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Closed loop insulin pump

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https://www.readbyqxmd.com/read/27837162/sensor-life-and-overnight-closed-loop-a-randomized-clinical-trial
#1
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
#2
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...
November 11, 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
#3
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
#4
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 participant-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...
October 1, 2016: 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
#5
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
#6
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
#7
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...
September 9, 2016: Diabetes Care
https://www.readbyqxmd.com/read/27532830/closed-loop-insulin-delivery-during-pregnancy-in-women-with-type-1-diabetes
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/27364374/insulin-therapy-new-directions-of-research
#12
Edyta Cichocka, Anna Wietchy, Katarzyna Nabrdalik, Janusz Gumprecht
Insulin therapy is the most effective method of lowering blood glucose. Over 100 years have passed the studies for the optimisation of insulin action. To date, subcutaneous insulin administration has been the basic route of insulin delivery. The search for insulin therapy is simultaneously conducted in the following directions: the optimisation of insulin action, automatisation, and the decrease in the invasiveness of insulin delivery methods. The optimisation of insulin action has led to the discovery of ultra-rapid-acting human insulin analogues, ultra-long-acting human insulin analogues, and biosimilar insulin...
2016: Endokrynologia Polska
https://www.readbyqxmd.com/read/27208331/day-and-night-closed-loop-glucose-control-in-patients-with-type-1-diabetes-under-free-living-conditions-results-of-a-single-arm-1-month-experience-compared-with-a-previously-reported-feasibility-study-of-evening-and-night-at-home
#13
Eric Renard, Anne Farret, Jort Kropff, Daniela Bruttomesso, Mirko Messori, Jerome Place, Roberto Visentin, Roberta Calore, Chiara Toffanin, Federico Di Palma, Giordano Lanzola, Paolo Magni, Federico Boscari, Silvia Galasso, Angelo Avogaro, Patrick Keith-Hynes, Boris Kovatchev, Simone Del Favero, Claudio Cobelli, Lalo Magni, J Hans DeVries
OBJECTIVE: After testing of a wearable artificial pancreas (AP) during evening and night (E/N-AP) under free-living conditions in patients with type 1 diabetes (T1D), we investigated AP during day and night (D/N-AP) for 1 month. RESEARCH DESIGN AND METHODS: Twenty adult patients with T1D who completed a previous randomized crossover study comparing 2-month E/N-AP versus 2-month sensor augmented pump (SAP) volunteered for 1-month D/N-AP nonrandomized extension. AP was executed by a model predictive control algorithm run by a modified smartphone wirelessly connected to a continuous glucose monitor (CGM) and insulin pump...
July 2016: Diabetes Care
https://www.readbyqxmd.com/read/27207890/efficacy-of-an-overnight-predictive-low-glucose-suspend-system-in-relation-to-hypoglycemia-risk-factors-in-youth-and-adults-with-type-1-diabetes
#14
Peter M Calhoun, Bruce A Buckingham, David M Maahs, Irene Hramiak, Darrell M Wilson, Tandy Aye, Paula Clinton, Peter Chase, Laurel Messer, Craig Kollman, Roy W Beck, John Lum
BACKGROUND: We developed a system to suspend insulin pump delivery overnight when the glucose trend predicts hypoglycemia. This predictive low-glucose suspend (PLGS) system substantially reduces nocturnal hypoglycemia without an increase in morning ketosis. Evaluation of hypoglycemia risk factors that could potentially influence the efficacy of the system remains critical for understanding possible problems with the system and identifying patients that may have the greatest benefit when using the system...
November 2016: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/27191385/a-simplified-semiquantitative-meal-bolus-strategy-combined-with-single-and-dual-hormone-closed-loop-delivery-in-patients-with-type-1-diabetes-a-pilot-study
#15
Véronique Gingras, Ahmad Haidar, Virginie Messier, Laurent Legault, Martin Ladouceur, Rémi Rabasa-Lhoret
BACKGROUND: Single- and dual-hormone closed-loop systems can improve glycemic control and have the potential to reduce carbohydrate-counting burden for patients with type 1 diabetes; however, simplification of meal insulin calculation should not compromise glycemic control. METHODS: We compared in a randomized outpatient pilot trial: (1) a single-hormone closed-loop system accompanied with carbohydrate-content matched boluses versus accompanied with a simplified meal bolus strategy, and (2) a dual-hormone closed-loop system accompanied with carbohydrate-content matched boluses versus accompanied with a simplified meal bolus strategy...
