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Forlenza GP, DeSalvo DJ, Aleppo G, Wilmot EG, Berget C, Huyett LM, Hadjiyianni I, Méndez JJ, Conroy LR, Ly TT, Sherr JL. Real-World Evidence of Omnipod ® 5 Automated Insulin Delivery System Use in 69,902 People with Type 1 Diabetes. Diabetes Technol Ther 2024. [PMID: 38375861 DOI: 10.1089/dia.2023.0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background: The Omnipod® 5 Automated Insulin Delivery System was associated with favorable glycemic outcomes for people with type 1 diabetes (T1D) in two pivotal clinical trials. Real-world evidence is needed to explore effectiveness in nonstudy conditions. Methods: A retrospective analysis of the United States Omnipod 5 System users (aged ≥2 years) with T1D and sufficient data (≥90 days of data; ≥75% of days with ≥220 continuous glucose monitor readings/day) available in Insulet Corporation's device and person-reported datasets as of July 2023 was performed. Target glucose setting usage (i.e., 110-150 mg/dL in 10 mg/dL increments) was summarized and glycemic outcomes were examined. Subgroup analyses of those using the lowest average glucose target (110 mg/dL) and stratification by baseline characteristics (e.g., age, prior therapy, health insurance coverage) were conducted. Results: In total, 69,902 users were included. Multiple and higher glucose targets were more commonly used in younger age groups. Median percentage of time in range (TIR; 70-180 mg/dL) was 68.8%, 61.3%, and 53.6% for users with average glucose targets of 110, 120, and 130-150 mg/dL, respectively, with minimal time <70 mg/dL (all median <1.13%). Among those with an average glucose target of 110 mg/dL (n = 37,640), median TIR was 65.0% in children and adolescents (2-17 years) and 69.9% in adults (≥18 years). Subgroup analyses of users transitioning from Omnipod DASH or multiple daily injections and of Medicaid/Medicare users demonstrated favorable glycemic outcomes among these groups. Conclusion: These glycemic outcomes from a large and diverse sample of nearly 70,000 children and adults demonstrate effective use of the Omnipod 5 System under real-world conditions.
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Affiliation(s)
- Gregory P Forlenza
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel J DeSalvo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emma G Wilmot
- Translational Medical Sciences, University of Nottingham, School of Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Cari Berget
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | | | - Trang T Ly
- Insulet Corporation, Acton, Massachusetts, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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Davis GM, Peters AL, Bode BW, Carlson AL, Dumais B, Vienneau TE, Huyett LM, Ly TT. Safety and Efficacy of the Omnipod 5 Automated Insulin Delivery System in Adults With Type 2 Diabetes: From Injections to Hybrid Closed-Loop Therapy. Diabetes Care 2023; 46:742-750. [PMID: 36787903 PMCID: PMC10090930 DOI: 10.2337/dc22-1915] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Automated insulin delivery (AID) has rarely been studied in adults with type 2 diabetes. We tested the feasibility of using AID for type 2 diabetes with the Omnipod 5 System in a multicenter outpatient trial. RESEARCH DESIGN AND METHODS Participants previously were using either basal-only or basal-bolus insulin injections, with or without the use of a continuous glucose monitor (CGM), and had a baseline HbA1c ≥8% (≥64 mmol/mol). Participants completed 2 weeks of CGM sensor data collection (blinded for those not previously using CGM) with their standard therapy (ST), then transitioned to 8 weeks of AID. Participants who previously used basal-only injections used the AID system in manual mode for 2 weeks before starting AID. Antihyperglycemic agents were continued at clinician discretion. Primary safety outcomes were percentage of time with sensor glucose ≥250 mg/dL and <54 mg/dL during AID. Additional outcomes included HbA1c and time in target range (TIR) (70-180 mg/dL). RESULTS Participants (N = 24) had a mean (± SD) age of 61 ± 8 years, baseline HbA1c of 9.4% ± 0.9% (79 ± 10 mmol/mol), and diabetes duration of 19 ± 9 years. Percentage of time with sensor glucose ≥250 mg/dL decreased with AID by 16.9% ± 16.2% (P < 0.0001), whereas percentage of time at <54 mg/dL remained low during both ST and AID (median [interquartile range] 0.0% [0.00%, 0.06%] vs. 0.00% [0.00%, 0.03%]; P = 0.4543). HbA1c (± SD) decreased by 1.3% ± 0.7% (14 ± 8 mmol/mol; P < 0.0001) and TIR increased by 21.9% ± 15.2% (P < 0.0001) without a significant change in total daily insulin or BMI with AID. CONCLUSIONS Findings from this feasibility trial of AID in adults with type 2 diabetes with suboptimal glycemic outcomes justify further evaluation of this technology in this population.
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Affiliation(s)
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Anders L Carlson
- International Diabetes Center, Park Nicollet, HealthPartners, Minneapolis, MN
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Aleppo G, DeSalvo DJ, Lauand F, Huyett LM, Chang A, Vienneau T, Ly TT. Improvements in Glycemic Outcomes in 4738 Children, Adolescents, and Adults with Type 1 Diabetes Initiating a Tubeless Insulin Management System. Diabetes Ther 2023; 14:593-610. [PMID: 36763329 PMCID: PMC9913031 DOI: 10.1007/s13300-023-01366-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Despite recent advances in diabetes technology, most people living with type 1 diabetes mellitus (T1D) are unable to meet glycemic targets. Real-world evidence can provide insight into outcomes achieved with specific treatment devices when used in clinical practice. The aim of this study was to analyze real-world outcomes collected from a large cohort of people living with T1D and initiating treatment with the Omnipod DASH System. METHODS In this retrospective observational study, real-world outcomes were analyzed from a database of information collected from people with T1D initiating the Omnipod DASH System. Information in the database was either taken directly from the patient's medical record or self-reported if medical records were unavailable. The primary outcome was change in glycated hemoglobin (HbA1c) from baseline (before initiation) to 3 months after initiation. Secondary outcomes were changes in total daily dose of insulin (TDD) and self-reported frequency of hypoglycemic events (< 70 mg/dL). Results are separated for the adult (≥ 18 years, N = 3341) and pediatric (< 18 years, N = 1397) cohorts. RESULTS The change in HbA1c from baseline was - 0.9 ± 1.6% ( - 10 ± 18 mmol/mol; p < 0.0001) in adults and - 0.9 ± 2.0% ( - 10 ± 22 mmol/mol; p < 0.0001) in the pediatric cohort. For those previously using multiple daily injections, HbA1c decreased by - 1.0 ± 1.7% ( - 11 ± 19 mmol/mol) in adults and - 1.0 ± 2.1% ( - 11 ± 23 mmol/mol) in the pediatric cohort (both p < 0.0001). Hypoglycemic events decreased in adults from 2.9 to 1.3 episodes per week ( - 1.6 ± 3.2 events/week; p < 0.0001), and in the pediatric cohort from 2.8 to 1.5 episodes per week ( - 1.3 ± 2.7 events/week; p < 0.0001). In adults, TDD decreased by 19.9% (p < 0.0001), and it remained stable in the pediatric cohort (p > 0.05). CONCLUSIONS Real-world outcomes from this large cohort of people initiating therapy with the Omnipod DASH System showed significant improvement in HbA1c and a substantial reduction in hypoglycemic events after 3 months of use.
