STUDY OF CLOSED-LOOP GLUCOSE CONTROL IN PEOPLE WITH TYPE 1 DIABETES

这个子项目是许多利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 越来越多的科学和工业努力集中在闭环系统（人工胰腺）的开发上，以控制糖尿病患者（特别是T1 DM）的葡萄糖代谢。实验正在进行与CGM加上胰岛素泵和控制算法。虽然这些系统已被证明在稳定的代谢状态下是可行的，但它们在不断变化的代谢需求（如膳食和体力活动）中失败了。为了解释这种代谢紊乱，我们已经开发并测试了一种新的闭环控制算法，该算法使用胰岛素敏感性和心率的个体参数。 拟议的初步试验将在使用胰岛素泵维持血糖控制的T1 DM患者体内测试该算法。心率的变化将被用作与代谢需求增加的相关性。 如果成功，本研究将建立以下范例：而不是用通用控制算法“盲目”接近一个人，初始测试（例如口服葡萄糖耐量测试）将允许设置单个参数，然后将其用于初始化闭环控制。这种方法有可能克服目前闭环控制的一些局限性，特别是它无法解释一个人对代谢紊乱的高度特异质反应，如膳食和体力活动。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Increasing scientific and industrial effort is focused on the development of closed-loop systems (artificial pancreas) to control glucose metabolism in people with diabetes, particularly T1DM. Experiments are being conducted with CGM coupled with insulin pumps and a control algorithm. While such systems have proven feasible in steady metabolic states, they fail during changing metabolic demands, such as meals and physical activity. In order to account for such metabolic disturbances we have developed and tested in silico a new closed-loop control algorithm, which uses individual parameters of insulin sensitivity and heart rate. The proposed pilot trial will test this algorithm in vivo with T1DM patients who use insulin pumps to maintain glycemic control. Changes in heart rate will be used as a correlate to increased metabolic demand. If successful, this study will establish the following paradigm: instead of approaching a person "blindly" with a generic control algorithm, an initial test (e.g. oral glucose tolerance test) would allow setting individual parameters, which then will be used to initialize closed-loop control. This approach has the potential to overcome some of the current limitations of closed-loop control, particularly its inability to account for the highly idiosyncratic reaction of a person to metabolic disturbances, such as meals and physical activity.