Fully integrated artificial pancreas in type 1 diabetes: modular closed-loop glucose control maintains near normoglycemia.

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

Diabetes

journal_title

Diabetes

authors

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,Kovatche

doi

10.2337/db11-1445

subject

Has Abstract

pub_date

2012-09-01 00:00:00

pages

2230-7

issue

9

eissn

0012-1797

issn

1939-327X

pii

db11-1445

journal_volume

61

pub_type

杂志文章,多中心研究,随机对照试验

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