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Affiliation(s)
- Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 530, Chicago, IL, 60611, USA
| | - Daniel J DeSalvo
- Baylor College of Medicine, 1 Moursund St., Houston, TX, 77030, USA
| | - Felipe Lauand
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | | | - Albert Chang
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Todd Vienneau
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Trang T Ly
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
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Polonsky WH, Hood KK, Levy CJ, MacLeish SA, Hirsch IB, Brown SA, Bode BW, Carlson AL, Shah VN, Weinstock RS, Bhargava A, Jones TC, Aleppo G, Mehta SN, Laffel LM, Forlenza GP, Sherr JL, Huyett LM, Vienneau TE, Ly TT. How introduction of automated insulin delivery systems may influence psychosocial outcomes in adults with type 1 diabetes: Findings from the first investigation with the Omnipod® 5 System. Diabetes Res Clin Pract 2022; 190:109998. [PMID: 35853530 PMCID: PMC10901155 DOI: 10.1016/j.diabres.2022.109998] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate psychosocial outcomes for adults with type 1 diabetes (T1D) using the tubeless Omnipod® 5 Automated Insulin Delivery (AID) System. METHODS A single-arm, multicenter (across the United States), prospective safety and efficacy study of the tubeless AID system included 115 adults with T1D. Participants aged 18-70 years completed questionnaires assessing psychosocial outcomes - diabetes distress (T1-DDS), hypoglycemic confidence (HCS), well-being (WHO-5), sleep quality (PSQI), insulin delivery satisfaction (IDSS), diabetes treatment satisfaction (DTSQ), and system usability (SUS) - before and after 3 months of AID use. Associations among participant characteristics, psychosocial measures and glycemic outcomes were evaluated using linear regression analyses. RESULTS Adults using the tubeless AID system demonstrated improvements in diabetes-specific psychosocial measures, including diabetes distress, hypoglycemic confidence, insulin delivery satisfaction, diabetes treatment satisfaction, and system usability after 3 months (all P < 0.001). No changes in general well-being or sleep quality were observed. The psychosocial outcomes assessed were not consistently associated with baseline participant characteristics (i.e., age, sex, diabetes duration, glycemic outcomes including percent time in range 70-180 mg/dL, percent time below range < 70 mg/dL, hemoglobin A1c, or insulin regimen). CONCLUSIONS Use of the Omnipod 5 AID system was associated with significant improvements in diabetes-related psychosocial outcomes for adults with T1D. CLINICAL TRIALS REGISTRATION NUMBER NCT04196140.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, 5230 Carrol Canyon Road Ste 208, San Diego, CA 92121, United States; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Korey K Hood
- Department of Pediatrics, Psychiatry & Behavioral Sciences, Stanford Diabetes Research Center, Stanford University School of Medicine, 279 Campus Drive, B300, Stanford, CA 94305, United States
| | - Carol J Levy
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Sarah A MacLeish
- University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH 44106, United States
| | - Irl B Hirsch
- Department of Medicine, University of Washington, 750 Republican Street, Building F, Floor 3, Seattle, WA 98109, United States
| | - Sue A Brown
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, 560 Ray C Hunt Dr, Charlottesville, VA 22903, United States
| | - Bruce W Bode
- Atlanta Diabetes Associates, 1800 Howell Mill Rd #450, Atlanta, GA 30318, United States
| | - Anders L Carlson
- International Diabetes Center, Park Nicollet, HealthPartners, 3800 Park Nicollet Blvd, Minneapolis, MN 55415, United States
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct #A140, Aurora, CO 80045, United States
| | - Ruth S Weinstock
- Department of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, United States
| | - Anuj Bhargava
- Iowa Diabetes Research, 1031 Office Park Rd Suite #2, West Des Moines, IA 50265, United States
| | - Thomas C Jones
- Department of Research, East Coast Institute for Research at The Jones Center, 265 Sheraton Blvd, Macon, GA 31210, United States
| | - Grazia Aleppo
- Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave Ste 530, Chicago, IL 60611, United States
| | - Sanjeev N Mehta
- Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, United States
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, United States
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct #A140, Aurora, CO 80045, United States
| | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| | - Lauren M Huyett
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Todd E Vienneau
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Trang T Ly
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States.
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Pinsker JE, Church MM, Brown SA, Voelmle MK, Bode BW, Narron B, Huyett LM, Lee JB, O'Connor J, Benjamin E, Dumais B, Ly TT. Clinical Evaluation of a Novel CGM-Informed Bolus Calculator with Automatic Glucose Trend Adjustment. Diabetes Technol Ther 2022; 24:18-25. [PMID: 34491825 PMCID: PMC8783627 DOI: 10.1089/dia.2021.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Expert opinion guidelines and limited data from clinical trials recommend adjustment to bolus insulin doses based on continuous glucose monitor (CGM) trend data, yet minimal evidence exists to support this approach. We performed a clinical evaluation of a novel CGM-informed bolus calculator (CIBC) with automatic insulin bolus dose adjustment based on CGM trend used with sensor-augmented pump therapy. Materials and Methods: In this multicenter, outpatient study, participants 6-70 years of age with type 1 diabetes (T1D) used the Omnipod® 5 System in Manual Mode, first for 7 days without a connected CGM (standard bolus calculator, SBC, phase 1) and then for 7 days with a connected CGM using the CIBC (CIBC phase 2). The integrated bolus calculator used stored pump settings plus user-estimated meal size and/or either a manually entered capillary glucose value (SBC phase) or an imported current CGM value and trend (CIBC phase) to recommend a bolus amount. The CIBC automatically increased or decreased the suggested bolus amount based on the CGM trend. Results: Twenty-five participants, (mean ± standard deviation) 27 ± 15 years of age, with T1D duration 12 ± 9 years and A1C 7.0% ± 0.9% completed the study. There were significantly fewer sensor readings <70 mg/dL 4 h postbolus with the CIBC compared to the SBC (2.1% ± 2.0% vs. 2.8 ± 2.7, P = 0.03), while percent of sensor readings >180 and 70-180 mg/dL remained the same. There was no difference in insulin use or number of boluses given between the two phases. Conclusion: The CIBC was safe when used with the Omnipod 5 System in Manual Mode, with fewer hypoglycemic readings in the postbolus period compared to the SBC. This trial was registered at ClinicalTrials.gov (NCT04320069).
