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Closed loop insulin pump

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https://www.readbyqxmd.com/read/28710224/assessing-the-effectiveness-of-a-3-month-day-and-night-home-closed-loop-control-combined-with-pump-suspend-feature-compared-with-sensor-augmented-pump-therapy-in-youths-and-adults-with-suboptimally-controlled-type-1-diabetes-a-randomised-parallel-study-protocol
#1
Lia Bally, Hood Thabit, Martin Tauschmann, Janet M Allen, Sara Hartnell, Malgorzata E Wilinska, Jane Exall, Viki Huegel, Judy Sibayan, Sarah Borgman, Peiyao Cheng, Maxine Blackburn, Julia Lawton, Daniela Elleri, Lalantha Leelarathna, Carlo L Acerini, Fiona Campbell, Viral N Shah, Amy Criego, Mark L Evans, David B Dunger, Craig Kollman, Richard M Bergenstal, Roman Hovorka
INTRODUCTION: Despite therapeutic advances, many individuals with type 1 diabetes are unable to achieve tight glycaemic target without increasing the risk of hypoglycaemia. The objective of this study is to determine the effectiveness of a 3-month day-and-night home closed-loop glucose control combined with a pump suspend feature, compared with sensor-augmented insulin pump therapy in youths and adults with suboptimally controlled type 1 diabetes. METHODS AND ANALYSIS: The study adopts an open-label, multi-centre, multi-national (UK and USA), randomised, single-period, parallel design and aims for 84 randomised patients...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28688482/enhancing-automatic-closed-loop-glucose-control-in-type-1-diabetes-with-an-adaptive-meal-bolus-calculator-in-silico-evaluation-under-intra-day-variability
#2
Pau Herrero, Jorge Bondia, Oloruntoba Adewuyi, Peter Pesl, Mohamed El-Sharkawy, Monika Reddy, Chris Toumazou, Nick Oliver, Pantelis Georgiou
BACKGROUND AND OBJECTIVE: Current prototypes of closed-loop systems for glucose control in type 1 diabetes mellitus, also referred to as artificial pancreas systems, require a pre-meal insulin bolus to compensate for delays in subcutaneous insulin absorption in order to avoid initial post-prandial hyperglycemia. Computing such a meal bolus is a challenging task due to the high intra-subject variability of insulin requirements. Most closed-loop systems compute this pre-meal insulin dose by a standard bolus calculation, as is commonly found in insulin pumps...
July 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28677416/manual-closed-loop-insulin-delivery-using-a-saddle-point-model-predictive-control-algorithm-results-of-a-crossover-randomized-overnight-study
#3
Isabelle Guilhem, Maxime Penet, Anaïs Paillard, Marc Carpentier, Annabelle Esvant, Marie-Anne Lefebvre, Jean-Yves Poirier
BACKGROUND: The purpose was to assess the efficacy of a new closed-loop algorithm (Saddle Point Model Predictive Control, SP-MPC) in achieving nocturnal normoglycemia while reducing the risk of hypoglycemia in patients with type 1 diabetes. METHOD: In this randomized crossover study, 10 adult patients (mean hemoglobin A1c 7.35 ± 1.04%) were assigned to be treated overnight by open loop using sensor-augmented pump therapy (open-loop SAP) or manual closed-loop delivery...
July 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28675686/the-challenges-of-achieving-postprandial-glucose-control-using-closed-loop-systems-in-patients-with-type-1-diabetes
#4
REVIEW
Véronique Gingras, Nadine Taleb, Amélie Roy-Fleming, Laurent Legault, Rémi Rabasa-Lhoret
For patients with type 1 diabetes, closed-loop delivery systems (CLS) combining an insulin pump, a glucose sensor and a dosing algorithm allowing a dynamic hormonal infusion have been shown to improve glucose control when compared to conventional therapy. Yet, reducing glucose excursion as well as simplification of prandial insulin doses remains a challenge. The objective of this literature review is to examine current meal-time strategies in the context of automated delivery systems in adults and children with type 1 diabetes...
July 4, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28666360/overnight-closed-loop-control-improves-glycemic-control-in-a-multicenter-study-of-adults-with-type-1-diabetes
#5
Sue A Brown, Marc D Breton, Stacey M Anderson, Laura Kollar, Patrick Keith-Hynes, Carol J Levy, David W Lam, Camilla Levister, Nihat Baysal, Yogish C Kudva, Ananda Basu, Vikash Dadlani, Ling Hinshaw, Shelly McCrady-Spitzer, Daniela Bruttomesso, Roberto Visentin, Silvia Galasso, Simone Del Favero, Yenny Leal, Federico Boscari, Angelo Avogaro, Claudio Cobelli, Boris P Kovatchev
Context: Closed-loop control (CLC) for the management of T1D is a novel method for optimizing glucose control and strategies for individualized implementation are being developed. Objective: Analyze glycemic control in an Overnight CLC system designed to "reset" the patient to near normal glycemic targets every morning. Design: Randomized cross-over multicenter clinical trial. Participants: 44 subjects with T1D on insulin pump therapy...
