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Dassau E, Brown SA, Basu A, Pinsker JE, Kudva YC, Gondhalekar R, Patek S, Lv D, Schiavon M, Lee JB, Dalla Man C, Hinshaw L, Castorino K, Mallad A, Dadlani V, McCrady-Spitzer SK, McElwee-Malloy M, Wakeman CA, Bevier WC, Bradley PK, Kovatchev B, Cobelli C, Zisser HC, Doyle FJ. Adjustment of Open-Loop Settings to Improve Closed-Loop Results in Type 1 Diabetes: A Multicenter Randomized Trial. J Clin Endocrinol Metab 2015; 100. [PMID: 26204135 PMCID: PMC4596045 DOI: 10.1210/jc.2015-2081] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CONTEXT Closed-loop control (CLC) relies on an individual's open-loop insulin pump settings to initialize the system. Optimizing open-loop settings before using CLC usually requires significant time and effort. OBJECTIVE The objective was to investigate the effects of a one-time algorithmic adjustment of basal rate and insulin to carbohydrate ratio open-loop settings on the performance of CLC. DESIGN This study reports a multicenter, outpatient, randomized, crossover clinical trial. PATIENTS Thirty-seven adults with type 1 diabetes were enrolled at three clinical sites. INTERVENTIONS Each subject's insulin pump settings were subject to a one-time algorithmic adjustment based on 1 week of open-loop (i.e., home care) data collection. Subjects then underwent two 27-hour periods of CLC in random order with either unchanged (control) or algorithmic adjusted basal rate and carbohydrate ratio settings (adjusted) used to initialize the zone-model predictive control artificial pancreas controller. Subject's followed their usual meal-plan and had an unannounced exercise session. MAIN OUTCOMES AND MEASURES Time in the glucose range was 80-140 mg/dL, compared between both arms. RESULTS Thirty-two subjects completed the protocol. Median time in CLC was 25.3 hours. The median time in the 80-140 mg/dl range was similar in both groups (39.7% control, 44.2% adjusted). Subjects in both arms of CLC showed minimal time spent less than 70 mg/dl (median 1.34% and 1.37%, respectively). There were no significant differences more than 140 mg/dL. CONCLUSIONS A one-time algorithmic adjustment of open-loop settings did not alter glucose control in a relatively short duration outpatient closed-loop study. The CLC system proved very robust and adaptable, with minimal (<2%) time spent in the hypoglycemic range in either arm.
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Affiliation(s)
- Eyal Dassau
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Sue A Brown
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Ananda Basu
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Jordan E Pinsker
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Yogish C Kudva
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Ravi Gondhalekar
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Steve Patek
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Dayu Lv
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Michele Schiavon
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Joon Bok Lee
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Chiara Dalla Man
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Ling Hinshaw
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Kristin Castorino
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Ashwini Mallad
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Vikash Dadlani
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Shelly K McCrady-Spitzer
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Molly McElwee-Malloy
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Christian A Wakeman
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Wendy C Bevier
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Paige K Bradley
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Boris Kovatchev
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Claudio Cobelli
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Howard C Zisser
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
| | - Francis J Doyle
- Department of Chemical Engineering (E.D., R.G., J.B.L., H.C.Z., F.J.D.), University of California Santa Barbara, Santa Barbara, CA 93106; William Sansum Diabetes Center (E.D., J.E.P., R.G., J.B.L., K.C., W.C.B., P.K.B., H.C.Z., F.J.D.), Santa Barbara, CA 93105; Center for Diabetes Technology (S.A.B., S.P., D.L., M.M.-M., C.A.W., B.K.), University of Virginia, Charlottesville, VA 22904; Endocrine Research Unit (A.B., Y.C.K., L.H., A.M., V.D., S.K.M.-S.), Mayo Clinic, Rochester, MN 55905; and Department of Information Engineering (M.S., D.M., C.C.), University of Padova, 35131 Padua, Italy
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