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Closed loop insulin pump

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https://www.readbyqxmd.com/read/28406034/analysis-of-a-new-optimized-percutaneous-access-system-for-cipii
#1
Eric Renard
While only used initially in cases with resistance to subcutaneous insulin therapy, intraperitoneal insulin therapy provides an overall more stable glucose control than subcutaneous insulin therapy thanks to its pharmacokinetics as pointed by Garcia-Verdugo et al from the experience of implantable insulin pumps. The expansion of these devices has been limited by underdelivery issues and high cost. The availability of a new percutaneous access to intraperitoneal route could allow a similar glucose control with less constraints of follow-up and expected lower cost...
April 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28371223/faster-insulin-action-is-associated-with-improved-glycemic-outcomes-during-closed-loop-insulin-delivery-and-sensor-augmented-pump-therapy-in-adults-with-type-1-diabetes
#2
Yue Ruan, Hood Thabit, Lalantha Leelarathna, Sara Hartnell, Malgorzata E Willinska, Martin Tauschmann, Sibylle Dellweg, Carsten Benesch, Julia K Mader, Manuel Holzer, Harald Kojzar, Mark L Evans, Thomas R Pieber, Sabine Arnolds, Roman Hovorka
AIMS: To evaluate relationship between insulin pharmacodynamics and glycemic outcomes during closed-loop insulin delivery and sensor-augmented pump therapy. METHODS: We retrospectively analyzed data from multicenter randomized control trial involving 32 adults with type 1 diabetes receiving day-and-night closed-loop insulin delivery and sensor-augmented pump therapy over 12 weeks. We estimated time-to-peak insulin action (tmax,IA ) and insulin sensitivity (SI ) during both interventions and correlated these with demographic factors and glycemic outcomes...
March 30, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28367636/closing-the-loop-in-adults-children-and-adolescents-with-suboptimally-controlled-type-1-diabetes-under-free-living-conditions-a-psychosocial-substudy
#3
Katharine D Barnard, Timothy Wysocki, Vanessa Ully, Julia K Mader, Thomas R Pieber, Hood Thabit, Martin Tauschmann, Lalantha Leelarathna, Sara Hartnell, Carlo L Acerini, Malgorzata E Wilinska, Sibylle Dellweg, Carsten Benesch, Sabine Arnolds, Manuel Holzer, Harald Kojzar, Fiona Campbell, James Yong, Jennifer Pichierri, Peter Hindmarsh, Lutz Heinemann, Mark L Evans, Roman Hovorka
OBJECTIVE: The objective was to explore psychosocial experiences of closed loop technology for adults, children, and adolescents with type 1 diabetes and their parents taking part in two multicenter, free-living, randomized crossover home studies. METHODS: Participants using insulin pump therapy were randomized to either 12 weeks of automated closed-loop glucose control, then 12 weeks of sensor augmented insulin pump therapy (open loop), or vice versa. Closed loop was used for 24 hours by adults and overnight only by children and adolescents...
April 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28358037/type-1-diabetes-mellitus
#4
REVIEW
Anastasia Katsarou, Soffia Gudbjörnsdottir, Araz Rawshani, Dana Dabelea, Ezio Bonifacio, Barbara J Anderson, Laura M Jacobsen, Desmond A Schatz, Åke Lernmark
Type 1 diabetes mellitus (T1DM), also known as autoimmune diabetes, is a chronic disease characterized by insulin deficiency due to pancreatic β-cell loss and leads to hyperglycaemia. Although the age of symptomatic onset is usually during childhood or adolescence, symptoms can sometimes develop much later. Although the aetiology of T1DM is not completely understood, the pathogenesis of the disease is thought to involve T cell-mediated destruction of β-cells. Islet-targeting autoantibodies that target insulin, 65 kDa glutamic acid decarboxylase, insulinoma-associated protein 2 and zinc transporter 8 - all of which are proteins associated with secretory granules in β-cells - are biomarkers of T1DM-associated autoimmunity that are found months to years before symptom onset, and can be used to identify and study individuals who are at risk of developing T1DM...
