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Deshpande S, Weinzimer SA, Gibbons K, Nally LM, Weyman K, Carria L, Zgorski M, Laffel LM, Doyle FJ, Dassau E. Feasibility and Preliminary Safety of Smartphone-Based Automated Insulin Delivery in Adolescents and Children With Type 1 Diabetes. J Diabetes Sci Technol 2024; 18:363-371. [PMID: 35971681 PMCID: PMC10973844 DOI: 10.1177/19322968221116384] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A smartphone-based automated insulin delivery (AID) controller device can facilitate use of interoperable components and acceptance in adolescents and children. METHODS Pediatric participants (N = 20, 8F) with type 1 diabetes were enrolled in three sequential age-based cohorts: adolescents (12-<18 years, n = 8, 5F), school-age (8-<12 years, n = 7, 2F), and young children (2-<8 years, n = 5, 1F). Participants used the interoperable artificial pancreas system (iAPS) and zone model predictive control (MPC) on an unlocked smartphone for 48 hours, consumed unrestricted meals of their choice, and engaged in various unannounced exercises. Primary outcomes and stopping criteria were defined using fingerstick blood glucose (BG) data; secondary outcomes compared continuous glucose monitoring (CGM) data with preceding sensor augmented pump (SAP) therapy. RESULTS During AID, there was no more than one BG <50 mg/dL except in one young child participant; no instance of more than two episodes of BG ≥300 mg/dL lasting longer than 2 hours; and no adverse events. Despite large meals (total of 404.9 grams of carbs) and unannounced exercise (total of 182 minutes), overall CGM percent time in range (TIR) of 70 to 180 mg/dL during AID was statistically similar to SAP (63.5% vs 57.3%, respectively, P = .145). Overnight glucose standard deviation was 43 mg/dL (vs SAP 57.9 mg/dL, P = .009) and coefficient of variation was 25.7% (vs SAP 34.9%, P < .001). The percent time in closed-loop mode and connected to the CGM was 92.7% and 99.6%, respectively. Surveys indicated that participants and parents/guardians were satisfied with the system. CONCLUSIONS The smartphone-based AID was feasible and safe in sequentially younger cohorts of adolescents and children. CLINICALTRIALS.GOV NCT04255381 (https://clinicaltrials.gov/ct2/show/NCT04255381).
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Affiliation(s)
- Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | | | | | | | - Kate Weyman
- Yale University School of Medicine, New Haven, CT, USA
| | - Lori Carria
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Smith V, Delaney H, Hunter A, Torgerson D, Treweek S, Gamble C, Mills N, Stanbury K, Dempsey E, Daly M, O'Shea J, Weatherup K, Deshpande S, Ryan MA, Lowe J, Black G, Devane D. The development and acceptability of an educational and training intervention for recruiters to neonatal trials: the TRAIN project. BMC Med Res Methodol 2023; 23:265. [PMID: 37951890 PMCID: PMC10638723 DOI: 10.1186/s12874-023-02086-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 10/28/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Suboptimal or slow recruitment affects 30-50% of trials. Education and training of trial recruiters has been identified as one strategy for potentially boosting recruitment to randomised controlled trials (hereafter referred to as trials). The Training tRial recruiters, An educational INtervention (TRAIN) project was established to develop and assess the acceptability of an education and training intervention for recruiters to neonatal trials. In this paper, we report the development and acceptability of TRAIN. METHODS TRAIN involved three sequential phases, with each phase contributing information to the subsequent phase(s). These phases were 1) evidence synthesis (systematic review of the effectiveness of training interventions and a content analysis of the format, content, and delivery of identified interventions), 2) intervention development using a Partnership (co-design/co-creation) approach, and 3) intervention acceptability assessments with recruiters to neonatal trials. RESULTS TRAIN, accompanied by a comprehensive intervention manual, has been designed for online or in-person delivery. TRAIN can be offered to recruiters before trial recruitment begins or as refresher sessions during a trial. The intervention consists of five core learning outcomes which are addressed across three core training units. These units are the trial protocol (Unit 1, 50 min, trial-specific), understanding randomisation (Unit 2, 5 min, trial-generic) and approaching and engaging with parents (Unit 3, 70 min, trial-generic). Eleven recruiters to neonatal trials registered to attend the acceptability assessment training workshops, although only four took part. All four positively valued the training Units and resources for increasing recruiter preparedness, knowledge, and confidence. More flexibility in how the training is facilitated, however, was noted (e.g., training divided across two workshops of shorter duration). Units 2 and 3 were considered beneficial to incorporate into Good Clinical Practice Training or as part of induction training for new staff joining neonatal units. CONCLUSION TRAIN offers a comprehensive co-produced training and education intervention for recruiters to neonatal trials. TRAIN was deemed acceptable, with minor modification, to neonatal trial recruiters. The small number of recruiters taking part in the acceptability assessment is a limitation. Scale-up of TRAIN with formal piloting and testing for effectiveness in a large cluster randomised trial is required.
