Format

Send to

Choose Destination
J Clin Endocrinol Metab. 2014 May;99(5):1701-11. doi: 10.1210/jc.2013-4151. Epub 2014 Jan 31.

Autonomous and continuous adaptation of a bihormonal bionic pancreas in adults and adolescents with type 1 diabetes.

Author information

1
Department of Biomedical Engineering (F.H.E.-K., K.M., E.R.D.), Boston University, Boston, Massachusetts 02215; and Diabetes Unit and Department of Medicine (S.J.R., K.L.M., M.S., D.M.N.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.

Abstract

CONTEXT:

A challenge for automated glycemic control in type 1 diabetes (T1D) is the large variation in insulin needs between individuals and within individuals at different times in their lives.

OBJECTIVES:

The objectives of the study was to test the ability of a third-generation bihormonal bionic pancreas algorithm, initialized with only subject weight; to adapt automatically to the different insulin needs of adults and adolescents; and to evaluate the impact of optional, automatically adaptive meal-priming boluses.

DESIGN:

This was a randomized controlled trial.

SETTING:

The study was conducted at an inpatient clinical research center.

PATIENTS:

Twelve adults and 12 adolescents with T1D participated in the study.

INTERVENTIONS:

Subjects in each age group were randomized to automated glycemic control for 48 hours with or without automatically adaptive meal-priming boluses.

MAIN OUTCOME MEASURES:

Mean plasma glucose (PG), time with PG less than 60 mg/dL, and insulin total daily dose were measured.

RESULTS:

The 48-hour mean PG values with and without adaptive meal-priming boluses were 132 ± 9 vs 146 ± 9 mg/dL (P = .03) in adults and 162 ± 6 vs 175 ± 9 mg/dL (P = .01) in adolescents. Adaptive meal-priming boluses improved mean PG without increasing time spent with PG less than 60 mg/dL: 1.4% vs 2.3% (P = .6) in adults and 0.1% vs 0.1% (P = 1.0) in adolescents. Large increases in adaptive meal-priming boluses and shifts in the timing and size of automatic insulin doses occurred in adolescents. Much less adaptation occurred in adults. There was nearly a 4-fold variation in the total daily insulin dose across all cohorts (0.36-1.41 U/kg · d).

CONCLUSIONS:

A single control algorithm, initialized only with subject weight, can quickly adapt to regulate glycemia in patients with TID and highly variable insulin requirements.

PMID:
24483160
PMCID:
PMC4010702
DOI:
10.1210/jc.2013-4151
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center