March 30, 2017: Nature Reviews. Disease Primers
https://www.readbyqxmd.com/read/28287847/the-first-hybrid-closed-loop-insulin-pump-will-it-meet-its-potential
#5
Irl B Hirsch
No abstract text is available yet for this article.
March 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28100606/predictive-hyperglycemia-and-hypoglycemia-minimization-in-home-evaluation-of-safety-feasibility-and-efficacy-in-overnight-glucose-control-in-type-1-diabetes
#6
Tamara Spaic, Marsha Driscoll, Dan Raghinaru, Bruce A Buckingham, Darrell M Wilson, Paula Clinton, H Peter Chase, David M Maahs, Gregory P Forlenza, Emily Jost, Irene Hramiak, Terri Paul, B Wayne Bequette, Faye Cameron, Roy W Beck, Craig Kollman, John W Lum, Trang T Ly
OBJECTIVE: The objective of this study was to determine the safety, feasibility, and efficacy of a predictive hyperglycemia and hypoglycemia minimization (PHHM) system compared with predictive low-glucose insulin suspension (PLGS) alone in overnight glucose control. RESEARCH DESIGN AND METHODS: A 42-night trial was conducted in 30 individuals with type 1 diabetes in the age range 15-45 years. Participants were randomly assigned each night to either PHHM or PLGS and were blinded to the assignment...
March 2017: Diabetes Care
https://www.readbyqxmd.com/read/28094136/day-and-night-glycaemic-control-with-closed-loop-insulin-delivery-versus-conventional-insulin-pump-therapy-in-free-living-adults-with-well-controlled-type-1-diabetes-an-open-label-randomised-crossover-study
#7
Lia Bally, Hood Thabit, Harald Kojzar, Julia K Mader, Jehona Qerimi-Hyseni, Sara Hartnell, Martin Tauschmann, Janet M Allen, Malgorzata E Wilinska, Thomas R Pieber, Mark L Evans, Roman Hovorka
BACKGROUND: Tight control of blood glucose concentration in people with type 1 diabetes predisposes to hypoglycaemia. We aimed to investigate whether day-and-night hybrid closed-loop insulin delivery can improve glucose control while alleviating the risk of hypoglycaemia in adults with HbA1c below 7·5% (58 mmol/mol). METHODS: In this open-label, randomised, crossover study, we recruited adults (aged ≥18 years) with type 1 diabetes and HbA1c below 7·5% from Addenbrooke's Hospital (Cambridge, UK) and Medical University of Graz (Graz, Austria)...
April 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/27981804/md-logic-overnight-type-1-diabetes-control-in-home-settings-a-multicentre-multinational-single-blind-randomized-trial
#8
Revital Nimri, Natasa Bratina, Olga Kordonouri, Magdalena Avbelj Stefanija, Maryam Fath, Torben Biester, Ido Muller, Eran Atlas, Shahar Miller, Aviel Fogel, Moshe Phillip, Thomas Danne, Tadej Battelino
AIMS: To evaluate the safety, efficacy and need for remote monitoring of the MD-Logic closed-loop system during short-term overnight use at home. METHODS: Seventy-five patients (38 male; aged 10-54 years; average A1c, 7.8% ± 0.7%, 61.8 ± 7.2 mmol/mol) were enrolled from 3 clinical sites. Patients were randomly assigned to participate in 2 overnight crossover periods, each including 4 consecutive nights, 1 under closed-loop control and 1 under sensor-augmented pump (SAP) therapy in the patient's home...
December 16, 2016: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/27973749/banting-memorial-lecture-2016-reducing-lifetime-risk-of-complications-in-adolescents-with-type-1-diabetes
#9
REVIEW
D B Dunger
Adolescence is a challenging period of life for any young person, and for those with Type 1 diabetes, physiological and psychological factors can result in a deterioration in glycaemic control. In young people with Type 1 diabetes, puberty may be an additional risk factor impacting on the lifetime risk for renal and cardiovascular complications. Our longitudinal studies have identified that increases in urinary albumin excretion through childhood are associated with the development of microalbuminuria and a generalized endotheliopathy linked to cardiovascular risk...
