Multicenter Closed-Loop/Hybrid Meal Bolus Insulin Delivery with Type 1 Diabetes

被引:33
作者
Chase, H. Peter [1 ]
Doyle, Francis J., III [2 ]
Zisser, Howard [3 ]
Renard, Eric [4 ,5 ]
Nimri, Revital [6 ,7 ]
Cobelli, Claudio [8 ]
Buckingham, Bruce A. [9 ]
Maahs, David M. [1 ]
Anderson, Stacey [10 ]
Magni, Lalo [11 ]
Lum, John [12 ]
Calhoun, Peter [12 ]
Kollman, Craig [12 ]
Beck, Roy W. [12 ]
机构
[1] Barbara Davis Ctr Childhood, Aurora, CO USA
[2] Univ Calif Santa Barbara, Dept Chem Engn, Santa Barbara, CA 93106 USA
[3] Sansum Diabet Res Inst, Santa Barbara, CA USA
[4] Univ Montpellier, Montpellier Univ Hosp, Dept Endocrinol, Montpellier, France
[5] Univ Montpellier, INSERM Clin Invest Ctr 1001, Inst Funct Genom, UMR CNRS 5203,INSERM U661, Montpellier, France
[6] Tel Aviv Univ, Jesse Z & Sara Lea Shafer Inst Endocrinol & Diabe, Natl Ctr Childhood Diabet, Schneider Childrens Med Ctr Israel, IL-69978 Tel Aviv, Israel
[7] Tel Aviv Univ, Sackler Fac Med, IL-69978 Tel Aviv, Israel
[8] Univ Padua, Padua, Italy
[9] Stanford Univ, Stanford, CA 94305 USA
[10] Univ Virginia, Charlottesville, VA USA
[11] Univ Pavia, I-27100 Pavia, Italy
[12] Jaeb Ctr Hlth Res, Tampa, FL USA
关键词
ARTIFICIAL PANCREAS; GLUCOSE CONTROL; LOOP CONTROL; GLYCEMIC EXCURSIONS; YOUNG-ADULTS; ADOLESCENTS; GLUCAGON; SYSTEM;
D O I
10.1089/dia.2014.0050
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: This study evaluated meal bolus insulin delivery strategies and associated postprandial glucose control while using an artificial pancreas (AP) system. Subjects and Methods: This study was a multicenter trial in 53 patients, 12-65 years of age, with type 1 diabetes for at least 1 year and use of continuous subcutaneous insulin infusion for at least 6 months. Four different insulin bolus strategies were assessed: standard bolus delivered with meal (n=51), standard bolus delivered 15 min prior to meal (n=40), over-bolus of 30% delivered with meal (n=40), and bolus purposely omitted (n=46). Meal carbohydrate (CHO) intake was 1 g of CHO/kg of body weight up to a maximum of 100 g for the first three strategies or up to a maximum of 50 g for strategy 4. Results: Only three of 177 meals (two with over-bolus and one with standard bolus 15 min prior to meal) had postprandial blood glucose values of <60 mg/dL. Postprandial hyperglycemia (blood glucose level >180 mg/dL) was prolonged for all four bolus strategies but was shorter for the over-bolus (41% of the 4-h period) than the two standard bolus strategies (73% for each). Mean postprandial blood glucose level was 15.9 mg/dL higher for the standard bolus with meal compared with the prebolus (baseline-adjusted, P=0.07 for treatment effect over the 4-h period). Conclusions: The AP handled the four bolus situations safely, but at the expense of having elevated postprandial glucose levels in most subjects. This was most likely secondary to suboptimal performance of the algorithm.
引用
收藏
页码:623 / 632
页数:10
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