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Open and closed-loop control systems01:17

Open and closed-loop control systems

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Control systems are foundational elements in automation and engineering. They are broadly categorized into open-loop and closed-loop systems. These classifications hinge on the presence or absence of feedback mechanisms, significantly influencing the system's performance, complexity, and application.
An open-loop control system operates without feedback from the output. It consists of two primary elements: the controller and the controlled process. The controller receives an input signal...
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Unannounced Meal Challenges Using an Advanced Hybrid Closed-Loop System.

Roy Shalit1, Noga Minsky1, Maya Laron-Hirsh1

  • 1Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel.

Diabetes Technology & Therapeutics
|June 19, 2023
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Summary
This summary is machine-generated.

Meal announcement improves advanced hybrid closed-loop (AHCL) system performance in type 1 diabetes management. While unannounced meals up to 80g carbs are safe, they lead to suboptimal glycemic control, unlike small unannounced meals (≤20g).

Keywords:
Automated insulin deliveryClosed-loop artificial pancreasMeal announcementPostprandial glycemia

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Biomedical Engineering

Background:

  • Advanced hybrid closed-loop (AHCL) systems automate insulin delivery but often require meal announcements for optimal glycemic control.
  • The MiniMed™ 780G system is an AHCL algorithm designed to improve time in range (TIR) for individuals with type 1 diabetes (T1D).

Purpose of the Study:

  • To compare the glycemic control efficacy and safety of the MiniMed™ 780G AHCL system with and without meal announcements in adults with T1D.
  • To evaluate the impact of unannounced carbohydrate intake on TIR and glycemic variability.

Main Methods:

  • A single-arm study involving 14 adults with T1D was conducted.
  • Participants underwent a supervised 5-day period, followed by a 90-day at-home unannounced meal phase (≤80g carbohydrates), and a subsequent 90-day at-home announced meal phase.
  • Continuous glucose monitoring data was analyzed for TIR, hyperglycemia, and hypoglycemia metrics.

Main Results:

  • Time in range (TIR 70-180 mg/dL) was significantly lower in the unannounced phase (67.5%) compared to the announced phase (77.7%) (P<0.01).
  • Unannounced meals resulted in increased time spent in hyperglycemia (>180 mg/dL) and decreased time in hypoglycemia (<70 mg/dL).
  • Not announcing meals up to 60g carbohydrates did not increase extreme hyperglycemia (>250 mg/dL), and unannounced meals ≤20g did not significantly alter TIR.

Conclusions:

  • The AHCL system achieves optimal glycemic control when meals are announced.
  • While safe, not announcing meals ≤80g carbohydrates leads to suboptimal postprandial glycemic control, particularly with higher carbohydrate loads.
  • Announcing small meals (≤20g carbohydrates) does not negatively impact glycemic control, suggesting a threshold for effective AHCL function without announcement.