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Affiliation(s)
- Jordan E. Pinsker
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Sue A. Brown
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Mary K. Voelmle
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Bruce W. Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Brooke Narron
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Lauren M. Huyett
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Joon Bok Lee
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Jason O'Connor
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Eric Benjamin
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Bonnie Dumais
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
| | - Trang T. Ly
- Insulet Corporation, Acton, Massachusetts, USA
- Results of this study were presented in abstract form at the 14th International Conference on Advanced Technologies & Treatments for Diabetes, June 2021
- Address correspondence to: Trang T. Ly, MBBS, FRACP, PhD, Insulet Corporation, 100 Nagog Park, Acton, MA 01720, USA
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Forlenza GP, Buckingham BA, Brown SA, Bode BW, Levy CJ, Criego AB, Wadwa RP, Cobry EC, Slover RJ, Messer LH, Berget C, McCoy S, Ekhlaspour L, Kingman RS, Voelmle MK, Boyd J, O'Malley G, Grieme A, Kivilaid K, Kleve K, Dumais B, Vienneau T, Huyett LM, Lee JB, O'Connor J, Benjamin E, Ly TT. First Outpatient Evaluation of a Tubeless Automated Insulin Delivery System with Customizable Glucose Targets in Children and Adults with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:410-424. [PMID: 33325779 PMCID: PMC8215410 DOI: 10.1089/dia.2020.0546] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The objective of this study was to assess the safety and effectiveness of the first commercial configuration of a tubeless automated insulin delivery system, Omnipod® 5, in children (6-13.9 years) and adults (14-70 years) with type 1 diabetes (T1D) in an outpatient setting. Materials and Methods: This was a single-arm, multicenter, prospective clinical study. Data were collected over a 14-day standard therapy (ST) phase followed by a 14-day hybrid closed-loop (HCL) phase, where participants (n = 36) spent 72 h at each of three prespecified glucose targets (130, 140, and 150 mg/dL, 9 days total) then 5 days with free choice of glucose targets (110-150 mg/dL) using the Omnipod 5. Remote safety monitoring alerts were enabled during the HCL phase. Primary endpoints were difference in time in range (TIR) (70-180 mg/dL) between ST and HCL phases and proportion of participants reporting serious device-related adverse events. Results: Mean TIR was significantly higher among children in the free-choice period overall (64.9% ± 12.2%, P < 0.01) and when using a 110 mg/dL target (71.2% ± 10.2%, P < 0.01), a 130 mg/dL target (61.5% ± 7.7%, P < 0.01), and a 140 mg/dL target (64.8% ± 11.6%, P < 0.01), and among adults using a 130 mg/dL target (75.1% ± 11.6%, P < 0.05), compared to the ST phase (children: 51.0% ± 13.3% and adults: 65.6% ± 15.7%). There were no serious device-related adverse events reported during the HCL phase, nor were there episodes of severe hypoglycemia or diabetic ketoacidosis. Conclusion: The Omnipod 5 System was safe and effective when used at glucose targets from 110 to 150 mg/dL for 14 days at home in children and adults with T1D.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bruce A. Buckingham
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Sue A. Brown
- Division of Endocrinology and Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | - Carol J. Levy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy B. Criego
- Department of Pediatric Endocrinology, Park Nicollet Clinic, International Diabetes Center at Park Nicollet, Minneapolis, Minnesota, USA
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erin C. Cobry
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert J. Slover
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Laurel H. Messer
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan McCoy
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Laya Ekhlaspour
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Ryan S. Kingman
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Mary K. Voelmle
- Division of Endocrinology and Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | - Grenye O'Malley
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aimee Grieme
- Department of Pediatric Endocrinology, Park Nicollet Clinic, International Diabetes Center at Park Nicollet, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | | | | | - Trang T. Ly
- Insulet Corporation, Acton, Massachusetts, USA
- Address correspondence to: Trang T. Ly, MBBS, FRACP, PhD, Insulet Corporation, 100 Nagog Park, Acton, MA 01720, USA
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7
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Carlson AL, Huyett LM, Jantz J, Chang A, Vienneau T, Ly TT. Improved glycemic control in 3,592 adults with type 2 diabetes mellitus initiating a tubeless insulin management system. Diabetes Res Clin Pract 2021; 174:108735. [PMID: 33711396 DOI: 10.1016/j.diabres.2021.108735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/22/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
AIMS To compare glycemic outcomes in adults with type 2 diabetes mellitus (T2DM) before and 90 days after initiating Omnipod® or Omnipod DASH® Insulin Management Systems. METHODS In this retrospective observational study (N = 3,592) change in HbA1c level, total daily dose (TDD) of insulin (n = 3,053), and frequency of self-reported hypoglycemic events (HE, <70 mg/dL, n = 2,922) were assessed overall and by prior treatment modality (multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII)), age group, and baseline HbA1c category. RESULTS Change (mean ± SD) in HbA1c was -1.3 ± 1.7% [-14 ± 19 mmol/mol] overall, -1.4 ± 1.7% [-15 ± 19 mmol/mol] for prior MDI users, and -0.9 ± 1.5% [-10 ± 16 mmol/mol] for prior CSII users (p<0.0001). The percentage of patients with HbA1c ≥9% [≥75 mmol/mol] decreased (49% to 19%), and with HbA1c <7% [<53 mmol/mol] increased (10% to 22%) (p<0.0001). Prior therapy, age, and baseline HbA1c category were factors affecting change in HbA1c (p<0.05). Reductions in TDD (overall, -33 ± 52U, p<0.0001) and HE per week (overall, -0.5 ± 2.0, p<0.0001), were seen regardless of prior treatment, age, or baseline HbA1c. CONCLUSIONS Omnipod System use was associated with statistically and clinically meaningful reductions in HbA1c, TDD, and HE compared to prior treatments in T2DM.
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Affiliation(s)
- Anders L Carlson
- International Diabetes Center at Park Nicollet, 3800 Park Nicollet Blvd, Minneapolis, MN 55416, United States
| | - Lauren M Huyett
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Jay Jantz
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Albert Chang
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Todd Vienneau
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States
| | - Trang T Ly
- Insulet Corporation, 100 Nagog Park, Acton, MA 01720, United States.
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8
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Mehta SN, Tinsley LJ, Kruger D, Bode B, Layne JE, Huyett LM, Dryga K, Dumais B, Ly TT, Laffel LM. Improved Glycemic Control Following Transition to Tubeless Insulin Pump Therapy in Adults With Type 1 Diabetes. Clin Diabetes 2021; 39:72-79. [PMID: 33551556 PMCID: PMC7839599 DOI: 10.2337/cd20-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Continuous subcutaneous insulin infusion (CSII) treatment may improve long-term glycemic outcomes and enhance quality of life compared with a multiple daily injection (MDI) insulin regimen for people with type 1 diabetes. As the number of people treated with CSII via a tubeless insulin pump is increasing, there is growing interest in the long-term glycemic outcomes of this treatment option across diverse populations. This multicenter, retrospective study evaluated glycemic control in 156 adults with type 1 diabetes initiating tubeless insulin pump therapy following transition from either MDI or CSII with a tubed insulin pump. In this study, use of the tubeless insulin pump over 12 months was associated with significant improvement in A1C in adults with type 1 diabetes, most notably in those with an A1C ≥9.0% and those previously treated with MDI.
