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Closed loop insulin pump

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https://www.readbyqxmd.com/read/29769806/paediatric-type-1-diabetes-2018-clinical-and-research-insights
#1
Stephen J Zborovski, Farid H Mahmud
The management of children and adolescents with type 1 diabetes continues to progress as clinical and technological innovations enter into practice. Variability in glucose readings can present a significant challenge for care providers, patients and families alike and recent research demonstrates that insulin selection and site-related lipohypertrophy can significantly influence blood glucose levels. New technology aims to improve both glycemic control and quality of life. New insulin analogues have been developed and insulin pumps and continuous glucose monitoring systems continue to evolve toward a fully closed-loop system...
May 2018: Paediatrics & Child Health
https://www.readbyqxmd.com/read/29650309/open-loop-glucose-control-automatic-iob-based-super-bolus-feature-for-commercial-insulin-pumps
#2
Nicolás Rosales, Hernán De Battista, Josep Vehí, Fabricio Garelli
BACKGROUND AND OBJECTIVE: Although there has been significant progress towards closed-loop type 1 diabetes mellitus (T1DM) treatments, most diabetic patients still treat this metabolic disorder in an open-loop manner, based on insulin pump therapy (basal and bolus insulin infusion). This paper presents a method for automatic insulin bolus shaping based on insulin-on-board (IOB) as an alternative to conventional bolus dosing. METHODS: The methodology presented allows the pump to generate the so-called super-bolus (SB) employing a two-compartment IOB dynamic model...
June 2018: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/29577536/hypoglycaemia-incidence-and-recovery-during-home-use-of-hybrid-closed-loop-insulin-delivery-in-adults-with-type-1-diabetes
#3
Y Ruan, L Bally, H Thabit, L Leelarathna, S Hartnell, M Tauschmann, M E Wilinska, M L Evans, J K Mader, H Kojzar, S Dellweg, C Benesch, S Arnolds, T R Pieber, R Hovorka
INTRODUCTION: Glucose excursion were assessed prior and post hypoglycaemia to increase understanding of hypoglycaemia incidence and recovery during hybrid closed-loop insulin delivery. METHODS: We retrospectively analysed data from 60 adults with type 1 diabetes who received in crossover randomised design day-and-night hybrid closed-loop insulin delivery and insulin pump therapy, the latter with or without real-time continuous glucose monitoring. Over 4-week study periods, we identified hypoglycaemic episodes defined as sensor glucose < 3...
March 25, 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29565722/sensor-augmented-pump-based-customized-mathematical-model-for-type-1-diabetes
#4
Benyamin Grosman, Di Wu, Diana Miller, Louis Lintereur, Anirban Roy, Neha Parikh, Francine R Kaufman
BACKGROUND: Simulations using mathematical models are important for studying, developing, and improving therapies for people with type 1 diabetes. METHODS: The Medtronic CareLink® database was used to create virtual patients with a variety of inter-insulin sensitivities, meal absorption rates, pharmacokinetics, age, and gender. In addition, intra-insulin sensitivities of the virtual patients change over a 24-h cycle. RESULTS: A total of 2087 virtual patients were developed...
March 2018: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29547553/unannounced-meals-in-the-artificial-pancreas-detection-using-continuous-glucose-monitoring
#5
Charrise M Ramkissoon, Pau Herrero, Jorge Bondia, Josep Vehi
The artificial pancreas (AP) system is designed to regulate blood glucose in subjects with type 1 diabetes using a continuous glucose monitor informed controller that adjusts insulin infusion via an insulin pump. However, current AP developments are mainly hybrid closed-loop systems that include feed-forward actions triggered by the announcement of meals or exercise. The first step to fully closing the loop in the AP requires removing meal announcement, which is currently the most effective way to alleviate postprandial hyperglycemia due to the delay in insulin action...
March 16, 2018: Sensors
https://www.readbyqxmd.com/read/29535135/day-and-night-closed-loop-insulin-delivery-in-a-broad-population-of-pregnant-women-with-type-1-diabetes-a-randomized-controlled-crossover-trial
#6
Zoe A Stewart, Malgorzata E Wilinska, Sara Hartnell, Leanne K O'Neil, Gerry Rayman, Eleanor M Scott, Katharine Barnard, Conor Farrington, Roman Hovorka, Helen R Murphy
OBJECTIVE: Despite advances in technology, optimal glucose control remains elusive and neonatal complications ubiquitous in type 1 diabetes (T1D) pregnancy. Our aim was to examine the safety, efficacy, and longer-term feasibility of day-and-night closed-loop insulin delivery. RESEARCH DESIGN AND METHODS: We recruited 16 pregnant women (mean [SD]: age 32.8 [5.0] years, T1D duration 19.4 [10.2] years, HbA1c 8.0% [1.1%], BMI 26.6 [4.4] kg/m2 ) to an open-label, randomized, crossover trial...
