Day and Night Home Closed-Loop Insulin Delivery in Adults With Type 1 Diabetes: Three-Center Randomized Crossover Study

Leelarathna, Lalantha; Dellweg, Sibylle; Mader, Julia K.; Allen, Janet M.; Benesch, Carsten; Doll, Werner; Ellmerer, Martin; Hartnell, Sara; Heinemann, Lutz; Kojzar, Harald; Michalewski, Lucy; Nodale, Marianna; Thabit, Hood; Wilinska, Malgorzata E.; Pieber, Thomas R.; Arnolds, Sabine; Evans, Mark L.; Hovorka, Roman
July 2014
Diabetes Care;Jul2014, Vol. 37 Issue 7, p1931
Academic Journal
OBJECTIVE To evaluate the feasibility of day and night closed-loop insulin delivery in adults with type 1 diabetes under free-living conditions. RESEARCH DESIGN AND METHODS Seventeen adults with type 1 diabetes on insulin pump therapy (means ± SD age 34 ± 9 years, HbA1c 7.6 ± 0.8%, and duration of diabetes 19 ± 9 years) participated in an open-label multinational three-center crossover study. In a random order, participants underwent two 8-day periods (first day at the clinical research facility followed by 7 days at home) of sensor-augmented insulin pump therapy (SAP) or automated closed-loop insulin delivery. The primary end point was the time when sensor glucose was in target range between 3.9 and 10.0 mmol/L during the 7-day home phase. RESULTS During the home phase, the percentage of time when glucose was in target range was significantly higher during closed-loop compared with SAP (median 75% [interquartile range 61-79] vs. 62% [53-70], P = 0.005). Mean glucose (8.1 vs. 8.8 mmol/L, P = 0.027) and time spent above target (P = 0.013) were lower during closed loop, while time spent below target was comparable (P = 0.339). Increased time in target was observed during both daytime (P = 0.017) and nighttime (P = 0.013). CONCLUSIONS Compared with SAP, 1 week of closed-loop insulin delivery at home reduces mean glucose and increases time in target without increasing the risk of hypoglycemia in adults with relatively well-controlled type 1 diabetes.


Related Articles

  • Continuous Glucose Monitoring-Guided Insulin Adjustment in Children and Adolescents on Near-Physiological Insulin Regimens. Yates, Kylie; Milton, Abul Hasnat; Dear, Keith; Ambler, Geoffrey // Diabetes Care;Jul2006, Vol. 29 Issue 7, p1512 

    OBJECTIVE-- This randomized controlled trial assesses the effect on glycemic control of continuous glucose monitoring system (CGMS)-guided insulin therapy adjustment in young people with type 1 diabetes on intensive diabetes treatment regimens with continuous subcutaneous insulin infusion (CSII)...

  • Safety of Nighttime 2-Hour Suspension of Basal Insulin in Pump-Treated Type 1 Diabetes Even in the Absence of Low Glucose. Sherr, Jennifer L.; Collazo, Miladys Palau; Cengiz, Eda; Michaud, Camille; Carria, Lori; Steffen, Amy T.; Weyman, Kate; Zgorski, Melinda; Tichy, Eileen; Tamborlane, William V.; Weinzimer, Stuart A. // Diabetes Care;Mar2013, Vol. 37 Issue 3, p773 

    OBJECTIVE An integrated sensor-augmented pump system has been introduced that interrupts basal insulin infusion for 2 h if patients fail to respond to low-glucose alarms. It has been suggested that such interruptions of basal insulin due to falsely low glucose levels detected by sensor could...

  • Continuous Subcutaneous Insulin Infusion.  // Diabetes Care;Jan2000 Supplement 1, Vol. 23, pS90 

    Presents information on the effectiveness of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injection therapy in implementing intensive diabetes management. How CSII therapy should be provided; Factors to be considered in choosing an insulin pump; Safety of CSII and...