April 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/27837162/sensor-life-and-overnight-closed-loop-a-randomized-clinical-trial
#10
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
#11
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
https://www.readbyqxmd.com/read/27824066/a-novel-insulin-glucose-model-after-a-mixed-meal-test-in-patients-with-type-1-diabetes-on-insulin-pump-therapy
#12
Luca Marchetti, Federico Reali, Marco Dauriz, Corinna Brangani, Linda Boselli, Giulia Ceradini, Enzo Bonora, Riccardo C Bonadonna, Corrado Priami
Current closed-loop insulin delivery methods stem from sophisticated models of the glucose-insulin (G/I) system, mostly based on complex studies employing glucose tracer technology. We tested the performance of a new minimal model (GLUKINSLOOP 2.0) of the G/I system to characterize the glucose and insulin dynamics during multiple mixed meal tests (MMT) of different sizes in patients with type 1 diabetes (T1D) on insulin pump therapy (continuous subcutaneous insulin infusion, CSII). The GLUKINSLOOP 2.0 identified the G/I system, provided a close fit of the G/I time-courses and showed acceptable reproducibility of the G/I system parameters in repeated studies of identical and double-sized MMTs...
November 8, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27696520/psychological-outcomes-of-evening-and-night-closed-loop-insulin-delivery-under-free-living-conditions-in-people-with-type-1-diabetes-a-2-month-randomized-crossover-trial
#13
J Kropff, J DeJong, S Del Favero, J Place, M Messori, B Coestier, A Farret, F Boscari, S Galasso, A Avogaro, D Bruttomesso, C Cobelli, E Renard, L Magni, J H DeVries
AIM: To assess the impact on fear of hypoglycaemia and treatment satisfaction with an artificial pancreas system used for 2 consecutive months, as well as participant acceptance of the artificial pancreas system. METHODS: In a randomized crossover trial patient-related outcomes associated with an evening-and-night artificial pancreas and sensor-augmented pump therapy were compared. Both intervention periods lasted 8 weeks. The artificial pancreas acceptance questionnaire (range 0-90, higher scores better), Hypoglycaemia Fear Survey II (range 0-72, higher scores worse) and Diabetes Treatment Satisfaction Questionnaire (range 0-36, higher scores better) were completed by 32 participants...
February 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/27695131/periodic-zone-mpc-with-asymmetric-costs-for-outpatient-ready-safety-of-an-artificial-pancreas-to-treat-type-1-diabetes
#14
Ravi Gondhalekar, Eyal Dassau, Francis J Doyle
A novel Model Predictive Control (MPC) law for an Artificial Pancreas (AP) to automatically deliver insulin to people with type 1 diabetes is proposed. The MPC law is an enhancement of the authors' zone-MPC approach that has successfully been trialled in-clinic, and targets the safe outpatient deployment of an AP. The MPC law controls blood-glucose levels to a diurnally time-dependent zone, and enforces diurnal, hard input constraints. The main algorithmic novelty is the use of asymmetric input costs in the MPC problem's objective function...
September 2016: Automatica: the Journal of IFAC, the International Federation of Automatic Control
https://www.readbyqxmd.com/read/27621142/early-detection-of-infusion-set-failure-during-insulin-pump-therapy-in-type-1-diabetes
#15
Marzia Cescon, Daniel J DeSalvo, Trang T Ly, David M Maahs, Laurel H Messer, Bruce A Buckingham, Francis J Doyle, Eyal Dassau
BACKGROUND: Insulin infusion set failure resulting in prolonged hyperglycemia or diabetic ketoacidosis can occur with pump therapy in type 1 diabetes. Set failures are frequently characterized by variable and unpredictable patterns of increasing glucose values despite increased insulin infusion. Early detection may minimize the risk of prolonged hyperglycemia, an important consideration for automated insulin delivery and closed-loop applications. METHODS: A novel algorithm designed to alert the patient to the onset of infusion set failure was developed based upon continuous glucose sensor values and insulin delivered from an insulin pump...