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Affiliation(s)
- V Smith
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin, Ireland.
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland.
| | - H Delaney
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
| | - A Hunter
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - D Torgerson
- York Trials Unit, University of York, York, YO10 5DD, UK
| | - S Treweek
- Health Services Research Unit, Trial Forge, University of Aberdeen, Aberdeen, UK
| | - C Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - N Mills
- QuinteT, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - K Stanbury
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E Dempsey
- INFANT Centre, University College Cork, Cork, Ireland
| | - M Daly
- Irish Neonatal Health Alliance, Public and Patient Involvement Contributor, Bray, Co-Wicklow, Ireland
| | - J O'Shea
- Public and Patient Involvement Contributor, Royal Hospital for Children, Glasgow, UK
| | - K Weatherup
- Public and Patient Involvement Contributor, Oxford, UK
| | | | - M A Ryan
- INFANT Centre, University College Cork, Cork, Ireland
| | - J Lowe
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - G Black
- Royal Hospital for Children and Young People, Edinburgh, UK
| | - D Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
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Deshpande S, Doyle FJ, Dassau E. Glucose Rate-of-Change and Insulin-on-Board Jointly Weighted Zone Model Predictive Control. IEEE Trans Control Syst Technol 2023; 31:2261-2274. [PMID: 38525198 PMCID: PMC10958373 DOI: 10.1109/tcst.2023.3291573] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
We present design and evaluation of closed-loop insulin delivery using zone model predictive control (MPC) featuring an adaptive weighting scheme to address prolonged hyperglycemia due to changes in insulin sensitivity, underdelivery from profile mismatch, and meal composition. In the MPC cost function, the penalty on predicted glucose deviation from the upper zone boundary is weighted by a joint function of predicted glucose rate-of-change (ROC) and insulin-on-board (IOB). The asymmetric weighting gradually increases when glucose ROC and IOB were jointly low, independent of glucose magnitude, to limit hyperglycemia while aggressively reduces for negative glucose ROC to avoid hypoglycemia. The proposed controller was evaluated using two simulation scenarios: an induced resistance scenario and a nominal scenario to highlight the performance over a reference zone MPC with glucose ROC weighting only. The continuous adaption scheme resulted in consistent improvement for the entire glucose range without incurring additional risk of hypoglycemia. For the induced resistance and no feedforward bolus scenario, the percent time in 70-180 mg/dL was higher (53.5% versus 48.9%, p<0.001) with larger improvement in the overnight percent time in tighter glucose range 70-140 mg/dL (70.9% versus 52.9%, p<0.001). The results from extensive simulations, as well as clinical validation in three different outpatient studies demonstrate the utility and safety of the proposed zone MPC.
