Journal
DIABETES
Volume 61, Issue 9, Pages 2230-2237Publisher
AMER DIABETES ASSOC
DOI: 10.2337/db11-1445
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Funding
- Juvenile Diabetes Research Foundation, Artificial Pancreas Consortium
- Fondo per gli investimenti della ricerca di base (HIM) Artificial Pancreas: In Silico Development and In Vivo Validation of Algorithms for Blood Glucose Control
- Italian Ministry of Education, Universities, and Research
- National Institute of Diabetes and Digestive and Kidney Diseases [5-R21-DK-85641]
- Dexcom
- Lilly
- Insulet
- LifeScan Medtronic
- Novo Nordisk
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Integrated closed-loop control (CLC), combining continuous glucose monitoring (CGM) with insulin pump (continuous subcutaneous insulin infusion [CSII]), known as artificial pancreas, can help optimize glycemic control in diabetes. We present a fundamental modular concept for CLC design, illustrated by clinical studies involving 11 adolescents and 27 adults at the Universities of Virginia, Padova, and Montpellier. We tested two modular CLC constructs: standard control to range (sCTR), designed to augment pump plus CGM by preventing extreme glucose excursions; and enhanced control to range (eCTR), designed to truly optimize control within near normoglycemia of 3.9-10 trillion. The CLC system was fully integrated using automated data transfer CGM -> algorithm -> CSII All studies used randomized crossover design comparing CSII versus CLC during identical 22-h hospitalizations including meals, overnight rest, and 30-min exercise. sCTR increased significantly the time in near normoglycemia from 61 to 74%, simultaneously reducing hypoglycemia 2.7-fold. eCTR improved mean blood glucose from 7.73 to 6.68 nunol/L without increasing hypoglycemia, achieved 97% in near normoglycemia and 77% in tight glycemic control, and reduced variability overnight. In conclusion, sCTR and eCTR represent sequential steps toward automated CLC, preventing extremes (sCTR) and further optimizing control (eCTR). This approach inspires compelling new concepts: modular assembly, sequential deployment, testing, and clinical acceptance of custom-built CLC systems tailored to individual patient needs. Diabetes 61:2230-2237, 2012
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