  • Predictive Hyperglycemia and Hypoglycemia Minimization: In-Home Evaluation of Safety, Feasibility, and Efficacy in Overnight Glucose Control in Type 1 Diabetes. Spaic, Tamara; Driscoll, Marsha; Raghinaru, Dan; Buckingham, Bruce A.; Wilson, Darrell M.; Clinton, Paula; Chase, H. Peter; Maahs, David M.; Forlenza, Gregory P.; Jost, Emily; Hramiak, Irene; Paul, Terri; Bequette, B. Wayne; Cameron, Faye; Beck, Roy W.; Kollman, Craig; Lum, John W.; Ly, Trang T.; In-Home Closed-Loop (IHCL) Study Group // Diabetes Care;Mar2017, Vol. 40 Issue 3, p359 

    Objective: The objective of this study was to determine the safety, feasibility, and efficacy of a predictive hyperglycemia and hypoglycemia minimization (PHHM) system compared with predictive low-glucose insulin suspension (PLGS) alone in overnight glucose control.Research...

  • Continuous Subcutaneous Insulin Infusion.  // Diabetes Care;Jan2003 Supplement, Vol. 26, pS125 

    Presents the 2003 position statement of the American Diabetes Association on continuous subcutaneous insulin infusion. Provider aspects; Patient selection; Insulin pumps; Safety.

  • Efficacy and Safety of Sitagliptin Added to Insulin in Japanese Patients with Type 2 Diabetes: The EDIT Randomized Trial. Sato, Seiji; Saisho, Yoshifumi; Kou, Kinsei; Meguro, Shu; Tanaka, Masami; Irie, Junichiro; Kawai, Toshihide; Itoh, Hiroshi // PLoS ONE;Mar2015, Vol. 10 Issue 3, p1 

    Aims: To clarify the efficacy and safety of adding sitagliptin to insulin therapy in Japanese patients with suboptimally controlled type 2 diabetes (T2DM). Study Design and Methods: This was a 24-week, prospective, randomized, open-labeled, controlled trial. Patients with T2DM who were...

  • Rapid-Acting Insulin Analogues in Basal-Bolus Regimens in Type 1 Diabetes Mellitus. Satish Garg; Francisco Ampudia-Blasco; Martin Pfohl // Endocrine Practice;May2010, Vol. 16 Issue 3, p486 

    Objective: To compare rapid-acting insulin analogues with regular human insulin in terms of hemoglobin A1c, hypoglycemia, and insulin dose when used in a basal-bolus regimen in patients with type 1 diabetes mellitus.Methods: MEDLINE and congress proceedings were searched for randomized...

  • Daily insulin dose and incidence of hypoglycemia in children with type 1 Diabetes using insulin pump therapy. Hasanbegovic, S.; Hasanbegovic, E. // HealthMed;Jun2009, Vol. 3 Issue 2, p142 

    In retrospective study we followed all TYPE 1 Diabetes mellitus (T1DM) patients with insulin pump (IP) therapy started in the period from the 1st March 2005 to the 1st September 2008. We analyzed: age and sex structure of the observed patients; their therapy before IP use; total daily insulin...

  • Safety of Outpatient Closed-Loop Control: First Randomized Crossover Trials of a Wearable Artificial Pancreas. Kovatchev, Boris P.; Renard, Eric; Cobelli, Claudio; Zisser, Howard C.; Keith-Hynes, Patrick; Anderson, Stacey M.; Brown, Sue A.; Chernavvsky, Daniel R.; Breton, Marc D.; Mize, Lloyd B.; Farret, Anne; Place, Jérôme; Bruttomesso, Daniela; Favero, Simone Del; Boscari, Federico; Galasso, Silvia; Avogaro, Angelo; Magni, Lalo; Di Palma, Federico; Toffanin, Chiara // Diabetes Care;Jul2014, Vol. 37 Issue 7, p1789 

    OBJECTIVE We estimate the effect size of hypoglycemia risk reduction on closed-loop control (CLC) versus open-loop (OL) sensor-augmented insulin pump therapy in supervised outpatient setting. RESEARCH DESIGN AND METHODS Twenty patients with type 1 diabetes initiated the study at the Universities...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics