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https://www.readbyqxmd.com/read/28503717/a-review-of-the-current-challenges-associated-with-the-development-of-an-artificial-pancreas-by-a-double-subcutaneous-approach
#1
REVIEW
Sverre Christian Christiansen, Anders Lyngvi Fougner, Øyvind Stavdahl, Konstanze Kölle, Reinold Ellingsen, Sven Magnus Carlsen
INTRODUCTION: Patients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range. METHODS: Based on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach...
May 13, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28484424/continuous-subcutaneous-insulin-infusion-in-children-a-pilot-study-validating-a-protocol-to-avoid-hypoglycemia-at-initiation
#2
Despoina Manousaki, Johnny Deladoëy, Louis Geoffroy, Patricia Olivier
BACKGROUND: The occurrence of hypoglycemia and hyperglycemia during the first days after transition to continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes has not been systematically studied in children. The aim of this prospective study was to demonstrate that the protocol applied in our diabetes clinic is safe at CSII initiation in children. METHODS: We assessed 22 pediatric patients with type 1 diabetes, using continuous glucose monitoring (CGM) before and after CSII initiation (±3 days)...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28459603/closed-loop-control-of-postprandial-glycemia-using-an-insulin-on-board-limitation-through-continuous-action-on-glucose-target
#3
Paolo Rossetti, Carmen Quirós, Vanessa Moscardó, Anna Comas, Marga Giménez, F Javier Ampudia-Blasco, Fabián León, Eslam Montaser, Ignacio Conget, Jorge Bondia, Josep Vehí
BACKGROUND: Postprandial (PP) control remains a challenge for closed-loop (CL) systems. Few studies with inconsistent results have systematically investigated the PP period. OBJECTIVE: To compare a new CL algorithm with current pump therapy (open loop [OL]) in the PP glucose control in type 1 diabetes (T1D) subjects. METHODS: A crossover randomized study was performed in two centers. Twenty T1D subjects (F/M 13/7, age 40.7 ± 10.4 years, disease duration 22...
May 1, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28426239/performance-of-an-artificial-pancreas-system-for-young-children-with-type-1-diabetes
#4
Mark D DeBoer, Marc D Breton, Christian Wakeman, Elaine M Schertz, Emma G Emory, Jessica L Robic, Laura L Kollar, Boris P Kovatchev, Daniel R Cherñavvsky
BACKGROUND: Young children 5-8 years old with type 1 diabetes (T1D) exhibit clear needs for improved glycemic control but may be limited in their ability to safely interact with an artificial pancreas system. Our goal was to evaluate the safety and performance of an artificial pancreas (AP) system among young children with T1D. RESEARCH DESIGN AND METHODS: In a randomized, crossover trial, children with T1D age 5-8 years were enrolled to receive on separate study periods (in random order) either the UVa AP using the DiAs Control Platform software with child-resistant lock-out screens (followed as an out-patient admission) or their usual insulin pump+continuous glucose monitor (CGM) care at home...
May 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28296467/comparison-of-insulin-pump-therapy-and-multiple-daily-injections-insulin-regimen-in-patients-with-type-1-diabetes-during-ramadan-fasting
#5
Reem Alamoudi, Maram Alsubaiee, Ali Alqarni, Yousef Saleh, Saleh Aljaser, Abdul Salam, Mohsen Eledrisi
INTRODUCTION: Fasting Ramadan carries a high risk for patients with type 1 diabetes (T1DM). Data on the optimum insulin regimen in these patients are limited. OBJECTIVES: To compare glucose profiles in patients with T1DM who use continuous subcutaneous insulin infusion (CSII) compared with those who use multiple daily injections (MDI) insulin regimen during Ramadan fast. The primary outcome was rates of hypoglycemia. Other outcomes included glycemic control, number of days needed to break fasting, and acute glycemic complications...
March 15, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28272368/use-of-wearable-sensors-and-biometric-variables-in-an-artificial-pancreas-system
#6
Kamuran Turksoy, Colleen Monforti, Minsun Park, Garett Griffith, Laurie Quinn, Ali Cinar
An artificial pancreas (AP) computes the optimal insulin dose to be infused through an insulin pump in people with Type 1 Diabetes (T1D) based on information received from a continuous glucose monitoring (CGM) sensor. It has been recognized that exercise is a major challenge in the development of an AP system. The use of biometric physiological variables in an AP system may be beneficial for prevention of exercise-induced challenges and better glucose regulation. The goal of the present study is to find a correlation between biometric variables such as heart rate (HR), heat flux (HF), skin temperature (ST), near-body temperature (NBT), galvanic skin response (GSR), and energy expenditure (EE), 2D acceleration-mean of absolute difference (MAD) and changes in glucose concentrations during exercise via partial least squares (PLS) regression and variable importance in projection (VIP) in order to determine which variables would be most useful to include in a future artificial pancreas...
