP-2014.pdf |
2014-11-15 |
| 7 |
9378-delnp-2014-Correspondence Others-(08-01-2015).pdf |
2015-01-08 |
| 7 |
FORM 2 + SPECIFICATION.pdf |
2014-11-14 |
| 8 |
9378-delnp-2014-Assignment-(08-01-2015).pdf |
2015-01-08 |
| 8 |
FORM 3.pdf |
2014-11-14 |
| 9 |
Form 18 [17-06-2016(online)].pdf |
2016-06-17 |
| 9 |
FORM 5.pdf |
2014-11-14 |
| 10 |
OTHER RELEVANT DOCUMENT.pdf |
2014-11-14 |
| 10 |
9378-DELNP-2014-FORM 4(ii) [30-12-2020(online)].pdf |
2020-12-30 |
| 11 |
PCT-IB-304.pdf |
2014-11-14 |
| 11 |
9378-DELNP-2014-FER.pdf |
2021-10-17 |
Search Strategy
| 1 |
Searchstrategy9378delnp2014E_23-06-2020.pdf |