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Affiliation(s)
- Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
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Umbarkar P, Kannan V, Anand VJ, Deshpande S, Hinduja R, Babu V, Naidu S, Jadhav O, Jejurkar A. A comparative study of rectal volume variation in patients with prostate cancer: A tertiary care center study. Radiography (Lond) 2023; 29:845-850. [PMID: 37399732 DOI: 10.1016/j.radi.2023.06.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Every day variations in rectal filling in prostate cancer radiotherapy can significantly alter the delivered dose distribution from what was intended. The goal of this study was to see if the time of treatment delivery affected the rectal filling. METHODS This is a retrospective study which included 50 patients with localized prostate cancer treated with volumetric modulated arc therapy (VMAT) to the primary and regional lymph nodes. Cone Beam Computed Tomography (CBCT) image-sets were done for all patient's daily setup verification. The radiation therapist contoured the rectum on all CBCT image sets. The rectal volumes delineated on CBCT and the planning CT image sets were compared. The change in rectal volumes between morning and afternoon treatments were calculated and compared. RESULTS A total of 1000 CBCT image sets were obtained on 50 patients in the morning and afternoon. The percentage variation of the CBCT rectal volumes over the planning CT scan was 16.57% in the AM group and 24.35% in the PM group. CONCLUSION The percentage change in rectal volume was significantly lesser in AM group compared to PM group and therefore morning treatments may result in dose distribution that is close to the intended dose distribution. IMPLICATIONS FOR PRACTICE In prostate cancer radiotherapy our study suggests that a simple technique of changing the time of treatment from afternoon to morning can help to reduce the rectal volume.
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Affiliation(s)
- P Umbarkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Kannan
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V J Anand
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Deshpande
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - R Hinduja
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Babu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Naidu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - O Jadhav
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - A Jejurkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
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Levy CJ, Kudva YC, Ozaslan B, Castorino K, O'Malley G, Kaur RJ, Levister CM, Church MM, Desjardins D, McCrady-Spitzer S, Ogyaadu S, Trinidad MC, Reid C, Rizvi S, Deshpande S, Zaniletti I, Kremers WK, Pinsker JE, Doyle FJ, Dassau E. At-Home Use of a Pregnancy-Specific Zone-MPC Closed-Loop System for Pregnancies Complicated by Type 1 Diabetes: A Single-Arm, Observational Multicenter Study. Diabetes Care 2023:148936. [PMID: 37196353 DOI: 10.2337/dc23-0173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE There are no commercially available hybrid closed-loop insulin delivery systems customized to achieve pregnancy-specific glucose targets in the U.S. This study aimed to evaluate the feasibility and performance of at-home use of a zone model predictive controller-based closed-loop insulin delivery system customized for pregnancies complicated by type 1 diabetes (CLC-P). RESEARCH DESIGN AND METHODS Pregnant women with type 1 diabetes using insulin pumps were enrolled in the second or early third trimester. After study sensor wear collecting run-in data on personal pump therapy and 2 days of supervised training, participants used CLC-P targeting 80-110 mg/dL during the day and 80-100 mg/dL overnight running on an unlocked smartphone at home. Meals and activities were unrestricted throughout the trial. The primary outcome was the continuous glucose monitoring percentage of time in the target range 63-140 mg/dL versus run-in. RESULTS Ten participants (HbA1c 5.8 ± 0.6%) used the system from mean gestational age of 23.7 ± 3.5 weeks. Mean percentage time in range increased 14.1 percentage points, equivalent to 3.4 h per day, compared with run-in (run-in: 64.5 ± 16.3% versus CLC-P: 78.6 ± 9.2%; P = 0.002). During CLC-P use, there was significant decrease in both time over 140 mg/dL (P = 0.033) and the hypoglycemic ranges of less than 63 mg/dL and 54 mg/dL (P = 0.037 for both). Nine participants exceeded consensus goals of above 70% time in range during CLC-P use. CONCLUSIONS The results show that the extended use of CLC-P at home until delivery is feasible. Larger, randomized studies are needed to further evaluate system efficacy and pregnancy outcomes.