March 7, 2017: Sensors
https://www.readbyqxmd.com/read/28251726/outcomes-of-algorithm-based-modifications-of-insulinotherapy-during-exercise-in-mdi-vs-insulin-pump-treated-children-with-type-1-diabetes-results-from-the-tread-diab-study
#7
S Moniotte, M Owen, T Barrea, A Robert, P A Lysy
OBJECTIVES: To evaluate the evolution of subcutaneous glucose (SG) after a standardized aerobic exercise in children and adolescents treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injection (MDI) regimen before and after adaptation of insulin doses. RESEARCH DESIGN AND METHODS: Eleven CSII- and 13 MDI-treated patients performed 2 30-minute sessions of moderate to vigorous (70% of age-based maximal heart rate) exercise on a treadmill under continuous glucose monitoring (CGM)...
March 2, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/28245152/real-world-use-and-self-reported-health-outcomes-of-a-patient-designed-do-it-yourself-mobile-technology-system-for-diabetes-lessons-for-mobile-health
#8
Joyce M Lee, Mark W Newman, Achamyeleh Gebremariam, Preciosa Choi, Dana Lewis, Weston Nordgren, John Costik, James Wedding, Benjamin West, Nancy Benovich Gilby, Christopher Hannemann, Josh Pasek, Ashley Garrity, Emily Hirschfeld
BACKGROUND: The aim of this study is to compare demographic/disease characteristics of users versus nonusers of a do-it-yourself (DIY) mobile technology system for diabetes (Nightscout), to describe its uses and personalization, and to evaluate associated changes in health behaviors and outcomes. METHODS: A cross-sectional, household-level online survey was used. Of 1268 household respondents who were members of the CGM in the Cloud Facebook group, there were 1157 individuals with diabetes who provided information about Nightscout use...
April 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28236571/multicentre-randomized-controlled-trial-with-sensor-augmented-pump-vs-multiple-daily-injections-in-hospitalized-patients-with-type-2-diabetes-in-china-time-to-reach-target-glucose
#9
W Gu, Y Liu, Y Chen, W Deng, X Ran, L Chen, D Zhu, J Yang, J Shin, S W Lee, T L Cordero, Y Mu
AIM: Sensor-augmented pump (SAP) technology, which combines continuous subcutaneous insulin infusion (CSII) and real-time continuous glucose monitoring (RT-CGM), has been available for several years in China. In this study, the time required to reach predefined glycaemic targets with SAP vs multiple daily injection (MDI) therapy was compared in hospitalized patients with type 2 diabetes mellitus (T2DM). METHODS: Adults (aged 18-65 years) with T2DM treated with insulin and admitted to hospital for glucose management were randomized to either SAP (Medtronic MiniMed™ Paradigm™ 722 system) or MDI with blinded CGM (Medtronic MiniMed CGMS System Gold™) for a 2-week period...
February 21, 2017: Diabetes & Metabolism
https://www.readbyqxmd.com/read/28221823/evaluation-of-a-predictive-low-glucose-management-system-in-clinic
#10
Bruce A Buckingham, Timothy S Bailey, Mark Christiansen, Satish Garg, Stuart Weinzimer, Bruce Bode, Stacey M Anderson, Ronald Brazg, Trang T Ly, Francine R Kaufman
BACKGROUND: Predictions based on continuous glucose monitoring (CGM) data are the basis for automatic suspension and resumption of insulin delivery by a predictive low-glucose management feature termed "suspend before low," which is part of the Medtronic MiniMed(®) 640G combined insulin pump and CGM system. This study assessed the safety and performance characteristics of the system in an in-clinic setting at eight sites. MATERIALS AND METHODS: In-clinic standardized increases in basal insulin delivery rates were used to induce nocturnal hypoglycemia in subjects (14-75 years) with type 1 diabetes wearing the MiniMed 640G system...
May 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28209654/replace-bg-a-randomized-trial-comparing-continuous-glucose-monitoring-with-and-without-routine-blood-glucose-monitoring-in-adults-with-well-controlled-type-1-diabetes
#11
Grazia Aleppo, Katrina J Ruedy, Tonya D Riddlesworth, Davida F Kruger, Anne L Peters, Irl Hirsch, Richard M Bergenstal, Elena Toschi, Andrew J Ahmann, Viral N Shah, Michael R Rickels, Bruce W Bode, Athena Philis-Tsimikas, Rodica Pop-Busui, Henry Rodriguez, Emily Eyth, Anuj Bhargava, Craig Kollman, Roy W Beck
OBJECTIVE: To determine whether the use of continuous glucose monitoring (CGM) without confirmatory blood glucose monitoring (BGM) measurements is as safe and effective as using CGM adjunctive to BGM in adults with well-controlled type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: A randomized noninferiority clinical trial was conducted at 14 sites in the T1D Exchange Clinic Network. Participants were ≥18 years of age (mean 44 ± 14 years), had T1D for ≥1 year (mean duration 24 ± 12 years), used an insulin pump, and had an HbA1c ≤9...
