scholarly journals Open Source Closed-Loop Insulin Delivery Systems: A Clash of Cultures or Merging of Diverse Approaches?

2018 ◽  
Vol 12 (6) ◽  
pp. 1223-1226 ◽  
Author(s):  
Katharine D. Barnard ◽  
Ralph Ziegler ◽  
David C. Klonoff ◽  
Katarina Braune ◽  
Bettina Petersen ◽  
...  
Keyword(s):  
Closed Loop ◽  
Therapeutic Option ◽  
Artificial Pancreas ◽  
Psychosocial Care ◽  
Insulin Delivery ◽  
Delivery Systems ◽  
Target Range ◽  
Related Quality ◽  
Do It Yourself ◽  
Glycemic Target

Biomedical outcomes for people with diabetes remain suboptimal for many. Psychosocial care in diabetes does not fare any better. “Artificial pancreas” (also known as “closed-loop” and “automated insulin delivery”) systems present a promising therapeutic option for people with diabetes (PWD)—simultaneously improving glycemic outcomes, reducing the burden of self-management, and improving health-related quality of life. In recent years there has emerged a growing movement of PWD innovators rallying behind the mantra #WeAreNotWaiting, developing “do-it-yourself artificial pancreas systems (DIY APS).” Self-reported results by DIY APS users show improved metabolic outcomes such as impressive stability of glucose profiles, significant reduction of A1c, and more time within their glycemic target range. However, the benefits remain unclear for the broader population of PWD beyond these highly engaged, highly tech-savvy users willing and able to engage in the demands of building and maintaining their DIY APS. We discuss the challenges faced by key stakeholder groups in terms of potential collaboration and open debate of these challenges.

scholarly journals The future of open- and closed-loop insulin delivery systems

2008 ◽  
Vol 60 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Terry G. Farmer ◽  
Thomas F. Edgar ◽  
Nicholas A. Peppas
Keyword(s):  
Closed Loop ◽  
Insulin Delivery ◽  
Delivery Systems ◽  
The Future

scholarly journals Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial Pancreas

Diabetes Care ◽  
2008 ◽  
Vol 31 (5) ◽  
pp. 934-939 ◽  
Author(s):  
S. A. Weinzimer ◽  
G. M. Steil ◽  
K. L. Swan ◽  
J. Dziura ◽  
N. Kurtz ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Pediatric Patients ◽  
Hybrid Control ◽  
Artificial Pancreas ◽  
Insulin Delivery

scholarly journals Improved Glycemic Outcomes With Medtronic MiniMed Advanced Hybrid Closed-Loop Delivery: Results From a Randomized Crossover Trial Comparing Automated Insulin Delivery With Predictive Low Glucose Suspend in People With Type 1 Diabetes

2021 ◽  
Author(s):  
Olivia J Collyns ◽  
Renee A Meier ◽  
Zara L Betts ◽  
Denis SH Chan ◽  
Chris Frampton ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Insulin Delivery ◽  
Target Range ◽  
Study Phase ◽  
Pump Therapy ◽  
Set Point ◽  
Sensor Glucose ◽  
Low Glucose

Objective:<br><p> To study the MiniMed™ Advanced Hybrid Closed-Loop system (AHCL) which includes an algorithm with individualised basal target set points, automated correction bolus function, and improved Auto Mode stability.<br> Research design and Methods:</p> <p>This dual-centre, randomized, open-label, two-sequence cross-over study in automated insulin delivery naïve participants with type 1 diabetes (aged 7-80yrs), compared AHCL to Sensor Augmented Pump therapy with Predictive Low Glucose Management (SAP+PLGM). Each study phase was 4 weeks, preceded by a 2-4 week run-in, and separated by 2-week washout.</p> <p><a>Results:<b> </b><br> 59/60 people completed the study (mean age 23.3±14.4yrs). Time in target range (TIR) 3.9-10mmol/L (70-180 mg/dL) favoured AHCL over SAP+PLGM (</a>70.4±8.1 vs 57.9±11.7) by 12.5±8.5% (p<0.001), with greater improvement overnight (18.8±12.9%, p<0.001). All age groups (children (7 – 13 years), adolescents (14 – 21 years), and adults (>22 years) demonstrated improvement, with adolescents showing the largest improvement (14.4±8.4%). Mean sensor glucose (SG) at run in was 9.3±0.9 mmol/L (167±16.2mg/dL) and improved with AHCL (8.5±0.7mmol/L (153±12.6mg/dL) (p < 0.001)), but deteriorated during PLGM (9.5±1.1mmol/L (17±19.8mg/dL), (p<0.001)).. TIR was optimal when the algorithm set point was 5.6 mmol/L (100 mg/dL) compared to 6.7 mmol/L (120 mg/dL), 72.0±7.9% vs 64.6±6.9% respectively with no additional hypoglycemia. Auto Mode was active 96.4±4.0% of the time. <a>The percentage of hypoglycemia at baseline (<3.9mmol/L (70mg/dl) and </a> £ 3.0mmol/L(54mg/dl)) was 3.1±2.1% and 0.5±0.6% respectively. During AHCL percentage time <3.9mmol/L (70mg/dl) improved to 2.1±1.4% (p=0.034) (70mg/dl), and was statistically but not clinically reduced for £ 3.0mmol/L(54mg/dl) (0.5±0.5%, p = 0.025) There was one episode of mild diabetic ketoacidosis attributed to an infusion set failure in combination with an intercurrent illness, which occurred during the SAP+PLGM arm.</p> <p>Conclusions</p> <p>AHCL with automated correction bolus demonstrated significant improvement in glucose control compared to SAP+PLGM. A lower algorithm sensor glucose set point during AHCL resulted in greater TIR, with no increase in hypoglycemia.</p>

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