Outpatient Closed-Loop Control with Unannounced Moderate Exercise in Adolescents Using Zone Model Predictive Control

Background: The artificial pancreas (AP) has the potential to improve glycemic control in adolescents. This article presents the first evaluation in adolescents of the Zone Model Predictive Control and Health Monitoring System (ZMPC+HMS) AP algorithms, and their first evaluation in a supervised outpatient setting with frequent exercise. Materials and Methods: Adolescents with type 1 diabetes underwent 3 days of closed-loop control (CLC) in a hotel setting with the ZMPC+HMS algorithms on the Diabetes Assistant platform. Subjects engaged in twice-daily exercise, including soccer, tennis, and bicycling. Meal size (unrestricted) was estimated and entered into the system by subjects to trigger a bolus, but exercise was not announced. Results: Ten adolescents (11.9-17.7 years) completed 72 h of CLC, with data on 95 +/- 14 h of sensor-augmented pump (SAP) therapy before CLC as a comparison to usual therapy. The percentage of time with continuous glucose monitor (CGM) 70-180mg/dL was 71% +/- 10% during CLC, compared to 57% +/- 16% during SAP (P=0.012). Nocturnal control during CLC was safe, with 0% (0%, 0.6%) of time with CGM < 70mg/dL compared to 1.1% (0.0%, 14%) during SAP. Despite large meals (estimated up to 120 g carbohydrate), only 8.0% +/- 6.9% of time during CLC was spent with CGM > 250 mg/dL (16% +/- 14% during SAP). The system remained connected in CLC for 97%-2% of the total study time. No adverse events or severe hypoglycemia occurred. Conclusions: The use of the ZMPC+HMS algorithms is feasible in the adolescent outpatient environment and achieved significantly more time in the desired glycemic range than SAP in the face of unannounced exercise and large announced meal challenges.