April 2017: Diabetes Care
https://www.readbyqxmd.com/read/28118453/effect-of-continuous-glucose-monitoring-on-glycemic-control-in-adults-with-type-1-diabetes-using-insulin-injections-the-diamond-randomized-clinical-trial
#12
RANDOMIZED CONTROLLED TRIAL
Roy W Beck, Tonya Riddlesworth, Katrina Ruedy, Andrew Ahmann, Richard Bergenstal, Stacie Haller, Craig Kollman, Davida Kruger, Janet B McGill, William Polonsky, Elena Toschi, Howard Wolpert, David Price
Importance: Previous clinical trials showing the benefit of continuous glucose monitoring (CGM) in the management of type 1 diabetes predominantly have included adults using insulin pumps, even though the majority of adults with type 1 diabetes administer insulin by injection. Objective: To determine the effectiveness of CGM in adults with type 1 diabetes treated with insulin injections. Design, Setting, and Participants: Randomized clinical trial conducted between October 2014 and May 2016 at 24 endocrinology practices in the United States that included 158 adults with type 1 diabetes who were using multiple daily insulin injections and had hemoglobin A1c (HbA1c) levels of 7...
January 24, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28007348/home-use-of-a-bihormonal-bionic-pancreas-versus-insulin-pump-therapy-in-adults-with-type-1-diabetes-a-multicentre-randomised-crossover-trial
#13
Firas H El-Khatib, Courtney Balliro, Mallory A Hillard, Kendra L Magyar, Laya Ekhlaspour, Manasi Sinha, Debbie Mondesir, Aryan Esmaeili, Celia Hartigan, Michael J Thompson, Samir Malkani, J Paul Lock, David M Harlan, Paula Clinton, Eliana Frank, Darrell M Wilson, Daniel DeSalvo, Lisa Norlander, Trang Ly, Bruce A Buckingham, Jamie Diner, Milana Dezube, Laura A Young, April Goley, M Sue Kirkman, John B Buse, Hui Zheng, Rajendranath R Selagamsetty, Edward R Damiano, Steven J Russell
BACKGROUND: The safety and effectiveness of a continuous, day-and-night automated glycaemic control system using insulin and glucagon has not been shown in a free-living, home-use setting. We aimed to assess whether bihormonal bionic pancreas initialised only with body mass can safely reduce mean glycaemia and hypoglycaemia in adults with type 1 diabetes who were living at home and participating in their normal daily routines without restrictions on diet or physical activity. METHODS: We did a random-order crossover study in volunteers at least 18 years old who had type 1 diabetes and lived within a 30 min drive of four sites in the USA...
January 28, 2017: Lancet
https://www.readbyqxmd.com/read/28004007/clinical-efficacy-of-two-different-methods-to-initiate-sensor-augmented-insulin-pumps-a-randomized-controlled-trial
#14
RANDOMIZED CONTROLLED TRIAL
Jesus Moreno-Fernandez, Francisco Javier Gómez, Maria Ángeles Gálvez Moreno, Justo P Castaño
Aim. To analyze clinical effect of a novel approach to initiate sensor-augmented insulin pumps in type 1 diabetes mellitus (T1DM) patients through early real-time continuous glucose monitoring (RT-CGM) initiation. Methods. A 26-week pilot study with T1DM subjects randomized (1 : 1) to start RT-CGM three weeks before continuous subcutaneous insulin infusion (CGM pre-CSII) or adding RT-CGM three weeks after continuous subcutaneous insulin infusion (CGM post-CSII). Results. Twenty-two patients were enrolled with a mean age of 36...
2016: Journal of Diabetes Research
https://www.readbyqxmd.com/read/27996321/measures-of-glycemic-variability-in-type-1-diabetes-and-the-effect-of-real-time-continuous-glucose-monitoring
#15
Ahmed H El-Laboudi, Ian F Godsland, Desmond G Johnston, Nick S Oliver
OBJECTIVE: To report the impact of continuous glucose monitoring (CGM) on glycemic variability (GV) indices, factors predictive of change, and to correlate variability with conventional markers of glycemia. METHODS: Data from the JDRF study of CGM in participants with type 1 diabetes were used. Participants were randomized to CGM or self-monitored blood glucose (SMBG). GV indices at baseline, at 26 weeks in both groups, and at 52 weeks in the control group were analyzed...