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Affiliation(s)
| | | | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA
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Sherr JL, Buckingham BA, Forlenza GP, Galderisi A, Ekhlaspour L, Wadwa RP, Carria L, Hsu L, Berget C, Peyser TA, Lee JB, O'Connor J, Dumais B, Huyett LM, Layne JE, Ly TT. Safety and Performance of the Omnipod Hybrid Closed-Loop System in Adults, Adolescents, and Children with Type 1 Diabetes Over 5 Days Under Free-Living Conditions. Diabetes Technol Ther 2020; 22:174-184. [PMID: 31596130 PMCID: PMC7047109 DOI: 10.1089/dia.2019.0286] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The objective of this study was to assess the safety and performance of the Omnipod® personalized model predictive control (MPC) algorithm in adults, adolescents, and children aged ≥6 years with type 1 diabetes (T1D) under free-living conditions using an investigational device. Materials and Methods: A 96-h hybrid closed-loop (HCL) study was conducted in a supervised hotel/rental home setting following a 7-day outpatient standard therapy (ST) phase. Eligible participants were aged 6-65 years with A1C <10.0% using insulin pump therapy or multiple daily injections. Meals during HCL were unrestricted, with boluses administered per usual routine. There was daily physical activity. The primary endpoints were percentage of time with sensor glucose <70 and ≥250 mg/dL. Results: Participants were 11 adults, 10 adolescents, and 15 children aged (mean ± standard deviation) 28.8 ± 7.9, 14.3 ± 1.3, and 9.9 ± 1.0 years, respectively. Percentage time ≥250 mg/dL during HCL was 4.5% ± 4.2%, 3.5% ± 5.0%, and 8.6% ± 8.8% per respective age group, a 1.6-, 3.4-, and 2.0-fold reduction compared to ST (P = 0.1, P = 0.02, and P = 0.03). Percentage time <70 mg/dL during HCL was 1.9% ± 1.3%, 2.5% ± 2.0%, and 2.2% ± 1.9%, a statistically significant decrease in adults when compared to ST (P = 0.005, P = 0.3, and P = 0.3). Percentage time 70-180 mg/dL increased during HCL compared to ST, reaching significance for adolescents and children: HCL 73.7% ± 7.5% vs. ST 68.0% ± 15.6% for adults (P = 0.08), HCL 79.0% ± 12.6% vs. ST 60.6% ± 13.4% for adolescents (P = 0.01), and HCL 69.2% ± 13.5% vs. ST 54.9% ± 12.9% for children (P = 0.003). Conclusions: The Omnipod personalized MPC algorithm was safe and performed well over 5 days and 4 nights of use by a cohort of participants ranging from youth aged ≥6 years to adults with T1D under supervised free-living conditions with challenges, including daily physical activity and unrestricted meals.
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Affiliation(s)
- Jennifer L. Sherr
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
- Address correspondence to: Jennifer L. Sherr, MD, PhD, Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, One Long Wharf Drive Suite 503, New Haven, CT 06511
| | - Bruce A. Buckingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alfonso Galderisi
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Laya Ekhlaspour
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - R. Paul Wadwa
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lori Carria
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Liana Hsu
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Cari Berget
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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10
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Layne JE, Huyett LM, Ly TT. Glycemic Control and Factors Impacting Treatment Choice in Tubeless Insulin Pump Users: A Survey of the T1D Exchange Glu Online Community. J Diabetes Sci Technol 2019; 13:1180-1181. [PMID: 31409136 PMCID: PMC6835191 DOI: 10.1177/1932296819868698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Trang T. Ly
- Insulet Corporation, Acton, MA, USA
- Trang T. Ly, MBBS, FRACP, PhD, Insulet Corporation, 100 Nagog Park, Acton, MA 01720, USA.
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11
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Forlenza GP, Buckingham BA, Christiansen MP, Wadwa RP, Peyser TA, Lee JB, O'Connor J, Dassau E, Huyett LM, Layne JE, Ly TT. Performance of Omnipod Personalized Model Predictive Control Algorithm with Moderate Intensity Exercise in Adults with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:265-272. [PMID: 30925077 PMCID: PMC6532546 DOI: 10.1089/dia.2019.0017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: The objective of this study was to assess the safety and performance of the Omnipod® personalized model predictive control (MPC) algorithm with variable glucose setpoints and moderate intensity exercise using an investigational device in adults with type 1 diabetes (T1D). Materials and Methods: A supervised 54-h hybrid closed-loop (HCL) study was conducted in a hotel setting after a 7-day outpatient standard treatment phase. Adults aged 18-65 years with T1D and HbA1c between 6.0% and 10.0% were eligible. Subjects completed two moderate intensity exercise sessions of >30 min duration on consecutive days: the first with the glucose set point increased from 130 to 150 mg/dL and the second with a temporary basal rate of 50%, both started 90 min pre-exercise. Primary endpoints were percentage time in hypoglycemia <70 mg/dL and hyperglycemia ≥250 mg/dL. Results: Twelve subjects participated in the study, with (mean ± standard deviation) age 36.5 ± 14.4 years, diabetes duration 21.7 ± 15.7 years, HbA1c 7.6% ± 1.1%, and total daily dose 0.60 ± 0.22 U/kg. Outcomes for the 54-h HCL period were mean glucose: 136 ± 14 mg/dL, percentage time <70 mg/dL: 1.4% ± 1.3%, 70-180 mg/dL: 85.1% ± 9.3%, and ≥250 mg/dL: 1.8% ± 2.4%. In the 12-h period after exercise start, percentage time <70 mg/dL was 1.4% ± 2.7% with the raised glucose set point and 1.6% ± 3.0% with reduced basal rate. The percentage time <70 mg/dL overnight was 0% ± 0% on both study nights. Conclusions: The Omnipod personalized MPC algorithm performed well and was safe during day and night use in response to variable glucose set points and with temporarily raised glucose set point or reduced basal rate 90 min in advance of moderate intensity exercise in adults with T1D.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado
- Address correspondence to: Gregory P. Forlenza, MD, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 1775 Aurora CT, MS A140, Aurora, CO 80045
| | - Bruce A. Buckingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | | | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
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12
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Abstract
The Omnipod DASH™ Insulin Management System (Insulet Corp, Billerica, MA) is a discreet, tubeless, wearable insulin pump that holds up to 200 units of U-100 insulin and delivers therapy through customizable basal rates and bolus amounts. This recently FDA-cleared system consists of the insulin pump ("Pod"), which is worn on body and delivers insulin, and the Personal Diabetes Manager (PDM), which is a handheld device used to wirelessly control and monitor the Pod functionality. The PDM can also be paired with the CONTOUR® NEXT ONE blood glucose (BG) meter (Ascensia Diabetes Care, Basel, Switzerland) to wirelessly receive BG readings. This review provides a detailed description of the Pod and PDM. Key features of the Pod are described, including the novel pump delivery mechanism, waterproof (IP28) housing design, and automated cannula insertion. The technology introduced in the new system, such as touchscreen PDM interface, Bluetooth® wireless technology, and wireless internet connectivity, is also presented. Last, Omnipod® Insulin Management System clinical data are reviewed, including early feasibility results for the Omnipod Horizon™ Automated Glucose Control hybrid closed-loop system.
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Affiliation(s)
- Trang T. Ly
- Insulet Corporation, Billerica, MA, USA
- Trang T. Ly, MBBS, FRACP, PhD, Insulet Corporation, 600 Technology Park Dr, Billerica, MA 01821, USA.
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13
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Pillalamarri SS, Huyett LM, Abdel-Malek A. Novel Bluetooth-Enabled Tubeless Insulin Pump: A User Experience Design Approach for a Connected Digital Diabetes Management Platform. J Diabetes Sci Technol 2018; 12:1132-1142. [PMID: 30304951 PMCID: PMC6232743 DOI: 10.1177/1932296818804802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medical device technology is evolving at a rapid pace, with increasing patient expectations to use modern technologies for diabetes management. With the significant expansion of the use of wireless technology and complex, securely connected digital platforms in medical devices, end user needs and behaviors have become essential areas of focus. METHODS This article provides a detailed description of the user-centered design approach implemented in developing the Omnipod DASH™ Insulin Management System (Insulet Corp., Billerica, MA) Bluetooth®-enabled locked-down Android device handheld controller (Personal Diabetes Manager, PDM). Key methodologies used in the PDM design are described, including how the science of user experience (UX) was integrated into new agile product development. UX methods employed included heuristic evaluations of insulin pumps, iterative formative usability testing, information architecture studies, in-home ethnographic visits, participatory design activities, and interviews. RESULTS Over 343 users participated in UX research and testing. Key design choices informed by UX research included updating the layout of critical data on the PDM home page, providing access to requested contextual information while a bolus is in progress, and creating an easy-to-understand visual of a 24-hour basal program. Task completion rates for comprehending information on the PDM home page were 87% or greater. The System Usability Scale result for the design prior to limited market release was 84.4 ± 13.4 (out of 100; n = 37). CONCLUSIONS The UX process described in this article can serve as a blueprint for medical device manufacturers seeking to enhance product development. Adopting UX research methodologies will help ensure that new diabetes devices are safe, easy-to-use, and meet the needs of users.