March 13, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29530081/evaluating-optimal-utilisation-of-technology-in-type-1-diabetes-mellitus-from-a-clinical-and-health-economic-perspective-protocol-for-a-systematic-review
#7
Anthony Pease, Clement Lo, Arul Earnest, Danny Liew, Sophia Zoungas
BACKGROUND: Technology has been implemented since the 1970s with the hope of improving glycaemic control and reducing the burden of complications for those living with type 1 diabetes. A clinical and cost-effectiveness comparison of all available technologies including continuous subcutaneous insulin infusion (CSII), continuous glucose monitors (CGMs), sensor-augmented pump therapy (including either low-glucose suspend or predictive low-glucose suspend), hybrid closed-loop systems, closed-loop (single-hormone or dual-hormone) systems, flash glucose monitoring (FGM), insulin bolus calculators, and 'smart-device' applications is currently lacking...
March 12, 2018: Systematic Reviews
https://www.readbyqxmd.com/read/29412837/glucose-lowering-therapies-in-type-2-diabetes-opportunities-and-challenges-for-peptides
#8
REVIEW
Clifford J Bailey
This overview considers the opportunities and challenges that face the use of gluco-regulatory peptides to treat type 2 diabetes. New insulin analogues and formulations are being developed with pharmacokinetic properties to speed-up or prolong transfer from a subcutaneous injection site to the target tissues, or to selectively favour effects on the liver. Alternative routes of insulin administration continue to attract attention, and advances in the integration of glucose monitoring with insulin pump devices are improving miniaturised 'closed loop' artificial pancreas systems...
February 2018: Peptides
https://www.readbyqxmd.com/read/29390915/real-time-detection-of-infusion-site-failures-in-a-closed-loop-artificial-pancreas
#9
Daniel P Howsmon, Nihat Baysal, Bruce A Buckingham, Gregory P Forlenza, Trang T Ly, David M Maahs, Tatiana Marcal, Lindsey Towers, Eric Mauritzen, Sunil Deshpande, Lauren M Huyett, Jordan E Pinsker, Ravi Gondhalekar, Francis J Doyle, Eyal Dassau, Juergen Hahn, B Wayne Bequette
BACKGROUND: As evidence emerges that artificial pancreas systems improve clinical outcomes for patients with type 1 diabetes, the burden of this disease will hopefully begin to be alleviated for many patients and caregivers. However, reliance on automated insulin delivery potentially means patients will be slower to act when devices stop functioning appropriately. One such scenario involves an insulin infusion site failure, where the insulin that is recorded as delivered fails to affect the patient's glucose as expected...
January 1, 2018: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29383544/emerging-technologies-for-the-management-of-type-1-diabetes-in-pregnancy
#10
REVIEW
Jennifer M Yamamoto, Helen R Murphy
PURPOSE OF REVIEW: The purpose of the study is to discuss emerging technologies available in the management of type 1 diabetes in pregnancy. RECENT FINDINGS: The latest evidence suggests that continuous glucose monitoring (CGM) should be offered to all women on intensive insulin therapy in early pregnancy. Studies have additionally demonstrated the ability of CGM to help gain insight into specific glucose profiles as they relate to glycaemic targets and pregnancy outcomes...
January 30, 2018: Current Diabetes Reports
https://www.readbyqxmd.com/read/29355438/insulin-sensitivity-index-based-optimization-of-insulin-to-carbohydrate-ratio-in-silico-study-shows-efficacious-protection-against-hypoglycemic-events-caused-by-suboptimal-therapy
#11
Michele Schiavon, Chiara Dalla Man, Claudio Cobelli
BACKGROUND AND AIM: The insulin to carbohydrate ratio (CR) is a parameter used by patients with type 1 diabetes (T1D) to calculate the premeal insulin bolus. Usually, it is estimated by the physician based on patient diary, but modern diabetes technologies, such as subcutaneous glucose sensing (continuous glucose monitoring, CGM) and insulin delivery (continuous subcutaneous insulin infusion, CSII) systems, can provide important information for its optimization. In this study, a method for CR optimization based on CGM and CSII data is presented and its efficacy and robustness tested in several in silico scenarios, with the primary aim of increasing protection against hypoglycemia...
February 2018: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29258910/glucose-responsive-insulin-delivery-for-type-1-diabetes-the-artificial-pancreas-story
#12
Lia Bally, Hood Thabit, Roman Hovorka
Insulin replacement therapy is integral to the management of type 1 diabetes, which is characterised by absolute insulin deficiency. Optimal glycaemic control, as assessed by glycated haemoglobin, and avoidance of hyper- and hypoglycaemic excursions have been shown to prevent diabetes-related complications. Insulin pump use has increased considerably over the past decade with beneficial effects on glycaemic control, quality of life and treatment satisfaction. The advent and progress of ambulatory glucose sensor technology has enabled continuous glucose monitoring based on real-time glucose levels to be integrated with insulin therapy...
