Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas
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 senso...
Gespeichert in:
| Veröffentlicht in: | Diabetes care 2008-05, Vol.31 (5), p.934-939 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 939 |
|---|---|
| container_issue | 5 |
| container_start_page | 934 |
| container_title | Diabetes care |
| container_volume | 31 |
| creator | Weinzimer, Stuart A Steil, Garry M Swan, Karena L Dziura, Jim Kurtz, Natalie Tamborlane, William V |
| description | 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 141 ± 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. |
| doi_str_mv | 10.2337/dc07-1967 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pasca</sourceid><recordid>TN_cdi_pascalfrancis_primary_20317811</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A179241288</galeid><sourcerecordid>A179241288</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4257-77cbe459764f3abdfc98b9b56b14069f771595ba5f18c3d6d12585bc7614beb3</originalsourceid><addsrcrecordid>eNptkt9qFDEUxgdRbF298AU0CApeTM3fmcnlsrW2sGChW70MSebMNiWbrMmMsm_i45pllxak5CLh8PtODt_5quotwWeUsfZLb3FbE9m0z6pTIpmoheDd8-oUEy5rISU9qV7lfI8x5rzrXlYnpKOCSsxOq78Xk_c7NJ_GuNEj9GjhY4a-Xsa4RVchT94FdA7e_Ya0Qz8g5SmjG9g4_aC43JnkijCGMUWPCn8NvdNjchZd69FBGDP66cY7tNptARF07rSBETK6zS6skQ5onkY3OOu0L4pgE-j8unoxaJ_hzfGeVauLr6vFZb38_u1qMV_WllPR1m1rDXAh24YPTJt-sLIz0ojGEI4bObQtEVIYLQbSWdY3PaGiE8a2DeEGDJtVnw5ttyn-miCPauOyBe91gDhl1UgiSgNWwA__gfdxSqGMpihlmDHOaIHqA7TWHpQLQxyTtmsIkLSPAQZXynPSSsoJ7brCnz3Bl9MXh-2Tgs8HgU0x5wSD2ia30WmnCFb7LKh9FtQ-C4V9d5x4MhvoH8nj8gvw8QjobLUfUrHe5QeOYkbajpDHT-_c-u6PS6D64wb3D6tLgREllCwezKr3B3bQUel1Kv1ubygmDOOuWEk4-wdc79NJ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>223033432</pqid></control><display><type>article</type><title>Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas</title><source>MEDLINE</source><source>EZB Electronic Journals Library</source><creator>Weinzimer, Stuart A ; Steil, Garry M ; Swan, Karena L ; Dziura, Jim ; Kurtz, Natalie ; Tamborlane, William V</creator><creatorcontrib>Weinzimer, Stuart A ; Steil, Garry M ; Swan, Karena L ; Dziura, Jim ; Kurtz, Natalie ; Tamborlane, William V</creatorcontrib><description>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 141 ± 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.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc07-1967</identifier><identifier>PMID: 18252903</identifier><identifier>CODEN: DICAD2</identifier><language>eng</language><publisher>Alexandria, VA: American Diabetes Association</publisher><subject>Adolescent ; Adult ; Algorithms ; Artificial Organs ; Automation ; Biological and medical sciences ; Care and treatment ; Celiac disease ; Children ; Control algorithms ; Dextrose ; Diabetes ; Diabetes Mellitus, Type 1 - drug therapy ; Diabetes therapy ; Diabetes. Impaired glucose tolerance ; Diabetics ; Dietary Carbohydrates ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Equipment Design ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Glucose ; Health aspects ; Humans ; Hypoglycemia ; Hypoglycemia - prevention & control ; Hypothyroidism ; Insulin ; Insulin - administration & dosage ; Insulin - blood ; Insulin - therapeutic use ; Insulin Infusion Systems ; Islets of Langerhans - anatomy & histology ; Meals ; Medical sciences ; Metabolic diseases ; Miscellaneous ; Pancreas ; Pediatrics ; Plasma ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Regulatory approval ; Sensors</subject><ispartof>Diabetes care, 2008-05, Vol.31 (5), p.934-939</ispartof><rights>2008 INIST-CNRS</rights><rights>COPYRIGHT 2008 American Diabetes Association</rights><rights>Copyright American Diabetes Association May 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4257-77cbe459764f3abdfc98b9b56b14069f771595ba5f18c3d6d12585bc7614beb3</citedby><cites>FETCH-LOGICAL-c4257-77cbe459764f3abdfc98b9b56b14069f771595ba5f18c3d6d12585bc7614beb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20317811$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18252903$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weinzimer, Stuart