Deborah Branigan | Searcharxiv

arXiv2026

Explainable AI-based Decision Support for Nocturnal Hypoglycemia Prevention in Type 1 Diabetes

Purpose: Nocturnal hypoglycemia (NH) remains a challenge for individuals with type 1 diabetes (T1D), particularly those who are physically active or on multiple daily injections (MDI). We leveraged an explainable evidential neural network model that forecasts minimum overnight glucose to identify NH risk factors and generate recommendations for NH prevention. Methods: We analyzed the impact of glucose and physical activity (PA) factors on predicted NH probability using SHapley Additive exPlanations (SHAP). Data were from 20 adults with T1D on MDI (10 females; mean age 39 years; HbA1c 7\%) who participated in a cross-over study (NCT05967260). Results: A total of 502 nights were analyzed. Bedtime glucose was the strongest predictor of NH. Other relevant factors included recent exposure to high or low glucose, glucose variability before bedtime, and timing of PA. Some associations appeared physiologically counterintuitive, possibly reflecting behavioral adjustments. Based on the identified risk factors and their SHAP values, we determined key decision points and developed recommendations that may help prevent NH, such as consuming a bedtime snack or discussing potential adjustments to insulin therapy with a healthcare provider. Conclusion: Identifying predictors of NH offers insights for managing NH risk in clinical decision support.

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arXiv2025

An AI-enabled dual-hormone model predictive control algorithm that delivers insulin and pramlintide

Current closed-loop insulin delivery algorithms need to be informed of carbohydrate intake disturbances. This can be a burden on people using these systems. Pramlintide is a hormone that delays gastric emptying, which enables insulin kinetics to align with the kinetics of carbohydrate absorption. Integrating pramlintide into an automated insulin delivery system can be helpful in reducing the postprandial glucose excursion and may be helpful in enabling fully-closed loop whereby meals do not need to be announced. We present an AI-enabled dual-hormone model predictive control (MPC) algorithm that delivers insulin and pramlintide without requiring meal announcements that uses a neural network to automatically detect and deliver meal insulin. The MPC algorithm includes a new pramlintide pharmacokinetics and pharmacodynamics model that was identified using data collected from people with type 1 diabetes undergoing a meal challenge. Using a simulator, we evaluated the performance of various pramlintide delivery methods and controller models, as well as the baseline insulin-only scenario. Meals were automatically dosed using a neural network meal detection and dosing (MDD) algorithm. The primary outcome was the percent time glucose is in the target range (TIR: 70-180 mg/dL). Results show that delivering pramlintide at a fixed ratio of 6 mcg pramlintide:1 u insulin using an MPC that is aware of the pramlintide achieved the most significant improved TIR compared with an insulin-only MPC (91.6% vs. 64.1%). Delivering pramlintide as a fixed ratio was better than delivering basal pramlintide at a constant rate, indicating the benefit of the MDD algorithm. There was no advantage of independent control of insulin and pramlintide compared with insulin and pramlintide delivered as a fixed ratio. Preliminary real-world results from a human subject further indicate the benefit of pramlintide delivery.

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