Unannounced meal analysis of the ARG algorithm

One of the main challenges in automatic glycemic regulation in patients with type 1 diabetes (T1D) is to dispense with carbohydrate counting. In this context, we propose to equip a previously introduced switched Linear Quadratic Gaussian (LQG) controller-the so-called Automatic Regulation of Glucose (ARG) algorithm-with an automatic switching signal generator (SSG). The ARG algorithm not only regulates the basal insulin infusion rate but also generates feedback insulin spikes at meal times, i.e., no open-loop insulin boluses are needed to mitigate postprandial glucose excursions. However, in its former version, it was required to announce the meal time. In this work, the performance of the ARG algorithm combined with the proposed SSG is assessed in silico with unannounced meals. In addition, the response of the SSG is estimated using clinical data obtained with the ARG algorithm in the first-ever artificial pancreas (AP) trials carried out in Latin America.