Incorporating Unannounced Meals and Exercise in Adaptive Learning of Personalized Models for Multivariable Artificial Pancreas Systems

Background: Despite the recent advancements in the modeling of glycemic dynamics for type 1 diabetes mellitus, automatically considering unannounced meals and exercise without manual user inputs remains challenging. Method: An adaptive model identification technique that incorporates exercise information and estimates of the effects of unannounced meals obtained automatically without user input is proposed in this work. The effects of the unknown consumed carbohydrates are estimated using an individualized unscented Kalman filtering algorithm employing an augmented glucose-insulin dynamic model, and exercise information is acquired from noninvasive physiological measurements. The additional information on meals and exercise is incorporated with personalized estimates of plasma insulin concentration and glucose measurement data in an adaptive model identification algorithm. Results: The efficacy of the proposed personalized and adaptive modeling algorithm is demonstrated using clinical data involving closed-loop experiments of the artificial pancreas system, and the results demonstrate accurate glycemic modeling with the average root-mean-square error (mean absolute error) of 25.50 mg/dL (18.18 mg/dL) for six-step (30 minutes ahead) predictions. Conclusions: The approach presented is able to identify reliable time-varying individualized glucose-insulin models.