PMID- 20144414
OWN - NLM
STAT- MEDLINE
DCOM- 20100602
LR  - 20221207
IS  - 1932-2968 (Electronic)
IS  - 1932-2968 (Linking)
VI  - 3
IP  - 5
DP  - 2009 Sep 1
TI  - Closed-loop artificial pancreas using subcutaneous glucose sensing and insulin 
      delivery and a model predictive control algorithm: preliminary studies in Padova 
      and Montpellier.
PG  - 1014-21
AB  - New effort has been made to develop closed-loop glucose control, using 
      subcutaneous (SC) glucose sensing and continuous subcutaneous insulin infusion 
      (CSII) from a pump, and a control algorithm. An approach based on a model 
      predictive control (MPC) algorithm has been utilized during closed-loop control 
      in type 1 diabetes patients. Here we describe the preliminary clinical experience 
      with this approach. Six type 1 diabetes patients (three in each of two clinical 
      investigation centers in Padova and Montpellier), using CSII, aged 36 +/- 8 and 
      48 +/- 6 years, duration of diabetes 12 +/- 8 and 29 +/- 4 years, hemoglobin A1c 
      7.4% +/- 0.1% and 7.3% +/- 0.3%, body mass index 23.2 +/- 0.3 and 28.4 +/- 2.2 
      kg/m(2), respectively, were studied on two occasions during 22 h overnight 
      hospital admissions 2-4 weeks apart. A Freestyle Navigator(R) continuous glucose 
      monitor and an OmniPod insulin pump were applied in each trial. Admission 1 used 
      open-loop control, while admission 2 employed closed-loop control using our MPC 
      algorithm. In Padova, two out of three subjects showed better performance with 
      the closed-loop system compared to open loop. Altogether, mean overnight plasma 
      glucose (PG) levels were 134 versus 111 mg/dl during open loop versus closed 
      loop, respectively. The percentage of time spent at PG > 140 mg/dl was 45% versus 
      12%, while postbreakfast mean PG was 165 versus 156 mg/dl during open loop versus 
      closed loop, respectively. Also, in Montpellier, two patients out of three showed 
      a better glucose control during closed-loop trials. Avoidance of nocturnal 
      hypoglycemic excursions was a clear benefit during algorithm-guided insulin 
      delivery in all cases. This preliminary set of studies demonstrates that 
      closed-loop control based entirely on SC glucose sensing and insulin delivery is 
      feasible and can be applied to improve glucose control in patients with type 1 
      diabetes, although the algorithm needs to be further improved to achieve better 
      glycemic control.
CI  - 2009 Diabetes Technology Society.
FAU - Bruttomesso, Daniela
AU  - Bruttomesso D
AD  - Department of Clinical and Experimental Medicine, Division of Metabolic Diseases, 
      University of Padova, Padova, Italy.
FAU - Farret, Anne
AU  - Farret A
FAU - Costa, Silvana
AU  - Costa S
FAU - Marescotti, Maria Cristina
AU  - Marescotti MC
FAU - Vettore, Monica
AU  - Vettore M
FAU - Avogaro, Angelo
AU  - Avogaro A
FAU - Tiengo, Antonio
AU  - Tiengo A
FAU - Dalla Man, Chiara
AU  - Dalla Man C
FAU - Place, Jerome
AU  - Place J
FAU - Facchinetti, Andrea
AU  - Facchinetti A
FAU - Guerra, Stefania
AU  - Guerra S
FAU - Magni, Lalo
AU  - Magni L
FAU - De Nicolao, Giuseppe
AU  - De Nicolao G
FAU - Cobelli, Claudio
AU  - Cobelli C
FAU - Renard, Eric
AU  - Renard E
FAU - Maran, Alberto
AU  - Maran A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20090901
PL  - United States
TA  - J Diabetes Sci Technol
JT  - Journal of diabetes science and technology
JID - 101306166
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Adult
MH  - *Algorithms
MH  - Blood Glucose/*drug effects
MH  - *Blood Glucose Self-Monitoring/instrumentation
MH  - Diabetes Mellitus, Type 1/blood/diagnosis/*drug therapy
MH  - Diagnostic Equipment
MH  - Feasibility Studies
MH  - Female
MH  - France
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemia/chemically induced/prevention & control
MH  - Hypoglycemic Agents/*administration & dosage/adverse effects
MH  - Infusion Pumps, Implantable
MH  - Infusions, Subcutaneous
MH  - Insulin/*administration & dosage/adverse effects
MH  - *Insulin Infusion Systems
MH  - Italy
MH  - Male
MH  - Middle Aged
MH  - Models, Biological
MH  - *Pancreas, Artificial
MH  - Pilot Projects
MH  - Predictive Value of Tests
MH  - Time Factors
PMC - PMC2769890
EDAT- 2010/02/11 06:00
MHDA- 2010/06/03 06:00
PMCR- 2010/09/01
CRDT- 2010/02/11 06:00
PHST- 2010/02/11 06:00 [entrez]
PHST- 2010/02/11 06:00 [pubmed]
PHST- 2010/06/03 06:00 [medline]
PHST- 2010/09/01 00:00 [pmc-release]
AID - dst.3.5.1014 [pii]
AID - 10.1177/193229680900300504 [doi]
PST - epublish
SO  - J Diabetes Sci Technol. 2009 Sep 1;3(5):1014-21. doi: 10.1177/193229680900300504.