June 28, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28631849/experiences-of-closed-loop-insulin-delivery-among-pregnant-women-with-type-1-diabetes
#6
C Farrington, Z A Stewart, K Barnard, R Hovorka, H R Murphy
AIMS: To explore the experiences of pregnant women with Type 1 diabetes, and the relationships between perceptions of glucose control, attitudes to technology and glycaemic responses with regard to closed-loop insulin delivery. METHODS: We recruited 16 pregnant women with Type 1 diabetes [mean ± sd age 34.1 ± 4.6 years, duration of diabetes 23.6 ± 7.2 years, baseline HbA1c 51±5 mmol/mol (6.8 ± 0.6%)] to a randomized crossover trial of sensor-augmented pump therapy vs automated closed-loop therapy...
June 20, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/28585879/continuous-glucose-monitoring-a-review-of-recent-studies-demonstrating-improved-glycemic-outcomes
#7
David Rodbard
Continuous Glucose Monitoring (CGM) has been demonstrated to be clinically valuable, reducing risks of hypoglycemia and hyperglycemia, glycemic variability (GV), and improving patient quality of life for a wide range of patient populations and clinical indications. Use of CGM can help reduce HbA1c and mean glucose. One CGM device, with accuracy (%MARD) of approximately 10%, has recently been approved for self-adjustment of insulin dosages (nonadjuvant use) and approved for reimbursement for therapeutic use in the United States...
June 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28584075/application-of-zone-model-predictive-control-artificial-pancreas-during-extended-use-of-infusion-set-and-sensor-a-randomized-crossover-controlled-home-use-trial
#8
Gregory P Forlenza, Sunil Deshpande, Trang T Ly, Daniel P Howsmon, Faye Cameron, Nihat Baysal, Eric Mauritzen, Tatiana Marcal, Lindsey Towers, B Wayne Bequette, Lauren M Huyett, Jordan E Pinsker, Ravi Gondhalekar, Francis J Doyle, David M Maahs, Bruce A Buckingham, Eyal Dassau
OBJECTIVE: As artificial pancreas (AP) becomes standard of care, consideration of extended use of insulin infusion sets (IIS) and continuous glucose monitors (CGMs) becomes vital. We conducted an outpatient randomized crossover study to test the safety and efficacy of a zone model predictive control (zone-MPC)-based AP system versus sensor augmented pump (SAP) therapy in which IIS and CGM failures were provoked via extended wear to 7 and 21 days, respectively. RESEARCH DESIGN AND METHODS: A smartphone-based AP system was used by 19 adults (median age 23 years [IQR 10], mean 8...
June 5, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28574723/closed-loop-insulin-delivery-for-adults-with-type-1-diabetes-undertaking-high-intensity-interval-exercise-versus-moderate-intensity-exercise-a-randomized-crossover-study
#9
Dilshani C Jayawardene, Sybil A McAuley, Jodie C Horsburgh, André La Gerche, Alicia J Jenkins, Glenn M Ward, Richard J MacIsaac, Timothy J Roberts, Benyamin Grosman, Natalie Kurtz, Anirban Roy, David N O'Neal
BACKGROUND: We aimed to compare closed-loop glucose control for people with type 1 diabetes undertaking high-intensity interval exercise (HIIE) versus moderate-intensity exercise (MIE). METHODS: Adults with type 1 diabetes established on insulin pumps undertook HIIE and MIE stages in random order during automated insulin delivery via a closed-loop system (Medtronic). Frequent venous sampling for glucose, lactate, ketones, insulin, catecholamines, cortisol, growth hormone, and glucagon levels was performed...
June 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28537437/-it-is-definitely-a-game-changer-a-qualitative-study-of-experiences-with-in-home-overnight-closed-loop-technology-among-adults-with-type-1-diabetes
#10
Christel Hendrieckx, Lucinda A Poole, Amin Sharifi, Dilshani Jayawardene, Margaret M Loh, Jodie C Horsburgh, Leon A Bach, Peter G Colman, Kavita Kumareswaran, Alicia J Jenkins, Richard J MacIsaac, Glenn M Ward, Benyamin Grosman, Anirban Roy, David N O'Neal, Jane Speight
BACKGROUND: This qualitative study explored trial participants' experiences of four nights of in-home closed loop. METHODS: Sixteen adults with type 1 diabetes, who completed a randomized crossover trial, were interviewed after four consecutive nights of closed-loop. Interviews were audio recorded, transcribed, and analyzed with a coding framework developed to identify the main themes. RESULTS: Participants had a mean age of 42 ± 10 years, nine were women; mean diabetes duration was 27 ± 7 years, and all were using insulin pumps...