August 2016: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/27191182/automated-hybrid-closed-loop-control-with-a-proportional-integral-derivative-based-system-in-adolescents-and-adults-with-type-1-diabetes-individualizing-settings-for-optimal-performance
#16
Trang T Ly, Stuart A Weinzimer, David M Maahs, Jennifer L Sherr, Anirban Roy, Benyamin Grosman, Martin Cantwell, Natalie Kurtz, Lori Carria, Laurel Messer, Rie von Eyben, Bruce A Buckingham
BACKGROUND: Automated insulin delivery systems, utilizing a control algorithm to dose insulin based upon subcutaneous continuous glucose sensor values and insulin pump therapy, will soon be available for commercial use. The objective of this study was to determine the preliminary safety and efficacy of initialization parameters with the Medtronic hybrid closed-loop controller by comparing percentage of time in range, 70-180 mg/dL (3.9-10 mmol/L), mean glucose values, as well as percentage of time above and below target range between sensor-augmented pump therapy and hybrid closed-loop, in adults and adolescents with type 1 diabetes...
May 18, 2016: Pediatric Diabetes
https://www.readbyqxmd.com/read/27183197/automated-overnight-closed-loop-control-using-a-proportional-integral-derivative-algorithm-with-insulin-feedback-in-children-and-adolescents-with-type-1-diabetes-at-diabetes-camp
#17
Trang T Ly, D Barry Keenan, Anirban Roy, Jino Han, Benyamin Grosman, Martin Cantwell, Natalie Kurtz, Rie von Eyben, Paula Clinton, Darrell M Wilson, Bruce A Buckingham
OBJECTIVE: This study determined the feasibility and efficacy of an automated proportional-integral-derivative with insulin feedback (PID-IFB) controller in overnight closed-loop (OCL) control of children and adolescents with type 1 diabetes over multiple days in a diabetes camp setting. RESEARCH DESIGN AND METHODS: The Medtronic (Northridge, CA) Android™ (Google, Mountain View, CA)-based PID-IFB system consists of the Medtronic Minimed Revel™ 2.0 pump and Enlite™ sensor, a control algorithm residing on an Android phone, a translator, and remote monitoring capabilities...
June 2016: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/27142278/current-topics-in-glycemic-control-by-wearable-artificial-pancreas-or-bedside-artificial-pancreas-with-closed-loop-system
#18
REVIEW
Kazuhiro Hanazaki, Masaya Munekage, Hiroyuki Kitagawa, Tomoaki Yatabe, Eri Munekage, Mai Shiga, Hiromichi Maeda, Tsutomu Namikawa
The incidence of diabetes is increasing at an unprecedented pace and has become a serious health concern worldwide during the last two decades. Despite this, adequate glycemic control using an artificial pancreas has not been established, although the 21st century has seen rapid developments in this area. Herein, we review current topics in glycemic control for both the wearable artificial pancreas for type 1 and type 2 diabetic patients and the bedside artificial pancreas for surgical diabetic patients. In type 1 diabetic patients, nocturnal hypoglycemia associated with insulin therapy remains a serious problem that could be addressed by the recent development of a wearable artificial pancreas...
September 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/27022096/influences-on-technology-use-and-efficacy-in-type-1-diabetes
#19
Victoria Franklin
The majority of people with type 1 diabetes have suboptimal glycemic control, increasing their complication risk. Technology to support diabetes self-care has advanced significantly and includes self-monitoring of blood glucose (SMBG), insulin pump therapy (IPT), continuous glucose monitoring (CGM), and sensor-augmented pump therapy (SAPT), which are stepping stones toward the "artificial pancreas" using closed-loop technology. Use of these technologies improves clinical outcomes for patients with the appropriate skills and motivation...
May 2016: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/26969142/is-psychological-stress-a-factor-for-incorporation-into-future-closed-loop-systems
#20
Linda A Gonder-Frederick, Jesse H Grabman, Boris Kovatchev, Sue A Brown, Stephen Patek, Ananda Basu, Jordan E Pinsker, Yogish C Kudva, Christian A Wakeman, Eyal Dassau, Claudio Cobelli, Howard C Zisser, Francis J Doyle
BACKGROUND: The relationship between daily psychological stress and BG fluctuations in type 1 diabetes (T1DM) is unclear. More research is needed to determine if stress-related BG changes should be considered in glucose control algorithms. This study in the usual free-living environment examined relationships among routine daily stressors and BG profile measures generated from CGM readings. METHODS: A total of 33 participants with T1DM on insulin pumps wore a CGM device for 1 week and recorded daily ratings of psychological stress, carbohydrates, and insulin boluses...
May 2016: Journal of Diabetes Science and Technology
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