Intra-patient dynamic variations in Type 1 Diabetes: A review

Research on the development of a closed-loop artificial pancreas for automatically regulating the Blood Glucose (BG) level in Type 1 Diabetes Mellitus (T1DM) patients has intensified in the past years. However, the risk of hyper- and hypoglycemia remains an impediment to good glycemic control in some cases. A major source of limitations originates from model uncertainty, and the extremely high inter- and intra-patient variability that affects the dynamics of glucose regulation. Therefore, tools are required for the design of robust and time-varying control strategies that consider these issues. This work provides a general introduction to characterize intra-patient variations in glucose dynamics from its physiological description, and reviews available modeling/simulation approaches that include them, and therefore, allow the design of more sophisticated glucose controllers.