July 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28537427/overnight-counter-regulatory-hormone-levels-and-next-day-glycemia-in-adults-with-type-1-diabetes-during-closed-loop-insulin-delivery-versus-sensor-augmented-pump-with-low-glucose-suspend
#11
Anneke Graf, Glenn M Ward, Sara Vogrin, Vijaya Sundararajan, 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, Alicia J Jenkins, Kavita Kumareswaran, Natalie Kurtz, Andrew Kyoong, Richard J MacIsaac, Anirban Roy, Timothy W Jones, David N O'Neal
No abstract text is available yet for this article.
July 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28533136/effect-of-artificial-pancreas-systems-on-glycaemic-control-in-patients-with-type-1-diabetes-a-systematic-review-and-meta-analysis-of-outpatient-randomised-controlled-trials
#12
Alanna Weisman, Johnny-Wei Bai, Marina Cardinez, Caroline K Kramer, Bruce A Perkins
BACKGROUND: Closed-loop artificial pancreas systems have been in development for several years, including assessment in numerous varied outpatient clinical trials. We aimed to summarise the efficacy and safety of artificial pancreas systems in outpatient settings and explore the clinical and technical factors that can affect their performance. METHODS: We did a systematic review and meta-analysis of randomised controlled trials comparing artificial pancreas systems (insulin only or insulin plus glucagon) with conventional pump therapy (continuous subcutaneous insulin infusion [CSII] with blinded continuous glucose monitoring [CGM] or unblinded sensor-augmented pump [SAP] therapy) in adults and children with type 1 diabetes...
July 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/28514821/-the-way-to-closed-loop-dream-and-reality
#13
Torben Biester, Thomas Danne, Olga Kordonouri
An old dream of patients with type 1 diabetes and medical teams alike is a fully automated insulin therapy. Available sensor-augmented insulin-pumps are able to intervene in insulin therapy by reducing the dose. Aim of several studies is to add an algorithm to the interaction of pump and sensor, so that insulin doses can be regulated fully automatically. Totally closed loop systems are currently not yet available for outpatient use. Hybrid closed loop systems have been approved in the US. They can improve the metabolic status of patients with type 1 diabetes...
May 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28509784/pharmacotherapy-options-for-pediatric-diabetes
#14
Maria Loredana Marcovecchio, Francesco Chiarelli
PURPOSE OF REVIEW: Type 1 diabetes (T1D) and type 2 diabetes (T2D) are frequent conditions during childhood and adolescence. The present review offers an update on current available treatment strategies for T1D and T2D approved for use in children and adolescents. RECENT FINDINGS: Insulin remains the main and essential therapeutic strategy in youth with T1D. A second generation of insulin analogues is being evaluated and could help in improving glycemic control...
August 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28495545/asymptotic-tracking-and-disturbance-rejection-of-the-blood-glucose-regulation-system
#15
Brandon Ashley, Weijiu Liu
Type 1 diabetes patients need external insulin to maintain blood glucose within a narrow range from 65 to 108 mg/dl (3.6 to 6.0 mmol/l). A mathematical model for the blood glucose regulation is required for integrating a glucose monitoring system into insulin pump technology to form a closed-loop insulin delivery system on the feedback of the blood glucose, the so-called "artificial pancreas". The objective of this paper is to treat the exogenous glucose from food as a glucose disturbance and then develop a closed-loop feedback and feedforward control system for the blood glucose regulation system subject to the exogenous glucose disturbance...
May 8, 2017: Mathematical Biosciences
https://www.readbyqxmd.com/read/28463010/behavioral-patterns-and-associations-with-glucose-control-during-12-week-randomized-free-living-clinical-trial-of-day-and-night-hybrid-closed-loop-insulin-delivery-in-adults-with-type-1-diabetes
#16
Ali Emami, Malgorzata E Willinska, Hood Thabit, Lalantha Leelarathna, Sara Hartnell, Sibylle Dellweg, Carsten Benesch, Julia K Mader, Manuel Holzer, Harald Kojzar, Thomas R Pieber, Sabine Arnolds, Mark L Evans, Roman Hovorka
OBJECTIVES: We evaluated patterns of meal intake, insulin bolus delivery, and fingerstick glucose measurements during hybrid closed-loop and sensor-augmented pump (SAP) therapy, including associations with glucose control. METHODS: Data were retrospectively analyzed from pump-treated adults with type 1 diabetes who underwent, in random order, 12 weeks free-living closed-loop (n = 32) and 12 weeks SAP (n = 33) periods. We quantified daily patterns of main meals, snacks, prandial insulin boluses, correction boluses, and fingerstick glucose measurements by analyzing data recorded on the study glucometer and on study insulin pump...
July 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28459603/closed-loop-control-of-postprandial-glycemia-using-an-insulin-on-board-limitation-through-continuous-action-on-glucose-target
#17
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...
June 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28406034/analysis-of-a-new-optimized-percutaneous-access-system-for-cipii
#18
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
#19
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
#20
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
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