Behavioral Patterns and Associations with Glucose Control During 12-Week Randomized Free-Living Clinical Trial of Day and Night Hybrid Closed-Loop Insulin Delivery in Adults with Type 1 Diabetes.


OBJECTIVES:We evaluated patterns of meal intake, insulin bolus delivery, and fingerstick glucose measurements during hybrid closed-loop and sensor-augmented pump (SAP) therapy, including associations with glucose control. METHODS:Data were retrospectively analyzed from pump-treated adults with type 1 diabetes who underwent, in random order, 12 weeks free-living closed-loop (n = 32) and 12 weeks SAP (n = 33) periods. We quantified daily patterns of main meals, snacks, prandial insulin boluses, correction boluses, and fingerstick glucose measurements by analyzing data recorded on the study glucometer and on study insulin pump. RESULTS:We analyzed 1942 closed-loop days and 2530 SAP days. The total number of insulin boluses was reduced during closed-loop versus SAP periods by mean 1.0 per day (95% confidence interval 0.6-1.4, P < 0.001) mainly because of a reduced number of correction boluses by mean 0.7 per day (0.4-1.0, P < 0.001). Other behavioral patterns were unchanged. The carbohydrate content of snacks but not the number of snacks was positively correlated with (1) glycemic variability as measured by standard deviation of sensor glucose (closed-loop P < 0.05; SAP P < 0.01), (2) mean sensor glucose (P < 0.05), and (3) postintervention HbA1c (P < 0.05). Behavioral patterns explained 47% of between-subject variance in glucose variability during SAP period and 30%-33% of variance of means sensor glucose and postintervention HbA1c. CONCLUSION:Fewer correction boluses are delivered during closed-loop period. The size of snacks appears to worsen glucose control possibly because of carbohydrate-rich content of snacks. Modifiable behavioral patterns may be important determinants of glucose control.


Diabetes Technol Ther


Emami A,Willinska ME,Thabit H,Leelarathna L,Hartnell S,Dellweg S,Benesch C,Mader JK,Holzer M,Kojzar H,Pieber TR,Arnolds S,Evans ML,Hovorka R




Has Abstract


2017-07-01 00:00:00












  • Improved Postprandial Glycemic Control with Faster-Acting Insulin Aspart in Patients with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion.

    abstract:BACKGROUND:Faster aspart is insulin aspart (IAsp) in a new formulation, which in continuous subcutaneous insulin infusion (CSII) in subjects with type 1 diabetes has shown a faster onset and offset of glucose-lowering effect than IAsp. METHODS:This double-blind, randomized, crossover active-controlled trial compared 2...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,随机对照试验


    authors: Bode BW,Johnson JA,Hyveled L,Tamer SC,Demissie M

    更新日期:2017-01-01 00:00:00

  • A pilot study of the SPRINT protocol for tight glycemic control in critically Ill patients.

    abstract:BACKGROUND:Stress-induced hyperglycemia is prevalent in critical care, even in patients with no history of diabetes. Increased counter-regulatory hormone response increases gluconeogenesis and effective insulin resistance, which can be exacerbated by drug therapy. Control of blood glucose levels to the 4.0-6.1 mmol/L r...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Lonergan T,Compte AL,Willacy M,Chase JG,Shaw GM,Hann CE,Lotz T,Lin J,Wong XW

    更新日期:2006-08-01 00:00:00

  • High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass.

    abstract:BACKGROUND:Obesity surgery elicits complex changes in glucose metabolism that are difficult to observe with discontinuous glucose measurements. We aimed to evaluate glucose variability after gastric bypass by continuous glucose monitoring (CGM) in a real-life setting. METHODS:CGM was performed for 4.2 ± 1.3 days in th...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Hanaire H,Bertrand M,Guerci B,Anduze Y,Guillaume E,Ritz P

    更新日期:2011-06-01 00:00:00

  • Reduction in hemoglobin A1C with real-time continuous glucose monitoring: results from a 12-week observational study.

    abstract:BACKGROUND:Real-time continuous glucose monitoring (CGM) was studied in 140 adults with diabetes over a 12-week period of home use. Hemoglobin A(1c)(HbA1c) was measured on day 1 (baseline) and at weeks 6 and 12. METHODS:On day 1, participants received the CGM device (STS(R) System, DexCom, Inc., San Diego, CA) and und...

    journal_title:Diabetes technology & therapeutics

    pub_type: 临床试验,杂志文章,多中心研究


    authors: Bailey TS,Zisser HC,Garg SK

    更新日期:2007-06-01 00:00:00

  • Evaluation of a Nurse-Managed Insulin Infusion Protocol.

    abstract:BACKGROUND:The purpose of this study was to evaluate the performance of an insulin infusion protocol targeting a blood glucose (BG) level of 140-180 mg/dL and to characterize protocol adherence. MATERIALS AND METHODS:This was a retrospective observational cohort study including patients for whom the protocol was order...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Passarelli AJ,Gibbs H,Rowden AM,Efird L,Zink E,Mathioudakis N

    更新日期:2016-02-01 00:00:00

  • Point accuracy of interstitial continuous glucose monitoring during exercise in type 1 diabetes.

    abstract:BACKGROUND:Previous studies of aerobic exercise have found lower sensor accuracy during exercise. Whether or not resistance exercise would also be associated with lower sensor accuracy has not yet been examined. This study sought to investigate the accuracy of continuous glucose monitoring sensor values at rest, during...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Yardley JE,Sigal RJ,Kenny GP,Riddell MC,Lovblom LE,Perkins BA

    更新日期:2013-01-01 00:00:00

  • Integrating Continuous Glucose Monitor Data Directly into the Electronic Health Record: Proof of Concept.

    abstract:: Background: Continuous glucose monitoring (CGM) systems are widely and increasingly used in diabetes self-management and in the context of clinic visits. However, access to CGM data during visits can be challenging. Clinic inefficiencies can restrict the time available for...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Espinoza J,Shah P,Raymond J

    更新日期:2020-08-01 00:00:00

  • Nocturnal Glucose Metabolism in Type 1 Diabetes: A Study Comparing Single Versus Dual Tracer Approaches.

    abstract:BACKGROUND:Understanding the effect size, variability, and underlying physiology of the dawn phenomenon is important for next-generation closed-loop control algorithms for type 1 diabetes (T1D). SUBJECTS AND METHODS:We used an iterative protocol design to study 16 subjects with T1D on individualized insulin pump thera...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Mallad A,Hinshaw L,Dalla Man C,Cobelli C,Basu R,Lingineni R,Carter RE,Kudva YC,Basu A

    更新日期:2015-08-01 00:00:00

  • Safety and Efficacy of Initializing the Control-IQ Artificial Pancreas System Based on Total Daily Insulin in Adolescents with Type 1 Diabetes.

    abstract:: Objective: To assess the safety and efficacy of a simplified initialization for the Tandem t:slim X2 Control-IQ hybrid closed-loop system, using parameters based on total daily insulin ("MyTDI") in adolescents with type 1 diabetes under usual activity and during periods of...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Schoelwer MJ,Robic JL,Gautier T,Fabris C,Carr K,Clancy-Oliveri M,Brown SA,Anderson SM,DeBoer MD,Cherñavvsky DR,Breton MD

    更新日期:2020-08-01 00:00:00

  • Minimally invasive insulin delivery in subjects with type 1 diabetes using hollow microneedles.

    abstract:BACKGROUND:Microneedles have previously been used to deliver insulin to animal models, but not in human subjects. This study tested the hypothesis that hollow microneedles can deliver insulin to modulate blood glucose levels in subjects with type 1 diabetes in a minimally invasive manner. METHODS:This study was carrie...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Gupta J,Felner EI,Prausnitz MR

    更新日期:2009-06-01 00:00:00

  • Reduced weight gain with insulin detemir compared to NPH insulin is not explained by a reduction in hypoglycemia.

    abstract:BACKGROUND:Weight gain often occurs when insulin therapy is initiated. The long-acting insulin analog insulin detemir has been shown to be effective and well tolerated when used in basal-bolus regimens or as an add-on to oral antidiabetic drugs (OADs) and causes less weight gain than other insulins. The aim of this exp...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Davies MJ,Derezinski T,Pedersen CB,Clauson P

    更新日期:2008-08-01 00:00:00

  • The Impact of Insulin Pump Therapy on Glycemic Profiles in Patients with Type 2 Diabetes: Data from the OpT2mise Study.

    abstract:BACKGROUND:The OpT2mise randomized trial was designed to compare the effects of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) on glucose profiles in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS:Patients with glycated hemoglobin (HbA1c) levels of ≥8% (64 mmol/mol) and...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,随机对照试验


    authors: Conget I,Castaneda J,Petrovski G,Guerci B,Racault AS,Reznik Y,Cohen O,Runzis S,de Portu S,Aronson R,OpT2mise Study Group.

    更新日期:2016-01-01 00:00:00

  • Role of Continuous Glucose Monitoring in Clinical Trials: Recommendations on Reporting.

    abstract::Thanks to significant improvements in the precision, accuracy, and usability of continuous glucose monitoring (CGM), its relevance in both ambulatory diabetes care and clinical research is increasing. In this study, we address the latter perspective and derive provisional reporting recommendations. CGM systems have be...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,评审


    authors: Schnell O,Barnard K,Bergenstal R,Bosi E,Garg S,Guerci B,Haak T,Hirsch IB,Ji L,Joshi SR,Kamp M,Laffel L,Mathieu C,Polonsky WH,Snoek F,Home P

    更新日期:2017-07-01 00:00:00

  • Real-World Hypoglycemia Avoidance with a Continuous Glucose Monitoring System's Predictive Low Glucose Alert.

    abstract:BACKGROUND:Programmable and fixed auditory and/or vibratory threshold alerts are essential features of real-time continuous glucose monitoring (rtCGM) systems that provide users time to intervene before the onset of clinical hypoglycemia or hyperglycemia. A sixth-generation rtCGM system from Dexcom, Inc. (G6) includes ...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Puhr S,Derdzinski M,Welsh JB,Parker AS,Walker T,Price DA

    更新日期:2019-04-01 00:00:00

  • High Glucose Variability in Hospitalized Patients with Type 1 Diabetes Mellitus.

    abstract:BACKGROUND:Glucose variability (GV) has been increasingly (or more extensively) studied in patients with type 1 diabetes (T1D) in the ambulatory setting; limited data exist on GV in hospitalized patients with T1D. MATERIALS AND METHODS:Retrospective single center cohort study, we analyzed in-hospital glucose measureme...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Dadlani V,Tamhane SU,Sun A,Sharma A,Delivanis DA,Thapa P,Carter RE,Kudva YC

    更新日期:2017-10-01 00:00:00

  • Accuracy of continuous glucose monitoring during exercise in type 1 diabetes pregnancy.

    abstract:BACKGROUND:Performance of continuous glucose monitors (CGMs) may be lower when glucose levels are changing rapidly, such as occurs during physical activity. Our aim was to evaluate accuracy of a current-generation CGM during moderate-intensity exercise in type 1 diabetes (T1D) pregnancy. SUBJECTS AND METHODS:As part o...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Kumareswaran K,Elleri D,Allen JM,Caldwell K,Nodale M,Wilinska ME,Amiel SA,Hovorka R,Murphy HR

    更新日期:2013-03-01 00:00:00

  • Biochemical stabilization of glucagon at alkaline pH.

    abstract:BACKGROUND:For patients with type 1 diabetes mellitus, a bihormonal artificial endocrine pancreas system utilizing glucagon and insulin has been found to stabilize glycemic control. However, commercially available formulations of glucagon cannot currently be used in such systems because of physical instability characte...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Caputo N,Jackson MA,Castle JR,El Youssef J,Bakhtiani PA,Bergstrom CP,Carroll JM,Breen ME,Leonard GL,David LL,Roberts CT Jr,Ward WK

    更新日期:2014-11-01 00:00:00

  • Glycemic control and perinatal outcomes of pregnancies complicated by type 1 diabetes: influence of continuous subcutaneous insulin infusion and lispro insulin.

    abstract:AIMS:This study compared glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes mellitus (T1DM) treated with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) using regular (RI) or lispro (LP) insulin. METHODS:Three hundred fifteen consecutive singleton...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Chico A,Saigi I,García-Patterson A,Santos MD,Adelantado JM,Ginovart G,de Leiva A,Corcoy R

    更新日期:2010-12-01 00:00:00

  • Continuous subcutaneous insulin infusion and multiple dose of insulin regimen display similar patterns of blood glucose excursions in pediatric type 1 diabetes.

    abstract:BACKGROUND:Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic variability and clinical hypoglycemia compared with the multiple daily insulin (MDI) regimen. To compare the indices of glycemic instability between CSII and MDI, we analyzed the continuous glucose monitoring system (CGMS) (Medt...

    journal_title:Diabetes technology & therapeutics

    pub_type: 临床试验,杂志文章


    authors: Alemzadeh R,Palma-Sisto P,Parton EA,Holzum MK

    更新日期:2005-08-01 00:00:00

  • The effect of capsule composition in the reversal of hyperglycemia in diabetic mice transplanted with microencapsulated allogeneic islets.

    abstract::The transplantation of microencapsulated islets may allow reversal of hyperglycemia in the absence of immunosuppression. Poly-L-lysine (PLL) on capsules may potentiate the fibrotic reaction against implanted capsules. The aims of this study were to investigate how the biocompatibility of such capsules affects their fu...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: King A,Lau J,Nordin A,Sandler S,Andersson A

    更新日期:2003-01-01 00:00:00

  • Effect of vildagliptin on glucose and insulin concentrations during a 24-hour period in type 2 diabetes patients with different ranges of baseline hemoglobin A1c levels.

    abstract:BACKGROUND:Currently, it is still unknown whether differences in glycemic control have any effect on glucose and insulin kinetics after vildagliptin administration. The aim of this study was to evaluate the effect of vildagliptin on glucose and insulin concentrations during a 24-h period in type 2 diabetes patients wit...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,随机对照试验


    authors: González-Ortiz M,Sánchez-Peña MJ,González-Ortiz LJ,Robles-Cervantes JA,García-Ortega YE,Gómez-Gaitán EA,Pérez-Rubio KG,Martínez-Abundis E

    更新日期:2013-07-01 00:00:00

  • Personal glycation factors and calculated HbA1c for diabetes management: Real-world data from the DPV registry.

    abstract::Background Glycated hemoglobin A1c (HbA1c) is a key biomarker in the glycemic management of individuals with diabetes but the relationship with glucose levels can be variable. A recent kinetic model has described a calculated HbA1c (cHbA1c) that is individual-specific. Our aim was to validate the routine clinical use ...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Xu Y,Grimsmann JM,Karges B,Hofer SE,Danne T,Holl RW,Ajjan RA,Dunn TD

    更新日期:2021-01-04 00:00:00

  • Reviewing U.S. Connected Diabetes Care: The Newest Member of the Team.

    abstract::Recent years have brought about an explosion in the number of companies offering connected diabetes care products, defined as digital diabetes management systems based around (1) smartphone apps, (2) devices with built-in connectivity, and (3) remote human and automated coaching and support. These nascent models aim t...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,评审


    authors: Levine BJ,Close KL,Gabbay RA

    更新日期:2020-01-01 00:00:00

  • Perioperative Characteristics of the Accuracy of Subcutaneous Continuous Glucose Monitoring: Pilot Study in Neurosurgery and Cardiac Surgery.

