Advanced Artificial Pancreas Systems to Enable Fully Automated Glycemic Control in Type 1 Diabetes Mellitus

项目摘要 尽管自动化胰岛素输送系统的进步证明了上级血糖控制 结果，具有挑战性的临床问题仍然需要准确的碳水化合物 计数和膳食通知结合长效皮下胰岛素， 导致餐后高血糖的反复发生。血糖控制方面的临床差距 拟议项目涉及控制问题。我们打算利用现有的技术 在模式识别和预测，以完善和测试一个全自动闭环系统， 不需要用餐通知。这个系统的独特之处在于它依赖于模式 认识，特别是周围的膳食，以预期的方式，使胰岛素的作用， 在预期用餐前服用，而不是在预期用餐前服用的主要反应性溶液， 经常提议。我们打算在加速的背景下进一步测试和调整这个系统。 胰岛素，以进一步改善血糖结果，并消除使用这些系统的障碍， 减轻疾病管理负担。 我们已经开发了完全自动化闭环所需的基础工具， 将计划通过利用我们积累的临床研究数据库中的数据进行进一步的改进。 我们计划进行2项试点研究，然后进行一项更大的7个月的主要研究，以评估 本提案的具体目标如下： 1)我们假设，新型速效胰岛素类似物可以安全地用于提供更多的 有效的全自动闭环控制我们的第一个试点将测试Fiasp之间的差异 和一种新的门冬胰岛素制剂（AT 247）的监督试验。该试验结果将告知 选择后续试验中使用的胰岛素。 2)我们假设，随着设计适应这些新的胰岛素配方，完全自动化 闭环控制是一种有效的临床替代混合闭环系统，目前的状态- 最先进的系统 3)最后，我们假设，进一步增加血糖紊乱预期（例如，通常 周围的饭菜），以这种全自动闭环控制系统将进一步提高 与无干扰的全自动闭环系统相比的血糖结果 期待

PROJECT ABSTRACT Despite advancements in automated insulin delivery systems that demonstrate superior glycemic outcomes, challenging clinical issues remain with the continued need for accurate carbohydrate counting and meal announcement combined with slow-acting subcutaneous insulin that contribute to repeated occurrences of postprandial hyperglycemia. This clinical gap in glycemic control is addressed by the proposed project. We intend to leverage our existing advancements in pattern recognition and anticipation to refine and test a fully automated closed-loop system that does not require meal announcements. This system is unique in that it relies on pattern recognition, particularly surrounding meals, in an anticipatory manner so that insulin action is taken in advance of an expected meal rather than the predominantly reactive solutions that are often proposed. We intend to further test and tune this system within the context of accelerated insulins to further improve glycemic outcomes and remove barriers to use of these systems by lowering burden of disease management. We have already developed the foundational tools needed for a fully automated closed-loop and will plan for further refinement by leveraging data from our accumulated clinical studies database. We plan to conduct 2 pilots studies followed by a larger, 7-month main study to evaluate the following specific aims of this proposal: 1) We hypothesize that novel faster acting insulin analogs can be safely used to provide more effective fully automated closed-loop control. Our first pilot will test the differences between Fiasp and a novel formulation of aspart (AT247) in a supervised trial. This trial results will inform the selection of the insulin used in the subsequent trials. 2) We hypothesize that, with a design adapted to these new insulin formulations, fully automated closed-loop control is a valid clinical alternative to hybrid closed-loop systems, the current state- of-the-art systems. 3) Lastly, we hypothesize that further adding glycemic disturbance anticipation (e.g. generally surrounding meals) to this fully automated closed-loop control system will further improve glycemic outcomes compared with a fully automated closed-loop system without disturbance anticipation.