A</creatorcontrib><creatorcontrib>Steil, Garry M</creatorcontrib><creatorcontrib>Swan, Karena L</creatorcontrib><creatorcontrib>Dziura, Jim</creatorcontrib><creatorcontrib>Kurtz, Natalie</creatorcontrib><creatorcontrib>Tamborlane, William V</creatorcontrib><title>Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>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 141 ± 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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Algorithms</subject><subject>Artificial Organs</subject><subject>Automation</subject><subject>Biological and medical sciences</subject><subject>Care and treatment</subject><subject>Celiac disease</subject><subject>Children</subject><subject>Control algorithms</subject><subject>Dextrose</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 1 - drug therapy</subject><subject>Diabetes therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetics</subject><subject>Dietary Carbohydrates</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Equipment Design</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Glucose</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - prevention & control</subject><subject>Hypothyroidism</subject><subject>Insulin</subject><subject>Insulin - administration & dosage</subject><subject>Insulin - blood</subject><subject>Insulin - therapeutic use</subject><subject>Insulin Infusion Systems</subject><subject>Islets of Langerhans - anatomy & histology</subject><subject>Meals</subject><subject>Medical sciences</subject><subject>Metabolic diseases</subject><subject>Miscellaneous</subject><subject>Pancreas</subject><subject>Pediatrics</subject><subject>Plasma</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Regulatory approval</subject><subject>Sensors</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNptkt9qFDEUxgdRbF298AU0CApeTM3fmcnlsrW2sGChW70MSebMNiWbrMmMsm_i45pllxak5CLh8PtODt_5quotwWeUsfZLb3FbE9m0z6pTIpmoheDd8-oUEy5rISU9qV7lfI8x5rzrXlYnpKOCSsxOq78Xk_c7NJ_GuNEj9GjhY4a-Xsa4RVchT94FdA7e_Ya0Qz8g5SmjG9g4_aC43JnkijCGMUWPCn8NvdNjchZd69FBGDP66cY7tNptARF07rSBETK6zS6skQ5onkY3OOu0L4pgE-j8unoxaJ_hzfGeVauLr6vFZb38_u1qMV_WllPR1m1rDXAh24YPTJt-sLIz0ojGEI4bObQtEVIYLQbSWdY3PaGiE8a2DeEGDJtVnw5ttyn-miCPauOyBe91gDhl1UgiSgNWwA__gfdxSqGMpihlmDHOaIHqA7TWHpQLQxyTtmsIkLSPAQZXynPSSsoJ7brCnz3Bl9MXh-2Tgs8HgU0x5wSD2ia30WmnCFb7LKh9FtQ-C4V9d5x4MhvoH8nj8gvw8QjobLUfUrHe5QeOYkbajpDHT-_c-u6PS6D64wb3D6tLgREllCwezKr3B3bQUel1Kv1ubygmDOOuWEk4-wdc79NJ</recordid><startdate>200805</startdate><enddate>200805</enddate><creator>Weinzimer, Stuart A</creator><creator>Steil, Garry M</creator><creator>Swan, Karena L</creator><creator>Dziura, Jim</creator><creator>Kurtz, Natalie</creator><creator>Tamborlane, William V</creator><general>American Diabetes Association</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0K</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>200805</creationdate><title>Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas</title><author>Weinzimer, Stuart A ; Steil, Garry M ; Swan, Karena L ; Dziura, Jim ; Kurtz, Natalie ; Tamborlane, William V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4257-77cbe459764f3abdfc98b9b56b14069f771595ba5f18c3d6d12585bc7614beb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Algorithms</topic><topic>Artificial Organs</topic><topic>Automation</topic><topic>Biological and medical sciences</topic><topic>Care and treatment</topic><topic>Celiac disease</topic><topic>Children</topic><topic>Control algorithms</topic><topic>Dextrose</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 1 - drug therapy</topic><topic>Diabetes therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Diabetics</topic><topic>Dietary Carbohydrates</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Equipment