November 2016: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/27612500/home-use-of-day-and-night-hybrid-closed-loop-insulin-delivery-in-suboptimally-controlled-adolescents-with-type-1-diabetes-a-3-week-free-living-randomized-crossover-trial
#16
Martin Tauschmann, Janet M Allen, Malgorzata E Wilinska, Hood Thabit, Carlo L Acerini, David B Dunger, Roman Hovorka
OBJECTIVE: This study evaluated the feasibility, safety, and efficacy of day-and-night hybrid closed-loop insulin delivery in adolescents with type 1 diabetes under free-living conditions. RESEARCH DESIGN AND METHODS: In an open-label randomized crossover study, 12 suboptimally controlled adolescents on insulin pump therapy (mean ± SD age 14.6 ± 3.1 years; HbA1c 69 ± 8 mmol/mol [8.5 ± 0.7%]; duration of diabetes 7.8 ± 3.5 years) underwent two 21-day periods in which hybrid closed-loop insulin delivery was compared with sensor-augmented insulin pump therapy in random order...
November 2016: Diabetes Care
https://www.readbyqxmd.com/read/27532830/closed-loop-insulin-delivery-during-pregnancy-in-women-with-type-1-diabetes
#17
RANDOMIZED CONTROLLED TRIAL
Zoe A Stewart, Malgorzata E Wilinska, Sara Hartnell, Rosemary C Temple, Gerry Rayman, Katharine P Stanley, David Simmons, Graham R Law, Eleanor M Scott, Roman Hovorka, Helen R Murphy
BACKGROUND: In patients with type 1 diabetes who are not pregnant, closed-loop (automated) insulin delivery can provide better glycemic control than sensor-augmented pump therapy, but data are lacking on the efficacy, safety, and feasibility of closed-loop therapy during pregnancy. METHODS: We performed an open-label, randomized, crossover study comparing overnight closed-loop therapy with sensor-augmented pump therapy, followed by a continuation phase in which the closed-loop system was used day and night...
August 18, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27526329/insulin-infusion-set-use-european-perspectives-and-recommendations
#18
Dorothee Deiss, Peter Adolfsson, Marije Alkemade-van Zomeren, Geremia B Bolli, Guillaume Charpentier, Claudio Cobelli, Thomas Danne, Angela Girelli, Heiko Mueller, Carol A Verderese, Eric Renard
Insulin pump users worldwide depend on insulin infusion sets (IISs) for predictable delivery of insulin to the subcutaneous tissue. Yet emerging data indicates that IISs are associated with many pump-related adverse events and may contribute to potentially life-threatening problem of unexplained hyperglycemia. The relative scarcity of published research on IISs to date, the heterogeneity of regional IIS practices, and the increasing demand for international standards guiding their use prompted convening of a panel of diabetologists and diabetes nurse educators last February, in Milan, Italy, to discuss a framework for optimizing IIS practice in Europe...
September 2016: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/27402452/ketone-production-in-children-with-type-1-diabetes-ages-4-14-years-with-and-without-nocturnal-insulin-pump-suspension
#19
R Paul Wadwa, H Peter Chase, Dan Raghinaru, Bruce A Buckingham, Irene Hramiak, David M Maahs, Laurel Messer, Trang Ly, Tandy Aye, Paula Clinton, Craig Kollman, Roy W Beck, John Lum
OBJECTIVE: To compare the frequency of elevated morning blood ketone levels according to age in 4-14 year olds with type 1 diabetes following overnight use of an automated low glucose insulin suspension system, or following control nights when the system was not used. RESEARCH DESIGN AND METHODS: For 28 children ages 4-9 years and 54 youth ages 10-14 years, elevation of morning blood ketone levels was assessed using the Precision Xtra Ketone meter following 1155 and 2345 nights, respectively...
July 12, 2016: Pediatric Diabetes
https://www.readbyqxmd.com/read/27364997/coming-of-age-the-artificial-pancreas-for-type-1-diabetes
#20
REVIEW
Hood Thabit, Roman Hovorka
The artificial pancreas (closed-loop system) addresses the unmet clinical need for improved glucose control whilst reducing the burden of diabetes self-care in type 1 diabetes. Glucose-responsive insulin delivery above and below a preset insulin amount informed by sensor glucose readings differentiates closed-loop systems from conventional, threshold-suspend and predictive-suspend insulin pump therapy. Insulin requirements in type 1 diabetes can vary between one-third-threefold on a daily basis. Closed-loop systems accommodate these variations and mitigate the risk of hypoglycaemia associated with tight glucose control...
September 2016: Diabetologia
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