A Meal Detection Algorithm for the Artificial Pancreas: A Randomized Controlled Clinical Trial in Adolescents With Type 1 Diabetes

OBJECTIVE We developed a meal detection algorithm for the artificial pancreas (AP+MDA) that detects unannounced meals and delivers automatic insulin boluses. RESEARCH DESIGN AND METHODS We conducted a randomized crossover trial in 11 adolescents aged 12-18 years with HbA(1c) >= 7.5% who missed one or more boluses in the past 6 months. We compared 1) continuous subcutaneous insulin infusion (CSII), 2) artificial pancreas (AP), and 3) AP+MDA. Participants underwent three 9-h interventions involving breakfast with a bolus and lunch without a bolus. RESULTS In AP+MDA, the meal detection time was 40.0 (interquartile range 40.0-57.5) min. Compared with CSII, AP+MDA decreased the 4-h postlunch incremental area under the curve (iAUC) from 24.1 +/- 9.5 to 15.4 +/- 8.0 h . mmol/L (P = 0.03). iAUC did not differ between AP+MDA and AP (19.6 +/- 10.4 h . mmol/L, P = 0.21) or between AP and CSII (P = 0.33). The AP+MDA reduced time >10 mmol/L (58.0 +/- 26.6%) compared with CSII (79.6 +/- 27.5%, P = 0.02) and AP (74.2 +/- 20.6%, P = 0.047). CONCLUSIONS The AP+MDA improved glucose control after an unannounced meal.