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Affiliation(s)
| | | | - Aiman Abdel-Malek
- Insulet Corporation, Billerica, MA,
USA
- Aiman Abdel-Malek, PhD, Insulet Corporation,
600 Technology Park Dr, Billerica, MA 01821, USA.
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14
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Buckingham BA, Christiansen MP, Forlenza GP, Wadwa RP, Peyser TA, Lee JB, O'Connor J, Dassau E, Huyett LM, Layne JE, Ly TT. Performance of the Omnipod Personalized Model Predictive Control Algorithm with Meal Bolus Challenges in Adults with Type 1 Diabetes. Diabetes Technol Ther 2018; 20:585-595. [PMID: 30070928 PMCID: PMC6114075 DOI: 10.1089/dia.2018.0138] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study assessed the safety and performance of the Omnipod® personalized model predictive control (MPC) algorithm using an investigational device in adults with type 1 diabetes in response to overestimated and missed meal boluses and extended boluses for high-fat meals. MATERIALS AND METHODS A supervised 54-h hybrid closed-loop (HCL) study was conducted in a hotel setting after a 7-day outpatient open-loop run-in phase. Adults aged 18-65 years with type 1 diabetes and HbA1c 6.0%-10.0% were eligible. Primary endpoints were percentage time in hypoglycemia <70 mg/dL and hyperglycemia ≥250 mg/dL. Glycemic responses for 4 h to a 130% overestimated bolus and a missed meal bolus were compared with a 100% bolus for identical meals, respectively. The 12-h postprandial responses to a high-fat meal were compared using either a standard or extended bolus. RESULTS Twelve subjects participated in the study, with (mean ± standard deviation): age 35.4 ± 14.1 years, diabetes duration 16.5 ± 9.3 years, HbA1c 7.7 ± 0.9%, and total daily dose 0.58 ± 0.19 U/kg. Outcomes for the 54-h HCL period were mean glucose 153 ± 15 mg/dL, percentage time <70 mg/dL [median (interquartile range)]: 0.0% (0.0-1.2%), 70-180 mg/dL: 76.1% ± 8.0%, and ≥250 mg/dL: 4.5% ± 3.6%. After both the 100% and 130% boluses, postprandial percentage time <70 mg/dL was 0.0% (0.0-0.0%) (P = 0.50). After the 100% and missed boluses, postprandial percentage time ≥250 mg/dL was 0.2% ± 0.6% and 10.3% ± 16.5%, respectively (P = 0.06). Postprandial percentages time ≥250 mg/dL and <70 mg/dL were similar with standard or extended boluses for a high-fat meal. CONCLUSIONS The Omnipod personalized MPC algorithm performed well and was safe during day and night use in response to overestimated, missed, and extended meal boluses in adults with type 1 diabetes.
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Affiliation(s)
- Bruce A. Buckingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
- Address correspondence to:Bruce A. Buckingham, MDDivision of Endocrinology and DiabetesStanford School of Medicine780 Welch RoadPalo Alto, CA 94305
| | | | - Gregory P. Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | | | - Trang T. Ly
- Insulet Corporation, Billerica, Massachusetts
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15
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Howsmon DP, Baysal N, Buckingham BA, Forlenza GP, Ly TT, Maahs DM, Marcal T, Towers L, Mauritzen E, Deshpande S, Huyett LM, Pinsker JE, Gondhalekar R, Doyle FJ, Dassau E, Hahn J, Bequette BW. Real-Time Detection of Infusion Site Failures in a Closed-Loop Artificial Pancreas. J Diabetes Sci Technol 2018; 12:599-607. [PMID: 29390915 PMCID: PMC6154252 DOI: 10.1177/1932296818755173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As evidence emerges that artificial pancreas systems improve clinical outcomes for patients with type 1 diabetes, the burden of this disease will hopefully begin to be alleviated for many patients and caregivers. However, reliance on automated insulin delivery potentially means patients will be slower to act when devices stop functioning appropriately. One such scenario involves an insulin infusion site failure, where the insulin that is recorded as delivered fails to affect the patient's glucose as expected. Alerting patients to these events in real time would potentially reduce hyperglycemia and ketosis associated with infusion site failures. METHODS An infusion site failure detection algorithm was deployed in a randomized crossover study with artificial pancreas and sensor-augmented pump arms in an outpatient setting. Each arm lasted two weeks. Nineteen participants wore infusion sets for up to 7 days. Clinicians contacted patients to confirm infusion site failures detected by the algorithm and instructed on set replacement if failure was confirmed. RESULTS In real time and under zone model predictive control, the infusion site failure detection algorithm achieved a sensitivity of 88.0% (n = 25) while issuing only 0.22 false positives per day, compared with a sensitivity of 73.3% (n = 15) and 0.27 false positives per day in the SAP arm (as indicated by retrospective analysis). No association between intervention strategy and duration of infusion sets was observed ( P = .58). CONCLUSIONS As patient burden is reduced by each generation of advanced diabetes technology, fault detection algorithms will help ensure that patients are alerted when they need to manually intervene. Clinical Trial Identifier: www.clinicaltrials.gov,NCT02773875.
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Affiliation(s)
- Daniel P. Howsmon
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Nihat Baysal
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Bruce A. Buckingham
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | | | - Trang T. Ly
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | - David M. Maahs
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | - Tatiana Marcal
- Department of Pediatrics, Division of
Pediatric Endocrinology, Stanford University, Palo Alto, CA, USA
| | - Lindsey Towers
- Barbara Davis Center, University of
Colorado Denver, Denver, CO, USA
| | - Eric Mauritzen
- Department of Computer Science and
Engineering, University of California, San Diego, San Diego, CA, USA
| | - Sunil Deshpande
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Lauren M. Huyett
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
- Department of Chemical Engineering,
University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | - Ravi Gondhalekar
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | - Juergen Hahn
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute, Troy, NY, USA
| | - B. Wayne Bequette
- Department of Chemical & Biological
Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- B. Wayne Bequette, PhD, Chemical &
Biological Engineering, Rensselaer Polytechnic Institute, 110 8th St, Ricketts
Building, Troy, NY 12180, USA.