    abstract:BACKGROUND:The aim of this study was to elucidate the characteristics of accuracy of subcutaneous continuous glucose monitoring (SCGM) in the perioperative period for neurosurgical and cardiac surgery patients. METHODS:Forty-five subjects, including healthy volunteers (n = 15), neurosurgical patients (n = 15), and car...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Sugiyama Y,Wakabayashi R,Urasawa M,Maruyama Y,Shimizu S,Kawamata M

    更新日期:2018-10-01 00:00:00

  • A comparison between simplified and intensive dose-titration algorithms using AIR inhaled insulin for insulin-naive patients with type 2 diabetes in a randomized noninferiority trial.

    abstract:BACKGROUND:Insulin initiation and optimization is a challenge for patients with type 2 diabetes. Our objective was to determine whether safety and efficacy of AIR inhaled insulin (Eli Lilly and Co., Indianapolis, IN) (AIR is a registered trademark of Alkermes, Inc., Cambridge, MA) using a simplified regimen was noninfe...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,随机对照试验


    authors: Mathieu C,Cuddihy R,Arakaki RF,Belin RM,Planquois JM,Lyons JN,Heilmann CR

    更新日期:2009-09-01 00:00:00

  • Time is glucose, can't miss gestational diabetes.

    abstract:BACKGROUND:Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes, if not treated. International guidelines recommend screening "all or high-risk women" at the initial prenatal visit, when a fasting plasma glucose (FPG) between 92 and 126 mg/dL is diagnostic for GDM. However, glucose testing ...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Festa R,Carta M,Ceriello A,Testa R

    更新日期:2012-05-01 00:00:00

  • Mitigating Reductions in Glucose During Exercise on Closed-Loop Insulin Delivery: The Ex-Snacks Study.

    abstract:OBJECTIVE:To assess whether snacking could be used with closed-loop (CL) insulin delivery to avoid exercise-induced reductions in plasma glucose (PG), as well as elevations in PG at the end of exercise. RESEARCH DESIGN AND METHODS:Twelve type 1 diabetes (T1D) subjects (age 13-36 years, duration 10.7 ± 8.4 years, A1c 7...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章,随机对照试验


    authors: Patel NS,Van Name MA,Cengiz E,Carria LR,Tichy EM,Weyman K,Weinzimer SA,Tamborlane WV,Sherr JL

    更新日期:2016-12-01 00:00:00

  • Metrics to Evaluate Quality of Glycemic Control: Comparison of Time in Target, Hypoglycemic, and Hyperglycemic Ranges with "Risk Indices".

    abstract:OBJECTIVE:We sought to cross validate several metrics for quality of glycemic control, hypoglycemia, and hyperglycemia. RESEARCH DESIGN AND METHODS:We analyzed the mathematical properties of several metrics for overall glycemic control, and for hypo- and hyperglycemia, to evaluate their similarities, differences, and ...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Rodbard D

    更新日期:2018-05-01 00:00:00

  • Effects of sleep apnea severity on glycemic control in patients with type 2 diabetes prior to continuous positive airway pressure treatment.

    abstract:BACKGROUND:Obstructive sleep apnea (OSA), a highly prevalent condition, is independently associated with increased risks of developing type 2 diabetes mellitus (T2D) and metabolic syndrome. It is unclear, however, if the severity of OSA has any impact on glycemic control among patients with T2D. We therefore aimed to d...

    journal_title:Diabetes technology & therapeutics

    pub_type: 杂志文章


    authors: Pillai A,Warren G,Gunathilake W,Idris I

    更新日期:2011-09-01 00:00:00

  • Clinical trial of a noninvasive contact lens glucose sensor.

    abstract:OBJECTIVE:The purpose of the present study was to determine the effectiveness of a fluorescent contact lens glucose sensor in monitoring glucose in patients with diabetes. METHODS:Under an institutional review board-approved protocol, five fasting patients with type II diabetes were given a challenge consisting of 75 ...

    journal_title:Diabetes technology & therapeutics

    pub_type: 临床试验,杂志文章


    authors: March WF,Mueller A,Herbrechtsmeier P

    更新日期:2004-12-01 00:00:00