December 16, 2017: International Journal of Pharmaceutics
https://www.readbyqxmd.com/read/29247547/psychosocial-impacts-of-hybrid-closed-loop-systems-in-the-management-of-diabetes-a-review
#13
REVIEW
C Farrington
There is a pressing need for new treatment regimens that enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop, or artificial pancreas, systems represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms that process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps...
April 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/29159870/predictive-hyperglycemia-and-hypoglycemia-minimization-in-home-double-blind-randomized-controlled-evaluation-in-children-and-young-adolescents
#14
Gregory P Forlenza, Dan Raghinaru, Faye Cameron, B Wayne Bequette, H Peter Chase, R Paul Wadwa, David M Maahs, Emily Jost, Trang T Ly, Darrell M Wilson, Lisa Norlander, Laya Ekhlaspour, Hyojin Min, Paula Clinton, Nelly Njeru, John W Lum, Craig Kollman, Roy W Beck, Bruce A Buckingham
OBJECTIVE: The primary objective of this trial was to evaluate the feasibility, safety, and efficacy of a predictive hyperglycemia and hypoglycemia minimization (PHHM) system vs predictive low glucose suspension (PLGS) alone in optimizing overnight glucose control in children 6 to 14 years old. RESEARCH DESIGN AND METHODS: Twenty-eight participants 6 to 14 years old with T1D duration ≥1 year with daily insulin therapy ≥12 months and on insulin pump therapy for ≥6 months were randomized per night into PHHM mode or PLGS-only mode for 42 nights...
November 20, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/28942594/keeping-up-with-the-diabetes-technology-2016-endocrine-society-guidelines-of-insulin-pump-therapy-and-continuous-glucose-monitor-management-of-diabetes
#15
REVIEW
Alfonso Galderisi, Elise Schlissel, Eda Cengiz
PURPOSE OF REVIEW: Decades after the invention of insulin pump, diabetes management has encountered a technology revolution with the introduction of continuous glucose monitoring, sensor-augmented insulin pump therapy and closed-loop/artificial pancreas systems. In this review, we discuss the significance of the 2016 Endocrine Society Guidelines for insulin pump therapy and continuous glucose monitoring and summarize findings from relevant diabetes technology studies that were conducted after the publication of the 2016 Endocrine Society Guidelines...
September 23, 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28918653/setting-expectations-for-successful-artificial-pancreas-hybrid-closed-loop-automated-insulin-delivery-adoption
#16
Dana Lewis
No abstract text is available yet for this article.
March 2018: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28913745/management-of-type-1-diabetes-in-the-hospital-setting
#17
REVIEW
Carlos E Mendez, Guillermo E Umpierrez
PURPOSE OF REVIEW: The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings. RECENT FINDINGS: Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described...
September 14, 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28880188/a-review-of-safety-and-hazards-associated-with-the-artificial-pancreas
#18
Charrise M Ramkissoon, Brian Aufderheide, B Wayne Bequette, Josep Vehi
The artificial pancreas (AP) is a closed-loop device with the potential to reduce the complications associated with type 1 diabetes mellitus by maintaining euglycemia in patients. The AP encompasses an algorithm that determines the amount of insulin (and other hormones) to be administered to the patient via a continuous subcutaneous insulin infusion pump using information provided by a continuous glucose monitor and other sensors. As the AP approaches commercialization, special attention must be given to safety within all the individual components, including physiological changes in the patient, as well as safety issues that can arise when these components are combined into a single system...
2017: IEEE Reviews in Biomedical Engineering
https://www.readbyqxmd.com/read/28867311/distal-technologies-and-type-1-diabetes-management
#19
REVIEW
Danny C Duke, Samantha Barry, David V Wagner, Jane Speight, Pratik Choudhary, Michael A Harris
Type 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals...
February 2018: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/28840263/closed-loop-glucose-control-in-young-people-with-type-1-diabetes-during-and-after-unannounced-physical-activity-a-randomised-controlled-crossover-trial
#20
Klemen Dovc, Maddalena Macedoni, Natasa Bratina, Dusanka Lepej, Revital Nimri, Eran Atlas, Ido Muller, Olga Kordonouri, Torben Biester, Thomas Danne, Moshe Phillip, Tadej Battelino
AIMS/HYPOTHESIS: Hypoglycaemia during and after exercise remains a challenge. The present study evaluated the safety and efficacy of closed-loop insulin delivery during unannounced (to the closed-loop algorithm) afternoon physical activity and during the following night in young people with type 1 diabetes. METHODS: A randomised, two-arm, open-label, in-hospital, crossover clinical trial was performed at a single site in Slovenia. The order was randomly determined using an automated web-based programme with randomly permuted blocks of four...
November 2017: Diabetologia
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