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Algorithms for Automated Insulin Delivery: An Overview.

Authors
  • Thomas, Andreas1
  • Heinemann, Lutz1
  • 1 Working Group Diabetes & Technology of the German Diabetes Association, Germany. , (Germany)
Type
Published Article
Journal
Journal of Diabetes Science and Technology
Publisher
SAGE Publications
Publication Date
Sep 01, 2022
Volume
16
Issue
5
Pages
1228–1238
Identifiers
DOI: 10.1177/19322968211008442
PMID: 33955251
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The technology needed to "close the loop," that is, a system for continuous glucose monitoring and a pump that infuses insulin, are only 2 of the 3 components needed for each system for automated insulin delivery (AID), the other is a "translation" of the glucose information into the appropriate amount of insulin to be applied at a given point in time to keep glucose levels in the body in the target range. It might look straightforward to calculate the required insulin dose and control the pump to apply this immediately; however, once a given amount of insulin is in the body, it will be absorbed and become metabolically active. To avoid lowering glucose levels toward too low levels, the algorithms used to calculate the insulin dose have to take a number of other factors into account. This is needed to make sure that AID systems are not only efficient but also safe, that is, not only Time-in-Range should be maximal, also Time-below-Range should be minimal. The review characterizes the different types of AID algorithms that were developed in the last decades. Using a structured approach, the different algorithms are classified. A systematic evaluation of the performance of the different algorithms is missing, not only during the clinical development of AID systems, but also in daily practice. However, it might very well be that other factors determine which AID algorithms will be used in practice.

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