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16
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Dassau E, Pinsker JE, Kudva YC, Brown SA, Gondhalekar R, Dalla Man C, Patek S, Schiavon M, Dadlani V, Dasanayake I, Church MM, Carter RE, Bevier WC, Huyett LM, Hughes J, Anderson S, Lv D, Schertz E, Emory E, McCrady-Spitzer SK, Jean T, Bradley PK, Hinshaw L, Laguna Sanz AJ, Basu A, Kovatchev B, Cobelli C, Doyle FJ. Twelve-Week 24/7 Ambulatory Artificial Pancreas With Weekly Adaptation of Insulin Delivery Settings: Effect on Hemoglobin A 1c and Hypoglycemia. Diabetes Care 2017; 40:1719-1726. [PMID: 29030383 PMCID: PMC5711334 DOI: 10.2337/dc17-1188] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/14/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Artificial pancreas (AP) systems are best positioned for optimal treatment of type 1 diabetes (T1D) and are currently being tested in outpatient clinical trials. Our consortium developed and tested a novel adaptive AP in an outpatient, single-arm, uncontrolled multicenter clinical trial lasting 12 weeks. RESEARCH DESIGN AND METHODS Thirty adults with T1D completed a continuous glucose monitor (CGM)-augmented 1-week sensor-augmented pump (SAP) period. After the AP was started, basal insulin delivery settings used by the AP for initialization were adapted weekly, and carbohydrate ratios were adapted every 4 weeks by an algorithm running on a cloud-based server, with automatic data upload from devices. Adaptations were reviewed by expert study clinicians and patients. The primary end point was change in hemoglobin A1c (HbA1c). Outcomes are reported adhering to consensus recommendations on reporting of AP trials. RESULTS Twenty-nine patients completed the trial. HbA1c, 7.0 ± 0.8% at the start of AP use, improved to 6.7 ± 0.6% after 12 weeks (-0.3, 95% CI -0.5 to -0.2, P < 0.001). Compared with the SAP run-in, CGM time spent in the hypoglycemic range improved during the day from 5.0 to 1.9% (-3.1, 95% CI -4.1 to -2.1, P < 0.001) and overnight from 4.1 to 1.1% (-3.1, 95% CI -4.2 to -1.9, P < 0.001). Whereas carbohydrate ratios were adapted to a larger extent initially with minimal changes thereafter, basal insulin was adapted throughout. Approximately 10% of adaptation recommendations were manually overridden. There were no protocol-related serious adverse events. CONCLUSIONS Use of our novel adaptive AP yielded significant reductions in HbA1c and hypoglycemia.
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Affiliation(s)
- Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,William Sansum Diabetes Center, Santa Barbara, CA
| | | | | | - Sue A Brown
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Ravi Gondhalekar
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,William Sansum Diabetes Center, Santa Barbara, CA
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Steve Patek
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Michele Schiavon
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Isuru Dasanayake
- William Sansum Diabetes Center, Santa Barbara, CA.,Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA
| | | | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Lauren M Huyett
- William Sansum Diabetes Center, Santa Barbara, CA.,Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA
| | - Jonathan Hughes
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Stacey Anderson
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Dayu Lv
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Elaine Schertz
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Emma Emory
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | - Tyler Jean
- William Sansum Diabetes Center, Santa Barbara, CA
| | | | - Ling Hinshaw
- Endocrine Research Unit, Mayo Clinic, Rochester, MN
| | - Alejandro J Laguna Sanz
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,William Sansum Diabetes Center, Santa Barbara, CA
| | - Ananda Basu
- Endocrine Research Unit, Mayo Clinic, Rochester, MN
| | - Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA .,William Sansum Diabetes Center, Santa Barbara, CA
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17
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Dassau E, Renard E, Place J, Farret A, Pelletier MJ, Lee J, Huyett LM, Chakrabarty A, Doyle FJ, Zisser HC. Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control-based fully-automated artificial pancreas in patients with type 1 diabetes: a pilot study. Diabetes Obes Metab 2017; 19:1698-1705. [PMID: 28474383 PMCID: PMC5742859 DOI: 10.1111/dom.12999] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/15/2023]
Abstract
AIMS To compare intraperitoneal (IP) to subcutaneous (SC) insulin delivery in an artificial pancreas (AP). RESEARCH DESIGN AND METHODS Ten adults with type 1 diabetes participated in a non-randomized, non-blinded sequential AP study using the same SC glucose sensing and Zone Model Predictive Control (ZMPC) algorithm adjusted for insulin clearance. On first admission, subjects underwent closed-loop control with SC delivery of a fast-acting insulin analogue for 24 hours. Following implantation of a DiaPort IP insulin delivery system, the identical 24-hour trial was performed with IP regular insulin delivery. The clinical protocol included 3 unannounced meals with 70, 40 and 70 g carbohydrate, respectively. Primary endpoint was time spent with blood glucose (BG) in the range of 80 to 140 mg/dL (4.4-7.7 mmol/L). RESULTS Percent of time spent within the 80 to 140 mg/dL range was significantly higher for IP delivery than for SC delivery: 39.8 ± 7.6 vs 25.6 ± 13.1 ( P = .03). Mean BG (mg/dL) and percent of time spent within the broader 70 to 180 mg/dL range were also significantly better for IP insulin: 151.0 ± 11.0 vs 190.0 ± 31.0 ( P = .004) and 65.7 ± 9.2 vs 43.9 ± 14.7 ( P = .001), respectively. Superiority of glucose control with IP insulin came from the reduced time spent in hyperglycaemia (>180 mg/dL: 32.4 ± 8.9 vs 53.5 ± 17.4, P = .014; >250 mg/dL: 5.9 ± 5.6 vs 23.0 ± 11.3, P = .0004). Higher daily doses of insulin (IU) were delivered with the IP route (43.7 ± 0.1 vs 32.3 ± 0.1, P < .001) with no increased percent time spent <70 mg/dL (IP: 2.5 ± 2.9 vs SC: 4.1 ± 5.3, P = .42). CONCLUSIONS Glycaemic regulation with fully-automated AP delivering IP insulin was superior to that with SC insulin delivery. This pilot study provides proof-of-concept for an AP system combining a ZMPC algorithm with IP insulin delivery.
