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- Title
Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas.
- Authors
Weinzimer, Stuart A.; Steil, Garry M.; Swan, Karena L.; Dziura, Jim; Kurtz, Natalie; Tamborlane, William V.
- Abstract
OBJECTIVE -- The most promising β-cell replacement therapy for children with type 1 diabetes is a closed-loop artificial pancreas incorporating continuous glucose sensors and insulin pumps. The Medtronic MiniMed external physiological insulin delivery (ePID) system combines an external pump and sensor with a variable insulin infusion rate algorithm designed to emulate the physiological characteristics of the β-cell. However, delays in insulin absorption associated with the subcutaneous route of delivery, inevitably lead to large postprandial glucose excursions. RESEARCH DESIGN AND METHODS -- We studied the feasibility of the Medtronic ePID system in youth with type 1 diabetes and hypothesized that small manual premeal "priming" boluses would reduce postprandial excursions during closed-loop control. Seventeen adolescents (aged 15.9 ± 1.6 years; A1C 7.1 ± 0.8%) underwent 34 h of closed-loop control; 8 with full closed-loop (FCL) control and 9 with hybrid closed-loop (HCL) control (premeal priming bolus). RESULTS -- Mean glucose levels were 135 ± 45 mg/dl in the HCL group versus 441 ± 55 mg/dl in the FCL group (P = 0.09): daytime glucose levels averaged 149 ± 47 mg/dl in the HCL group versus 159 ± 59 mg/dl in the FCL group (P = 0.03). Peak postprandial glucose levels averaged 194 ± 47 mg/dl in the HCL group versus 226 ± 51 mg/dl in the FCL group (P = 0.04). Nighttime control was similar in both groups (111 ± 27 vs. 112 ± 28 mg/dl). CONCLUSIONS-- Closed-loop glucose control using an external sensor and insulin pump provides a means to achieve near-normal glucose concentrations in youth with type 1 diabetes during the overnight period The addition of small manual priming bolus doses of insulin, given 15 min before meals, improves postprandial glycemic excursions.
- Subjects
INSULIN; HYPOGLYCEMIC agents; ARTIFICIAL pancreases; TREATMENT of diabetes; DIABETES in children; GLUCOSE
- Publication
Diabetes Care, 2008, Vol 31, Issue 5, p934
- ISSN
0149-5992
- Publication type
Article
- DOI
10.2337/dc07-1967