Closed-Loop Control Without Meal Announcement in Type 1 Diabetes
Closed-Loop Control Without Meal Announcement in Type 1 Diabetes
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DOI：
10.1089/dia.2017.0078
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发表时间：
2017-09-01
影响因子：
5.4
通讯作者：
Bequette, B. Wayne
中科院分区：
文献类型：
--
作者：
Cameron, Faye M.;Ly, Trang T.;Bequette, B. Wayne
目的：开发了一种完全闭环的仅胰岛素系统，用于为1型糖尿病患者提供血糖控制，而无需宣布用餐或活动。我们的目标是评估初始的安全性和有效性，这个system.Research设计和方法：多模型概率控制器（MMPPC）预计吃饭时，病人是清醒的。控制器使用受试者的基础率和每日胰岛素总剂量进行初始化。该系统进行了测试，在两个网站上的10名患者在30小时的住院研究，其次是15名受试者在三个网站在54小时的监督酒店的研究，其中控制器的挑战运动和未经宣布的膳食。该系统是在UVA DiAs系统上使用Roche Spirit Combo胰岛素泵和Dexcom G4 Continuous Glucose Monitor.Results：平均总体（24小时基础）和夜间（11 PM-7 AM）连续葡萄糖监测（CGM）值分别为142和125 mg/dL。酒店的研究使用了不同的白天调谐和手动通知，而不是自动检测睡眠和清醒时间。这导致平均整体（24小时的基础上）和夜间CGM值为152和139 mg/dL的酒店研究，也有一个减少低血糖事件从1.6至0.91事件/患者/day.Conclusions：MMPPC系统实现了平均血糖，这将是特别有帮助的人与A1 C升高的结果，经常错过餐团。与使用进餐通知的算法相比，当前全闭环具有更高的低血糖风险。
Objective: A fully closed-loop insulin-only system was developed to provide glucose control in patients with type 1 diabetes without requiring announcement of meals or activity. Our goal was to assess initial safety and efficacy of this system.Research Design and Methods: The multiple model probabilistic controller (MMPPC) anticipates meals when the patient is awake. The controller used the subject's basal rates and total daily insulin dose for initialization. The system was tested at two sites on 10 patients in a 30-h inpatient study, followed by 15 subjects at three sites in a 54-h supervised hotel study, where the controller was challenged by exercise and unannounced meals. The system was implemented on the UVA DiAs system using a Roche Spirit Combo Insulin Pump and a Dexcom G4 Continuous Glucose Monitor.Results: The mean overall (24-h basis) and nighttime (11 PM-7 AM) continuous glucose monitoring (CGM) values were 142 and 125 mg/dL during the inpatient study. The hotel study used a different daytime tuning and manual announcement, instead of automatic detection, of sleep and wake periods. This resulted in mean overall (24-h basis) and nighttime CGM values of 152 and 139 mg/dL for the hotel study and there was also a reduction in hypoglycemia events from 1.6 to 0.91 events/patient/day.Conclusions: The MMPPC system achieved a mean glucose that would be particularly helpful for people with an elevated A1c as a result of frequent missed meal boluses. Current full closed loop has a higher risk for hypoglycemia when compared with algorithms using meal announcement.