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MESH Headings
- Adult
- Algorithms
- Blood Glucose/analysis
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/therapy
- Female
- France
- Glycated Hemoglobin/analysis
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Infusions, Parenteral
- Infusions, Subcutaneous
- Insulin Infusion Systems/adverse effects
- Insulin Lispro/administration & dosage
- Insulin Lispro/adverse effects
- Insulin Lispro/therapeutic use
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/therapeutic use
- Male
- Middle Aged
- Pancreas, Artificial/adverse effects
- Pilot Projects
- Proof of Concept Study
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Affiliation(s)
- Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition and INSERM Clinical Investigation Center 1411, University Hospital of Montpellier, Montpellier, France
- Department of Psychology, Institute of Functional Genomics, CNRS UMR5203, INSERM U1191, University of Montpellier, Montpellier, France
| | - Jérôme Place
- Department of Psychology, Institute of Functional Genomics, CNRS UMR5203, INSERM U1191, University of Montpellier, Montpellier, France
| | - Anne Farret
- Department of Endocrinology, Diabetes, Nutrition and INSERM Clinical Investigation Center 1411, University Hospital of Montpellier, Montpellier, France
- Department of Psychology, Institute of Functional Genomics, CNRS UMR5203, INSERM U1191, University of Montpellier, Montpellier, France
| | - Marie-José Pelletier
- Department of Endocrinology, Diabetes, Nutrition and INSERM Clinical Investigation Center 1411, University Hospital of Montpellier, Montpellier, France
| | - Justin Lee
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Lauren M. Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Ankush Chakrabarty
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
| | - Howard C. Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
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18
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Forlenza GP, Deshpande S, Ly TT, Howsmon DP, Cameron F, Baysal N, Mauritzen E, Marcal T, Towers L, Bequette BW, Huyett LM, Pinsker JE, Gondhalekar R, Doyle FJ, Maahs DM, Buckingham BA, Dassau E. Erratum. Application of Zone Model Predictive Control Artificial Pancreas During Extended Use of Infusion Set and Sensor: A Randomized Crossover-Controlled Home-Use Trial. Diabetes Care 2017;40:1096-1102. Diabetes Care 2017; 40:1606. [PMID: 28887408 PMCID: PMC5652589 DOI: 10.2337/dc17-er11a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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19
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Gilmore SP, Henske JK, Sexton JA, Solomon KV, Seppälä S, Yoo JI, Huyett LM, Pressman A, Cogan JZ, Kivenson V, Peng X, Tan Y, Valentine DL, O'Malley MA. Genomic analysis of methanogenic archaea reveals a shift towards energy conservation. BMC Genomics 2017; 18:639. [PMID: 28826405 PMCID: PMC5563889 DOI: 10.1186/s12864-017-4036-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/08/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The metabolism of archaeal methanogens drives methane release into the environment and is critical to understanding global carbon cycling. Methanogenesis operates at a very low reducing potential compared to other forms of respiration and is therefore critical to many anaerobic environments. Harnessing or altering methanogen metabolism has the potential to mitigate global warming and even be utilized for energy applications. RESULTS Here, we report draft genome sequences for the isolated methanogens Methanobacterium bryantii, Methanosarcina spelaei, Methanosphaera cuniculi, and Methanocorpusculum parvum. These anaerobic, methane-producing archaea represent a diverse set of isolates, capable of methylotrophic, acetoclastic, and hydrogenotrophic methanogenesis. Assembly and analysis of the genomes allowed for simple and rapid reconstruction of metabolism in the four methanogens. Comparison of the distribution of Clusters of Orthologous Groups (COG) proteins to a sample of genomes from the RefSeq database revealed a trend towards energy conservation in genome composition of all methanogens sequenced. Further analysis of the predicted membrane proteins and transporters distinguished differing energy conservation methods utilized during methanogenesis, such as chemiosmotic coupling in Msar. spelaei and electron bifurcation linked to chemiosmotic coupling in Mbac. bryantii and Msph. cuniculi. CONCLUSIONS Methanogens occupy a unique ecological niche, acting as the terminal electron acceptors in anaerobic environments, and their genomes display a significant shift towards energy conservation. The genome-enabled reconstructed metabolisms reported here have significance to diverse anaerobic communities and have led to proposed substrate utilization not previously reported in isolation, such as formate and methanol metabolism in Mbac. bryantii and CO2 metabolism in Msph. cuniculi. The newly proposed substrates establish an important foundation with which to decipher how methanogens behave in native communities, as CO2 and formate are common electron carriers in microbial communities.
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Affiliation(s)
- Sean P Gilmore
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA
| | - John K Henske
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA
| | - Jessica A Sexton
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA
| | - Kevin V Solomon
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA.,Present Address: Agricultural & Biological Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Susanna Seppälä
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA.,Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Hørsholm, Denmark
| | - Justin I Yoo
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA
| | - Lauren M Huyett
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA
| | - Abe Pressman
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA
| | - James Z Cogan
- Biology Program, College of Creative Studies, University of California, Santa Barbara, California, USA
| | - Veronika Kivenson
- Department of Earth Science and Marine Science Institute, University of California, Santa Barbara, California, USA
| | - Xuefeng Peng
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA.,Department of Earth Science and Marine Science Institute, University of California, Santa Barbara, California, USA
| | - YerPeng Tan
- California NanoScience Institute, University of California, Santa Barbara, California, USA
| | - David L Valentine
- Department of Earth Science and Marine Science Institute, University of California, Santa Barbara, California, USA
| | - Michelle A O'Malley
- Department of Chemical Engineering, University of California, Santa Barbara, California, USA.
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20
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Forlenza GP, Deshpande S, Ly TT, Howsmon DP, Cameron F, Baysal N, Mauritzen E, Marcal T, Towers L, Bequette BW, Huyett LM, Pinsker JE, Gondhalekar R, Doyle FJ, Maahs DM, Buckingham BA, Dassau E. Application of Zone Model Predictive Control Artificial Pancreas During Extended Use of Infusion Set and Sensor: A Randomized Crossover-Controlled Home-Use Trial. Diabetes Care 2017; 40:1096-1102. [PMID: 28584075 PMCID: PMC5521973 DOI: 10.2337/dc17-0500] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/06/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE As artificial pancreas (AP) becomes standard of care, consideration of extended use of insulin infusion sets (IIS) and continuous glucose monitors (CGMs) becomes vital. We conducted an outpatient randomized crossover study to test the safety and efficacy of a zone model predictive control (zone-MPC)-based AP system versus sensor augmented pump (SAP) therapy in which IIS and CGM failures were provoked via extended wear to 7 and 21 days, respectively. RESEARCH DESIGN AND METHODS A smartphone-based AP system was used by 19 adults (median age 23 years [IQR 10], mean 8.0 ± 1.7% HbA1c) over 2 weeks and compared with SAP therapy for 2 weeks in a crossover, unblinded outpatient study with remote monitoring in both study arms. RESULTS AP improved percent time 70-140 mg/dL (48.1 vs. 39.2%; P = 0.016) and time 70-180 mg/dL (71.6 vs. 65.2%; P = 0.008) and decreased median glucose (141 vs. 153 mg/dL; P = 0.036) and glycemic variability (SD 52 vs. 55 mg/dL; P = 0.044) while decreasing percent time <70 mg/dL (1.3 vs. 2.7%; P = 0.001). AP also improved overnight control, as measured by mean glucose at 0600 h (140 vs. 158 mg/dL; P = 0.02). IIS failures (1.26 ± 1.44 vs. 0.78 ± 0.78 events; P = 0.13) and sensor failures (0.84 ± 0.6 vs. 1.1 ± 0.73 events; P = 0.25) were similar between AP and SAP arms. Higher percent time in closed loop was associated with better glycemic outcomes. CONCLUSIONS Zone-MPC significantly and safely improved glycemic control in a home-use environment despite prolonged CGM and IIS wear. This project represents the first home-use AP study attempting to provoke and detect component failure while successfully maintaining safety and effective glucose control.
