Journal
DIABETES TECHNOLOGY & THERAPEUTICS
Volume 11, Issue 2, Pages 93-97Publisher
MARY ANN LIEBERT INC
DOI: 10.1089/dia.2008.0032
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Funding
- National Center for Research Resources, National Institutes of Health [M01 RR-00070, RR000051, 5 M01 RR00069]
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Background: Nocturnal hypoglycemia is a significant problem. From 50% to 75% of hypoglycemia seizures occur at night. Despite the development of real-time glucose sensors (real-time continuous glucose monitor [CGM]) with hypoglycemic alarms, many patients sleep through these alarms. The goal of this pilot study was to assess the feasibility using a real-time CGM to discontinue insulin pump therapy when hypoglycemia was predicted. Methods: Twenty-two subjects with type 1 diabetes had two daytime admissions to a clinical research center. On the first admission their basal insulin was increased until their blood glucose level was <60 mg/dL. On the second admission hypoglycemic prediction algorithms were tested to determine if hypoglycemia was prevented by a 90-min pump shutoff and to determine if the pump shutoff resulted in rebound hyperglycemia. Results: Using a statistical prediction algorithm with an 80 mg/dL threshold and a 30-min projection horizon, hypoglycemia was prevented 60% of the time. Using a linear prediction algorithm with an 80 mg/dL threshold and a 45-min prediction horizon, hypoglycemia was prevented 80% of the time. There was no rebound hyperglycemia following pump suspension. Conclusions: Further development of algorithms is needed to prevent all episodes of hypoglycemia from occurring.
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