Closed-Loop Control of Postprandial Glycemia Using an Insulin-on-Board Limitation Through Continuous Action on Glucose Target

Paolo Rossetti, Carmen Quirós, Vanessa Moscardó, Anna Comas, Marga Giménez, F. Javier Ampudia-Blasco, Fabián León, Eslam Montaser, Ignacio Conget, Jorge Bondia, Josep Vehí
2017 Diabetes Technology & Therapeutics  
Rossetti, P.; Quirós, C.; Moscardo-Garcia, V.; Comas, A.; Giménez, M.; Ampudia-Blasco, F.; León, F.Abstract 32 33 Background: Postprandial (PP) control remains a challenge for closed-loop (CL) systems. Few 34 studies with inconsistent results have systematically investigated the PP period. 35 Objective: To compare a new CL algorithm with current pump therapy (OL) in the PP glucose 36 control in type 1 diabetes (T1D) subjects. 37 Methods: A crossover-randomized study was performed in two
more » ... rmed in two centers. 20 T1D subjects (F/M 38 13/7, disease duration 22.6±9.9 years, A1c 7.8±0.7%) underwent an 8-hour mixed meal test on 39 4 occasions. On two (CL1/CL2), after meal-announcement a bolus was given followed by an 40 algorithm-driven basal infusion based on continuous glucose monitoring (CGM). Alternatively, 41 in OL1/OL2 conventional pump therapy was used. Main Outcome Measures were: Glucose 42 variability, estimated with the coefficient of variation (CV) of the area-under-the-curve (AUC) 43 of plasma glucose (PG) and CGM values and from the analysis of the glucose-time series; 44 mean, maximum (C max ) and time to C max glucose concentrations and time in range (<70, 70-180, 45 >180 mg/dl). 46 Results: CVs of the glucose AUCs were low and similar in all studies (around 10%). However, 47 CL achieved greater reproducibility and better PG control in the PP period: 48 CL1=CL20.05) nor the need 51 for oral glucose were significantly different (CL 40.0% vs. OL 22.5% of meals; p=0.054). 52 Conclusions: This novel CL algorithm effectively and consistently controls PP glucose 53 excursions without increasing hypoglycemia. 54 55
doi:10.1089/dia.2016.0443 pmid:28459603 fatcat:otsyi6z2s5butpxnn2kaay2xce