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Affiliation(s)
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,William Sansum Diabetes Center, Santa Barbara, CA
| | - Trang T Ly
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Daniel P Howsmon
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | - Faye Cameron
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | - Nihat Baysal
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | - Eric Mauritzen
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA
| | - Tatiana Marcal
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Lindsey Towers
- Barbara Davis Center, University of Colorado Denver, Denver, CO
| | - B Wayne Bequette
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | - Lauren M Huyett
- William Sansum Diabetes Center, Santa Barbara, CA.,Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA
| | | | - Ravi Gondhalekar
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,William Sansum Diabetes Center, Santa Barbara, CA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,William Sansum Diabetes Center, Santa Barbara, CA
| | - David M Maahs
- Barbara Davis Center, University of Colorado Denver, Denver, CO.,Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Bruce A Buckingham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA .,William Sansum Diabetes Center, Santa Barbara, CA
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21
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Huyett LM, Ly TT, Forlenza GP, Reuschel-DiVirgilio S, Messer LH, Wadwa RP, Gondhalekar R, Doyle FJ, Pinsker JE, Maahs DM, Buckingham BA, Dassau E. Outpatient Closed-Loop Control with Unannounced Moderate Exercise in Adolescents Using Zone Model Predictive Control. Diabetes Technol Ther 2017; 19:331-339. [PMID: 28459617 PMCID: PMC5510043 DOI: 10.1089/dia.2016.0399] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The artificial pancreas (AP) has the potential to improve glycemic control in adolescents. This article presents the first evaluation in adolescents of the Zone Model Predictive Control and Health Monitoring System (ZMPC+HMS) AP algorithms, and their first evaluation in a supervised outpatient setting with frequent exercise. MATERIALS AND METHODS Adolescents with type 1 diabetes underwent 3 days of closed-loop control (CLC) in a hotel setting with the ZMPC+HMS algorithms on the Diabetes Assistant platform. Subjects engaged in twice-daily exercise, including soccer, tennis, and bicycling. Meal size (unrestricted) was estimated and entered into the system by subjects to trigger a bolus, but exercise was not announced. RESULTS Ten adolescents (11.9-17.7 years) completed 72 h of CLC, with data on 95 ± 14 h of sensor-augmented pump (SAP) therapy before CLC as a comparison to usual therapy. The percentage of time with continuous glucose monitor (CGM) 70-180 mg/dL was 71% ± 10% during CLC, compared to 57% ± 16% during SAP (P = 0.012). Nocturnal control during CLC was safe, with 0% (0%, 0.6%) of time with CGM <70 mg/dL compared to 1.1% (0.0%, 14%) during SAP. Despite large meals (estimated up to 120 g carbohydrate), only 8.0% ± 6.9% of time during CLC was spent with CGM >250 mg/dL (16% ± 14% during SAP). The system remained connected in CLC for 97% ± 2% of the total study time. No adverse events or severe hypoglycemia occurred. CONCLUSIONS The use of the ZMPC+HMS algorithms is feasible in the adolescent outpatient environment and achieved significantly more time in the desired glycemic range than SAP in the face of unannounced exercise and large announced meal challenges.
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Affiliation(s)
- Lauren M. Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- William Sansum Diabetes Center, Santa Barbara, California
| | - Trang T. Ly
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Suzette Reuschel-DiVirgilio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Laurel H. Messer
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - R. Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ravi Gondhalekar
- William Sansum Diabetes Center, Santa Barbara, California
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Francis J. Doyle
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- William Sansum Diabetes Center, Santa Barbara, California
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | - David M. Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bruce A. Buckingham
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Eyal Dassau
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- William Sansum Diabetes Center, Santa Barbara, California
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
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22
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Huyett LM, Mittal R, Zisser HC, Luxon ES, Yee A, Dassau E, Doyle FJ, Burnett DR. Preliminary Evaluation of a Long-Term Intraperitoneal Glucose Sensor With Flushing Mechanism. J Diabetes Sci Technol 2016; 10:1192-4. [PMID: 26993253 PMCID: PMC5032950 DOI: 10.1177/1932296816640542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lauren M Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Howard C Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Alex Yee
- Theranova, LLC, San Francisco, CA, USA
| | - Eyal Dassau
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Francis J Doyle
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
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23
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Huyett LM, Dassau E, Zisser HC, Doyle FJ. Design and Evaluation of a Robust PID Controller for a Fully Implantable Artificial Pancreas. Ind Eng Chem Res 2015; 54:10311-10321. [PMID: 26538805 PMCID: PMC4627627 DOI: 10.1021/acs.iecr.5b01237] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/06/2015] [Accepted: 06/09/2015] [Indexed: 11/28/2022]
Abstract
Treatment of type 1 diabetes mellitus could be greatly improved by applying a closed-loop control strategy to insulin delivery, also known as an artificial pancreas (AP). In this work, we outline the design of a fully implantable AP using intraperitoneal (IP) insulin delivery and glucose sensing. The design process utilizes the rapid glucose sensing and insulin action offered by the IP space to tune a PID controller with insulin feedback to provide safe and effective insulin delivery. The controller was tuned to meet robust performance and stability specifications. An anti-reset windup strategy was introduced to prevent dangerous undershoot toward hypoglycemia after a large meal disturbance. The final controller design achieved 78% of time within the tight glycemic range of 80-140 mg/dL, with no time spent in hypoglycemia. The next step is to test this controller design in an animal model to evaluate the in vivo performance.
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Affiliation(s)
- Lauren M Huyett
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
| | - Eyal Dassau
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
| | - Howard C Zisser
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
| | - Francis J Doyle
- Department of Chemical Engineering, University of California Santa Barbara , Santa Barbara, California 93106-5080, United States
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24
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Doyle FJ, Huyett LM, Lee JB, Zisser HC, Kerr D, Dassau E. Response to comment on Doyle et al. Closed-loop artificial pancreas systems: engineering the algorithms. Diabetes Care 2014;37:1191-1197. Diabetes Care 2014; 37:e228. [PMID: 25249687 PMCID: PMC6898911 DOI: 10.2337/dc14-1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Francis J Doyle
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Lauren M Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Joon Bok Lee
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Howard C Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA Sansum Diabetes Research Institute, Santa Barbara, CA
| | - David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Eyal Dassau
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA Sansum Diabetes Research Institute, Santa Barbara, CA
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25
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Abstract
The paramount goal in the treatment of type 1 diabetes is the maintenance of normoglycemia. Continuous glucose monitoring (CGM) technologies enable frequent sensing of glucose to inform exogenous insulin delivery timing and dosages. The most commonly available CGMs are limited by the physiology of the subcutaneous space in which they reside. The very same advantages of this minimally invasive approach are disadvantages with respect to speed. Because subcutaneous blood flow is sensitive to local fluctuations (e.g., temperature, mechanical pressure), subcutaneous sensing can be slow and variable. We propose the use of a more central, physiologically stable body space for CGM: the intraperitoneal space. We compared the temporal response characteristics of simultaneously placed subcutaneous and intraperitoneal sensors during intravenous glucose tolerance tests in eight swine. Using compartmental modeling based on simultaneous intravenous sensing, blood draws, and intraarterial sensing, we found that intraperitoneal kinetics were more than twice as fast as subcutaneous kinetics (mean time constant of 5.6 min for intraperitoneal vs. 12.4 min for subcutaneous). Combined with the known faster kinetics of intraperitoneal insulin delivery over subcutaneous delivery, our findings suggest that artificial pancreas technologies may be optimized by sensing glucose and delivering insulin in the intraperitoneal space.
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Affiliation(s)
| | - Lauren M Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA
| | - Howard C Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CASansum Diabetes Research Institute, Santa Barbara, CA
| | - Francis J Doyle
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA
| | - Brett D Mensh
- Theranova, LLC, San Francisco, CAJanelia Farm Research Campus, Howard Hughes Medical Institute, Ashburn, VA
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26
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Abstract
In this two-part Bench to Clinic narrative, recent advances in both the preclinical and clinical aspects of artificial pancreas (AP) development are described. In the preceding Bench narrative, Kudva and colleagues provide an in-depth understanding of the modified glucoregulatory physiology of type 1 diabetes that will help refine future AP algorithms. In the Clinic narrative presented here, we compare and evaluate AP technology to gain further momentum toward outpatient trials and eventual approval for widespread use. We enumerate the design objectives, variables, and challenges involved in AP development, concluding with a discussion of recent clinical advancements. Thanks to the effective integration of engineering and medicine, the dream of automated glucose regulation is nearing reality. Consistent and methodical presentation of results will accelerate this success, allowing head-to-head comparisons that will facilitate adoption of the AP as a standard therapy for type 1 diabetes.
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