Design</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Glucose</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - prevention & control</topic><topic>Hypothyroidism</topic><topic>Insulin</topic><topic>Insulin - administration & dosage</topic><topic>Insulin - blood</topic><topic>Insulin - therapeutic use</topic><topic>Insulin Infusion Systems</topic><topic>Islets of Langerhans - anatomy & histology</topic><topic>Meals</topic><topic>Medical sciences</topic><topic>Metabolic diseases</topic><topic>Miscellaneous</topic><topic>Pancreas</topic><topic>Pediatrics</topic><topic>Plasma</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Regulatory approval</topic><topic>Sensors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weinzimer, Stuart A</creatorcontrib><creatorcontrib>Steil, Garry M</creatorcontrib><creatorcontrib>Swan, Karena L</creatorcontrib><creatorcontrib>Dziura, Jim</creatorcontrib><creatorcontrib>Kurtz, Natalie</creatorcontrib><creatorcontrib>Tamborlane, William V</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>Agricultural Science Collection</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep (ProQuest)</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Agricultural Science Database</collection><collection>ProQuest Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Research Library</collection><collection>ProQuest Science Journals</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weinzimer, Stuart A</au><au>Steil, Garry M</au><au>Swan, Karena L</au><au>Dziura, Jim</au><au>Kurtz, Natalie</au><au>Tamborlane, William V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2008-05</date><risdate>2008</risdate><volume>31</volume><issue>5</issue><spage>934</spage><epage>939</epage><pages>934-939</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><coden>DICAD2</coden><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 141 ± 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.</abstract><cop>Alexandria, VA</cop><pub>American Diabetes Association</pub><pmid>18252903</pmid><doi>10.2337/dc07-1967</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0149-5992 |
| ispartof | Diabetes care, 2008-05, Vol.31 (5), p.934-939 |
| issn | 0149-5992 1935-5548 |
| language | eng |
| recordid | cdi_pascalfrancis_primary_20317811 |
| source | MEDLINE; EZB Electronic Journals Library |
| subjects | Adolescent Adult Algorithms Artificial Organs Automation Biological and medical sciences Care and treatment Celiac disease Children Control algorithms Dextrose Diabetes Diabetes Mellitus, Type 1 - drug therapy Diabetes therapy Diabetes. Impaired glucose tolerance Diabetics Dietary Carbohydrates Endocrine pancreas. Apud cells (diseases) Endocrinopathies Equipment Design Etiopathogenesis. Screening. Investigations. Target tissue resistance Glucose Health aspects Humans Hypoglycemia Hypoglycemia - prevention & control Hypothyroidism Insulin Insulin - administration & dosage Insulin - blood Insulin - therapeutic use Insulin Infusion Systems Islets of Langerhans - anatomy & histology Meals Medical sciences Metabolic diseases Miscellaneous Pancreas Pediatrics Plasma Public health. Hygiene Public health. Hygiene-occupational medicine Regulatory approval Sensors |
| title | Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T20%3A27%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pasca&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Fully%20Automated%20Closed-Loop%20Insulin%20Delivery%20Versus%20Semiautomated%20Hybrid%20Control%20in%20Pediatric%20Patients%20With%20Type%201%20Diabetes%20Using%20an%20Artificial%20Pancreas&rft.jtitle=Diabetes%20care&rft.au=Weinzimer,%20Stuart%20A&rft.date=2008-05&rft.volume=31&rft.issue=5&rft.spage=934&rft.epage=939&rft.pages=934-939&rft.issn=0149-5992&rft.eissn=1935-5548&rft.coden=DICAD2&rft_id=info:doi/10.2337/dc07-1967&rft_dat=%3Cgale_pasca%3EA179241288%3C/gale_pasca%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=223033432&rft_id=info:pmid/18252903&rft_galeid=A179241288&rfr_iscdi=true |