Artificial pancreas: automatic control of insulin infusion in type 1 diabetes mellitus

[ES] La diabetes mellitus tipo 1 es una enfermedad crónica que afecta aproximadamente a 30 millones de personas en el mundo y se caracteriza por niveles de concentración de glucosa en sangre elevados producidos por una deficiencia absoluta de insulina. Ello produce numerosas complicaciones a largo plazo como retinopatía, nefropatía y neuropatía entre otras. Las terapias actuales basadas en el suministro de insulina exógena (por inyecciones o bomba de insulina), no consiguen normalizar los niveles de glucosa de forma eficiente. Los avances tecnológicos en la última década en sistemas de medición continua de glucosa e infusión de insulina, han impulsado el desarrollo del páncreas artificial, o control automático de infusión de insulina. En este trabajo se presentará, a modo de tutorial, el pasado, presente y futuro de esta tecnología, tan esperada por el paciente diabético. Se revisará el estado actual de la tecnología para la sensorización y actuación, principales desafíos desde el punto de vista de control, las diferentes ``escuelas'' y estudios clínicos del desempeño de controladores, así como herramientas de validación de controladores mediante simulación. Dada la complejidad del problema, el desarrollo del páncreas artificial será de forma escalonada, redundando progresivamente en la mejora de la calidad de vida del paciente. Los grandes avances en los últimos cinco años hacen preveer un horizonte cercano para la primera generación de páncreas artificial.[EN] Type 1 diabetes mellitus is a chronic disease that affects approximately to 30 million people worldwide and is characterized by high blood glucose concentration levels produced by an absolute deficiency of insulin. That produces numerous long-term complications like retinopathy, nephropathy and neuropathy among others. Current therapies based on the exogenous delivery of insulin (through injections or an insulin pump), do not manage to normalize the glucose levels efficiently. Technological advances in the last decade in continuous glucose monitoring and insulin infusion have been a springboard for the development of the artificial pancreas, or automatic control of insulin infusion. In this work, the past, present and future of this technology, so long awaited by the diabetic patient, will be presented in the form of a tutorial. Current technology for sensorization and actuation will be reviewed, as well as main challenges from the control point of view, different “schools of thought” and clinical studies for controllers performance evaluation, and tools for the validation of controllers through simulation. Due to the complexity of the problem, the development of the artificial pancreas will be staggered, resulting progressively in an improvement of the patient’s quality of life. 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