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J Diabetes Sci Technol. 2010 Nov 1;4(6):1374-81.

Multinational study of subcutaneous model-predictive closed-loop control in type 1 diabetes mellitus: summary of the results.

Author information

1
Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia 22908, USA. boris@virginia.edu

Abstract

BACKGROUND:

In 2008-2009, the first multinational study was completed comparing closed-loop control (artificial pancreas) to state-of-the-art open-loop therapy in adults with type 1 diabetes mellitus (T1DM).

METHODS:

The design of the control algorithm was done entirely in silico, i.e., using computer simulation experiments with N=300 synthetic "subjects" with T1DM instead of traditional animal trials. The clinical experiments recruited 20 adults with T1DM at the Universities of Virginia (11); Padova, Italy (6); and Montpellier, France (3). Open-loop and closed-loop admission was scheduled 3-4 weeks apart, continued for 22 h (14.5 h of which were in closed loop), and used a continuous glucose monitor and an insulin pump. The only difference between the two sessions was that insulin dosing was performed by the patient under a physician's supervision during open loop, whereas insulin dosing was performed by a control algorithm during closed loop.

RESULTS:

In silico design resulted in rapid (less than 6 months compared to years of animal trials) and cost-effective system development, testing, and regulatory approvals in the United States, Italy, and France. In the clinic, compared to open-loop, closed-loop control reduced nocturnal hypoglycemia (blood glucose below 3.9 mmol/liter) from 23 to 5 episodes (p<.01) and increased the amount of time spent overnight within the target range (3.9 to 7.8 mmol/liter) from 64% to 78% (p=.03).

CONCLUSIONS:

In silico experiments can be used as viable alternatives to animal trials for the preclinical testing of insulin treatment strategies. Compared to open-loop treatment under identical conditions, closed-loop control improves the overnight regulation of diabetes.

PMID:
21129332
PMCID:
PMC3005047
DOI:
10.1177/193229681000400611
[Indexed for MEDLINE]
Free PMC Article
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