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2014 ; 16
(11
): 728-34
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Inpatient trial of an artificial pancreas based on multiple model probabilistic
predictive control with repeated large unannounced meals
#MMPMID25259939
Cameron F
; Niemeyer G
; Wilson DM
; Bequette BW
; Benassi KS
; Clinton P
; Buckingham BA
Diabetes Technol Ther
2014[Nov]; 16
(11
): 728-34
PMID25259939
show ga
BACKGROUND: Closed-loop control of blood glucose levels in people with type 1
diabetes offers the potential to reduce the incidence of diabetes complications
and reduce the patients' burden, particularly if meals do not need to be
announced. We therefore tested a closed-loop algorithm that does not require meal
announcement. MATERIALS AND METHODS: A multiple model probabilistic predictive
controller (MMPPC) was assessed on four patients, revised to improve performance,
and then assessed on six additional patients. Each inpatient admission lasted for
32?h with five unannounced meals containing approximately 1?g/kg of carbohydrate
per admission. The system used an Abbott Diabetes Care (Alameda, CA) Navigator(®)
continuous glucose monitor (CGM) and Insulet (Bedford, MA) Omnipod(®) insulin
pump, with the MMPPC implemented through the artificial pancreas system platform.
The controller was initialized only with the patient's total daily dose and daily
basal pattern. RESULTS: On a 24-h basis, the first cohort had mean reference and
CGM readings of 179 and 167?mg/dL, respectively, with 53% and 62%, respectively,
of readings between 70 and 180?mg/dL and four treatments for glucose values
<70?mg/dL. The second cohort had mean reference and CGM readings of 161 and
142?mg/dL, respectively, with 63% and 78%, respectively, of the time spent
euglycemic. There was one controller-induced hypoglycemic episode. For the 30
unannounced meals in the second cohort, the mean reference and CGM premeal,
postmeal maximum, and 3-h postmeal values were 139 and 132, 223 and 208, and 168
and 156?mg/dL, respectively. CONCLUSIONS: The MMPPC, tested in-clinic against
repeated, large, unannounced meals, maintained reasonable glycemic control with a
mean blood glucose level that would equate to a mean glycated hemoglobin value of
7.2%, with only one controller-induced hypoglycemic event occurring in the second
cohort.
|*Meals
[MESH]
|*Pancreas, Artificial
[MESH]
|Adult
[MESH]
|Algorithms
[MESH]
|Blood Glucose Self-Monitoring
[MESH]
|Blood Glucose/*drug effects
[MESH]
|Cohort Studies
[MESH]
|Diabetes Mellitus, Type 1/blood/*drug therapy
[MESH]