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Multinight "bedside" closed-loop control for patients with type 1 diabetes.

Sue A Brown1, Boris P Kovatchev, Marc D Breton

  • 11 Center for Diabetes Technology, University of Virginia , Charlottesville, Virginia.

Diabetes Technology & Therapeutics
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Summary

Closed-loop control (CLC) systems significantly improved overnight glucose levels in type 1 diabetes patients, resetting them to near-normal levels each morning. This artificial pancreas approach enhanced time in target glucose range and improved subsequent daytime glucose control.

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Area of Science:

  • Endocrinology
  • Biomedical Engineering
  • Diabetes Technology

Background:

  • Closed-loop control (CLC) systems show promise in managing glucose levels for individuals with type 1 diabetes.
  • A novel CLC strategy aims to achieve near-normoglycemia each morning through overnight glucose regulation.

Purpose of the Study:

  • To evaluate a new CLC system designed to reset overnight glucose levels to near-normoglycemia.
  • To compare the efficacy of multi-night CLC with sensor-augmented insulin pump therapy in type 1 diabetes patients.

Main Methods:

  • A randomized crossover trial involving ten insulin pump users with type 1 diabetes.
  • Comparison of 5 consecutive nights of CLC versus sensor-augmented pump therapy in an outpatient setting.
  • Primary endpoints included overnight time in the 80-140 mg/dL glucose range and fasting blood glucose at 7:00 h.

Main Results:

  • CLC significantly increased time in the 80-140 mg/dL range (54.5% vs. 32.2%) and 70-180 mg/dL range (85.4% vs. 59.1%) compared to sensor-augmented therapy.
  • CLC reduced mean overnight glucose (139.0 vs. 170.3 mg/dL) and mean 7:00 h glucose (119.3 vs. 152.9 mg/dL).
  • Tighter overnight glucose control with CLC correlated with improved daytime glucose control (r=0.52, P<0.01).

Conclusions:

  • Multi-night CLC of insulin delivery, functioning as an artificial pancreas, significantly improves overnight and morning glucose control.
  • This CLC approach enhances time in target glucose range and demonstrates potential for improving daytime glucose management.
  • Resetting glucose levels to near-normoglycemia overnight offers a promising strategy for type 1 diabetes management.