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Advanced Closed-Loop Control System Improves Postprandial Glycemic Control Compared With a Hybrid Closed-Loop System
Jose Garcia-Tirado1, Jenny L Diaz1, Rebeca Esquivel-Zuniga2
1Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
Diabetes Care
|August 17, 2021
Summary
A new automated closed-loop control system significantly improved glycemic control in adolescents with type 1 diabetes, even without meal announcements. This innovative system enhances time-in-range and reduces high blood glucose levels safely.
Area of Science:
- Endocrinology
- Biomedical Engineering
- Diabetes Technology
Background:
- Meals present a significant challenge for maintaining glycemic control in individuals with type 1 diabetes (T1D).
- Adolescents with T1D frequently omit carbohydrate intake announcements, complicating automated diabetes management.
- Closed-loop control (CLC) systems aim to automate insulin delivery for improved glucose regulation.
Purpose of the Study:
- To evaluate the efficacy and safety of a novel fully automated CLC system (RocketAP) in adolescents with T1D.
- To compare the performance of RocketAP against a legacy hybrid CLC system (USS-Virginia) during both announced and unannounced meals.
- To assess the system's impact on glycemic control metrics, particularly in the absence of meal carbohydrate information.
Main Methods:
- A randomized crossover clinical trial involving 18 adolescents with T1D.
- Participants underwent two 46-hour supervised admissions, each featuring one announced and one unannounced dinner.
- Comparison between the RocketAP system and the USS-Virginia system, with primary outcome as time-in-range (TIR) after unannounced meals.
Main Results:
- RocketAP significantly increased TIR (83% vs. 53%) and time-in-tight-range (TTR) (49% vs. 27%) following unannounced meals compared to USS-Virginia.
- RocketAP led to a substantial reduction in time-above-range (TAR >180 mg/dL) without increasing time-below-range (TBR <70 mg/dL).
- Improvements in TIR, TTR, and TAR were also observed with RocketAP during announced meals, overall, and overnight, with reduced overall insulin delivery.
Conclusions:
- The novel fully automated CLC system (RocketAP) is safe and feasible for adolescents with T1D.
- RocketAP demonstrated superior glycemic control compared to the legacy USS-Virginia system, particularly when meal announcements were omitted.
- This technology holds promise for simplifying diabetes management and improving outcomes in T1D.
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