Fully Automated Artificial Pancreas for Adults With Type 1 Diabetes Using Multiple Hormones: Exploratory Experiments
| Autor: | Jennifer René, Jean-François Yale, Natasha Garfield, Dorsa Majdpour, Anas El Fathi, Michael A. Tsoukas, Joanna Rutkowski, Laurent Legault, Ahmad Haidar |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Blood Glucose Pancreas Artificial Endocrinology Diabetes and Metabolism medicine.medical_treatment 030209 endocrinology & metabolism Glucagon Artificial pancreas 03 medical and health sciences chemistry.chemical_compound Carbohydrate counting Young Adult 0302 clinical medicine Endocrinology Insulin Infusion Systems Internal Medicine medicine Humans Hypoglycemic Agents Insulin 030212 general & internal medicine Glycemic Type 1 diabetes Cross-Over Studies business.industry General Medicine Middle Aged medicine.disease Pramlintide Diabetes Mellitus Type 1 chemistry Anesthesia Glycated hemoglobin business medicine.drug |
| Zdroj: | Canadian journal of diabetes. 45(8) |
| ISSN: | 2352-3840 |
| Popis: | Objectives A fully automated insulin-pramlintide-glucagon artificial pancreas that alleviates the burden of carbohydrate counting without degrading glycemic control was iteratively enhanced until convergence through pilot experiments on adults with type 1 diabetes. Methods Nine participants (age, 37±13 years; glycated hemoglobin, 7.7±0.7%) completed two 27-hour interventions: a fully automated multihormone artificial pancreas and a comparator insulin-alone artificial pancreas with carbohydrate counting. The baseline algorithm was a model-predictive controller that administered insulin and pramlintide in a fixed ratio, with boluses triggered by a glucose threshold, and administered glucagon in response to low glucose levels. Results The baseline multihormone dosing algorithm resulted in noninferior time in target range (3.9 to 10.0 mmol/L) (71%) compared with the insulin-alone arm (70%) in 2 participants, with minimal glucagon delivery. The algorithm was modified to deliver insulin and pramlintide more aggressively to increase time in range and maximize the benefits of glucagon. The modified algorithm displayed a similar time in range for the multihormone arm (79%) compared with the insulin-alone arm (83%) in 2 participants, but with undesired glycemic fluctuations. Subsequently, we reduced the glucose threshold that triggers glucagon boluses. This resulted in inferior glycemic control for the multihormone arm (81% vs 91%) in 2 participants. Thereafter, a model-based meal-detection algorithm to deliver insulin and pramlintide boluses closer to mealtimes was added and glucagon was removed. The final dual-hormone system had comparable time in range (81% vs 83%) in the last 3 participants. Conclusion The final version of the fully automated system that delivered insulin and pramlintide warrants a randomized controlled trial. |
| Databáze: | OpenAIRE |
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