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

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 越来越多的科学和工业努力集中在开发闭环系统(人工胰腺)来控制糖尿病患者，特别是T1 DM患者的葡萄糖代谢。正在进行CGM与胰岛素泵和控制算法相结合的实验。虽然这种系统已被证明在稳定的代谢状态下是可行的，但在改变代谢需求时，例如饮食和体力活动，它们就会失败。为了解决这种代谢障碍，我们开发了一种新的闭环控制算法，并在计算机上进行了测试，该算法使用胰岛素敏感性和心率的单独参数。 拟议的试点试验将在使用胰岛素泵维持血糖控制的T1 DM患者身上测试该算法。心率的变化将被用作代谢需求增加的相关性。 如果成功，这项研究将建立以下范例：初始测试(例如口服葡萄糖耐量测试)将允许设置个人参数，然后这些参数将被用来初始化闭环控制，而不是用通用控制算法“盲目”地接近一个人。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新陈代谢干扰的高度特殊反应，如进餐和体力活动。

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.