December 2016: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/27983910/active-subjects-with-autoimmune-type-1-diabetes-have-better-metabolic-profiles-than-sedentary-controls
#16
M Adamo, R Codella, F Casiraghi, A Ferrulli, C Macrì, E Bazzigaluppi, I Terruzzi, L Inverardi, C Ricordi, L Luzi
Previous studies in humans with type 1 diabetes mellitus (T1D) and in nonobese diabetic mice have investigated the beneficial immunomodulatory potential of aerobic physical activity. Performing high volume of aerobic exercise may favorably regulate autoimmunity in diabetes. We tested whether increased physical activity is a self-sufficient positive factor in T1D subjects. During a 3-month observational period, active (six males; 40.5 ± 6.1 years; BMI: 24.5 ± 2.1) and sedentary (four males, three females; 35...
January 24, 2017: Cell Transplantation
https://www.readbyqxmd.com/read/27899489/diabetes-device-use-in-adults-with-type-1-diabetes-barriers-to-uptake-and-potential-intervention-targets
#17
Molly L Tanenbaum, Sarah J Hanes, Kellee M Miller, Diana Naranjo, Rachel Bensen, Korey K Hood
OBJECTIVE: Diabetes devices (insulin pumps, continuous glucose monitors [CGMs]) are associated with benefits for glycemic control, yet uptake of these devices continues to be low. Some barriers to device uptake may be modifiable through psychosocial intervention, but little is known about which barriers and which patients to target. RESEARCH DESIGN AND METHODS: We surveyed 1,503 adult T1D Exchange participants (mean age 35.3 [SD 14.8] years, mean diagnosis duration 20...
February 2017: Diabetes Care
https://www.readbyqxmd.com/read/27880079/relationship-between-gastric-emptying-and-diurnal-glycemic-control-in-type-1-diabetes-mellitus-a-randomized-trial
#18
Gopanandan Parthasarathy, Yogish C Kudva, Phillip A Low, Michael Camilleri, Ananda Basu, Adil E Bharucha
Context: In type 1 diabetes (T1D), delayed gastric emptying (GE) may predispose to a mismatch between insulin delivery and glucose absorption. Previous studies evaluated, only partly, the relationship between delayed GE and postprandial, but not diurnal, glycemia. Objective: To assess the relationship between GE disturbances and glycemic control in T1D and the effects of accelerating GE on glycemic control. Design, Setting, and Participants: This was a randomized placebo-controlled trial in 30 patients with T1D on an insulin pump at an academic medical center...
February 1, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27837162/sensor-life-and-overnight-closed-loop-a-randomized-clinical-trial
#19
Martin Tauschmann, Janet M Allen, Malgorzata E Wilinska, Yue Ruan, Hood Thabit, Carlo L Acerini, David B Dunger, Roman Hovorka
BACKGROUND: Closed-loop (CL) systems direct insulin delivery based on continuous glucose monitor (CGM) sensor values. CGM accuracy varies with sensor life, being least accurate on day 1 of sensor insertion. We evaluated the effect of sensor life (enhanced Enlite, Medtronic MiniMed, Northridge, CA) on overnight CL. METHODS: In an open-label, randomized, 2-period, inpatient crossover pilot study, 12 adolescents on insulin pump (age 16.7 ± 1.9 years; HbA1c 66 ± 10 mmol/mol) attended a clinical research facility on 2 overnight occasions...
November 10, 2016: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/27835037/glycemia-treatment-satisfaction-cognition-and-sleep-quality-in-adults-and-adolescents-with-type-1-diabetes-when-using-a-closed-loop-system-overnight-versus-sensor-augmented-pump-with-low-glucose-suspend-function-a-randomized-crossover-study
#20
Amin Sharifi, Martin I De Bock, Dilshani Jayawardene, Margaret M Loh, Jodie C Horsburgh, Carolyn L Berthold, Nirubasini Paramalingam, Leon A Bach, Peter G Colman, Elizabeth A Davis, Benyamin Grosman, Christel Hendrieckx, Alicia J Jenkins, Kavita Kumareswaran, Natalie Kurtz, Andrew Kyoong, Richard J MacIsaac, Jane Speight, Steven Trawley, Glenn M Ward, Anirban Roy, Timothy W Jones, David N O'Neal
BACKGROUND: We compared glycemia, treatment satisfaction, sleep quality, and cognition using a nighttime Android-based hybrid closed-loop system (Android-HCLS) with sensor-augmented pump with low-glucose suspend function (SAP-LGS) in people with type 1 diabetes. MATERIALS AND METHODS: An open-label, prospective, randomized crossover study of 16 adults (mean [SD] age 42.1 [9.6] years) and 12 adolescents (15.2 [1.6] years) was conducted. All participants completed four consecutive nights at home with Android-HCLS (proportional integral derivative with insulin feedback algorithm; Medtronic) and SAP-LGS...
December 2016: Diabetes Technology & Therapeutics
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