Abstract:
:Integrated closed-loop control (CLC), combining continuous glucose monitoring (CGM) with insulin pump (continuous subcutaneous insulin infusion [CSII]), known as artificial pancreas, can help optimize glycemic control in diabetes. We present a fundamental modular concept for CLC design, illustrated by clinical studies involving 11 adolescents and 27 adults at the Universities of Virginia, Padova, and Montpellier. We tested two modular CLC constructs: standard control to range (sCTR), designed to augment pump plus CGM by preventing extreme glucose excursions; and enhanced control to range (eCTR), designed to truly optimize control within near normoglycemia of 3.9-10 mmol/L. The CLC system was fully integrated using automated data transfer CGM→algorithm→CSII. All studies used randomized crossover design comparing CSII versus CLC during identical 22-h hospitalizations including meals, overnight rest, and 30-min exercise. sCTR increased significantly the time in near normoglycemia from 61 to 74%, simultaneously reducing hypoglycemia 2.7-fold. eCTR improved mean blood glucose from 7.73 to 6.68 mmol/L without increasing hypoglycemia, achieved 97% in near normoglycemia and 77% in tight glycemic control, and reduced variability overnight. In conclusion, sCTR and eCTR represent sequential steps toward automated CLC, preventing extremes (sCTR) and further optimizing control (eCTR). This approach inspires compelling new concepts: modular assembly, sequential deployment, testing, and clinical acceptance of custom-built CLC systems tailored to individual patient needs.
journal_name
Diabetesjournal_title
Diabetesauthors
Breton M,Farret A,Bruttomesso D,Anderson S,Magni L,Patek S,Dalla Man C,Place J,Demartini S,Del Favero S,Toffanin C,Hughes-Karvetski C,Dassau E,Zisser H,Doyle FJ 3rd,De Nicolao G,Avogaro A,Cobelli C,Renard E,Kovatchedoi
10.2337/db11-1445subject
Has Abstractpub_date
2012-09-01 00:00:00pages
2230-7issue
9eissn
0012-1797issn
1939-327Xpii
db11-1445journal_volume
61pub_type
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