Multicenter closed-loop/hybrid meal bolus insulin delivery with type 1 diabetes
H Peter Chase, Francis J Doyle 3rd, Howard Zisser, Eric Renard, Revital Nimri, Claudio Cobelli, Bruce A Buckingham, David M Maahs, Stacey Anderson, Lalo Magni, John Lum, Peter Calhoun, Craig Kollman, Roy W Beck, Control to Range Study Group, Howard Zisser, Lois Jovanovic, Alison Wollitzer, Wendy Bevier, Eyal Dassau, Kristin Castorino, Kateryna Markova, Jacqueline Wiley, Erin Beveridge, Nicolas Santibanez, Alexandra Sales, Maia Bradley, Adam Castorino, Boris Kovatchev, Stacey Anderson, Susan Demartini, Sue Brown, William Clarke, Marc Breton, Stephen Patek, Patrick Keith-Hynes, Colleen Hughes-Karvetski, Molly McElwee, Mary Oliveri, Christian Wakeman, Eric Renard, Anne Farret, Marie-Josee Pelletier, Hugues Chevassus, Jerome Place, Moshe Phillip, Eran Atlas, Revital Nimri, Tal Oron, Alon Farfel, Sharon Demol, Eran Mel, Tal Ben-Ari, Michael Gilon, Ayele Parnes, Ido Muller, Shahar Miller, Alona Hamou, Orna Hermon, Galit Shiovitch-Mantzuri, Galia Fayman, Claudio Cobelli, Chiara Dalla Man, Angelo Avogaro, Daniela Bruttomesso, Alberto Maran, Michele Schiavon, Simone Del Favero, Roberto Visentin, Rachele Scotton, Alessio Filippi, Lalo Magni, Chiara Toffanin, Giuseppe De Nicolao, Simone Mancini, Davide Martino Raimondo, Bruce Buckingham, Darrell M Wilson, Kari Benassi, Paula Clinton, Breanne P Harris, Satya Shanmugham, Kimberly Caswell, H Peter Chase, David M Maahs, Robert Slover, Sally Sullivan, Laurel Messer, Victoria Gage, Jaime Realsen, Emily Westfall, Hannah Goettle, Francis J Doyle 3rd, Roy W Beck, John Lum, Craig Kollman, Peter Calhoun, Judy Sibayan, Nelly M Njeru, Werner Sauer, John C Pickup, Irl Hirsch, Howard Wolpert, H Peter Chase, Francis J Doyle 3rd, Howard Zisser, Eric Renard, Revital Nimri, Claudio Cobelli, Bruce A Buckingham, David M Maahs, Stacey Anderson, Lalo Magni, John Lum, Peter Calhoun, Craig Kollman, Roy W Beck, Control to Range Study Group, Howard Zisser, Lois Jovanovic, Alison Wollitzer, Wendy Bevier, Eyal Dassau, Kristin Castorino, Kateryna Markova, Jacqueline Wiley, Erin Beveridge, Nicolas Santibanez, Alexandra Sales, Maia Bradley, Adam Castorino, Boris Kovatchev, Stacey Anderson, Susan Demartini, Sue Brown, William Clarke, Marc Breton, Stephen Patek, Patrick Keith-Hynes, Colleen Hughes-Karvetski, Molly McElwee, Mary Oliveri, Christian Wakeman, Eric Renard, Anne Farret, Marie-Josee Pelletier, Hugues Chevassus, Jerome Place, Moshe Phillip, Eran Atlas, Revital Nimri, Tal Oron, Alon Farfel, Sharon Demol, Eran Mel, Tal Ben-Ari, Michael Gilon, Ayele Parnes, Ido Muller, Shahar Miller, Alona Hamou, Orna Hermon, Galit Shiovitch-Mantzuri, Galia Fayman, Claudio Cobelli, Chiara Dalla Man, Angelo Avogaro, Daniela Bruttomesso, Alberto Maran, Michele Schiavon, Simone Del Favero, Roberto Visentin, Rachele Scotton, Alessio Filippi, Lalo Magni, Chiara Toffanin, Giuseppe De Nicolao, Simone Mancini, Davide Martino Raimondo, Bruce Buckingham, Darrell M Wilson, Kari Benassi, Paula Clinton, Breanne P Harris, Satya Shanmugham, Kimberly Caswell, H Peter Chase, David M Maahs, Robert Slover, Sally Sullivan, Laurel Messer, Victoria Gage, Jaime Realsen, Emily Westfall, Hannah Goettle, Francis J Doyle 3rd, Roy W Beck, John Lum, Craig Kollman, Peter Calhoun, Judy Sibayan, Nelly M Njeru, Werner Sauer, John C Pickup, Irl Hirsch, Howard Wolpert
Abstract
Background: This study evaluated meal bolus insulin delivery strategies and associated postprandial glucose control while using an artificial pancreas (AP) system.
Subjects and methods: This study was a multicenter trial in 53 patients, 12-65 years of age, with type 1 diabetes for at least 1 year and use of continuous subcutaneous insulin infusion for at least 6 months. Four different insulin bolus strategies were assessed: standard bolus delivered with meal (n=51), standard bolus delivered 15 min prior to meal (n=40), over-bolus of 30% delivered with meal (n=40), and bolus purposely omitted (n=46). Meal carbohydrate (CHO) intake was 1 g of CHO/kg of body weight up to a maximum of 100 g for the first three strategies or up to a maximum of 50 g for strategy 4.
Results: Only three of 177 meals (two with over-bolus and one with standard bolus 15 min prior to meal) had postprandial blood glucose values of <60 mg/dL. Postprandial hyperglycemia (blood glucose level >180 mg/dL) was prolonged for all four bolus strategies but was shorter for the over-bolus (41% of the 4-h period) than the two standard bolus strategies (73% for each). Mean postprandial blood glucose level was 15.9 mg/dL higher for the standard bolus with meal compared with the prebolus (baseline-adjusted, P=0.07 for treatment effect over the 4-h period).
Conclusions: The AP handled the four bolus situations safely, but at the expense of having elevated postprandial glucose levels in most subjects. This was most likely secondary to suboptimal performance of the algorithm.
Trial registration: ClinicalTrials.gov NCT01271023.
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Source: PubMed