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Affiliation(s)
- Carol J Levy
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Basak Ozaslan
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Sansum Diabetes Research Institute, Santa Barbara, CA
| | | | | | | | | | | | | | | | | | | | | | | | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Sansum Diabetes Research Institute, Santa Barbara, CA
| | | | | | | | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
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6
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Iler C, Backowski J, Bastardi H, Boyle C, Brickler M, Buesking C, Daneman S, Gambetta K, Ha L, Huston A, Sinicropi N, White R, Deshpande S. Non-HLA Antibodies: The State of Current Practice in Pediatric Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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7
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Dazo M, Foland J, Iler C, Norris L, Deshpande S. What's The Best Regimen? Impact of Everolimus Use on Chronic Kidney Disease after Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Nisar P, Katge F, Bhanushali P, Deshpande S, Poojari M, Shetty S. Comparative in vitro evaluation of remaining dentine thickness following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars: a systematic review. Eur Arch Paediatr Dent 2023; 24:15-32. [PMID: 36319891 DOI: 10.1007/s40368-022-00760-4] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/30/2022] [Indexed: 03/08/2023]
Abstract
PURPOSE The aim was to compare the remaining dentine thickness (RDT) following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars. Research question was 'Is there any difference between the remaining dentine thickness following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars?'. METHODS Electronic Databases like MEDLINE PubMed, Cochrane Library, EBSCOhost, Google scholar and grey literature were searched between January 1, 2006 and August 31, 2022 for in vitro and ex vivo studies that compared hand and rotary endodontic instrumentation to evaluate the RDT in primary molars. Articles published in English or which could be translated into English were searched. Two reviewers independently selected studies, extracted data, assessed risk of bias using the Revised, validated version of MINORS criteria. RESULTS Twelve studies were included in qualitative analysis. All included studies showed low risk of bias. Six studies showed more RDT with rotary instrumentation compared to manual instrumentation. Whereas, five studies showed variable results for RDT with manual and rotary instrumentation at different levels of root canals. One study showed no significant difference between manual and rotary instrumentation. In view of methodological heterogeneity of the findings, a meta-analysis was not conducted. CONCLUSION High quality of evidence based on low risk of bias was found in all the included studies. Statistically, rotary instrumentation showed more RDT than manual instrumentation according to majority of studies. Despite the shortcomings of this systematic review, it is possible to infer that the use of rotary instrumentation provides more RDT and thus there is considerable conservation of tooth structure.
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Affiliation(s)
- P Nisar
- Department of Pediatric and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - F Katge
- Department of Pediatric and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India.
| | - P Bhanushali
- Department of Pediatric and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - S Deshpande
- Department of Pediatric and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - M Poojari
- Department of Pediatric and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - S Shetty
- Department of Pediatric and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India
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Anuja I, Desurkar V, Juvekar N, Deshpande S, Gaidu J, Rath S. OPTIMIZATION OF ANAESTHETIC AND SURGICAL TIME SYNCHRONISED TO PERIOPERATIVE PROCESS FOR CARDIAC SURGICAL PATIENTS. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Antunes J, Pittock D, Jacobs P, Nelson A, Piper J, Young T, Deshpande S. Assessing Multiple MRI Sequences in Deep Learning-Based Synthetic CT Generation for MR Only-Guided Radiation Therapy of Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moukthika KVN, Krishnappa D, Patloori Sirish Chandra S, Bhole C, Deshpande S, Roshan J, Barthur A, Parameshwaran S, Mehta R, Padmanabhan D. Inflammation begets isolated atrioventricular conduction disturbances in young an observation from indian registry data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High grade AV block is less commonly encountered in patients <60 years. The aetiological role of inflammatory conditions is not well studied in this group of patients.
Purpose
To determine the prevalence of myocardial inflammation in young patients presenting with High grade AV block and assess its response to immunosuppression.
Methodology
This is a prospective, registry based, observational study conducted at two centers from Jan 2020 to Dec 2021. Myocardial inflammation was detected using Cardiac PET, and/or histopathological examination. Those with evidence of inflammation were started on graded immunosuppression.
Results
318 patients were enrolled. Mean EF was 55.2±7.0%. Cardiac PET was performed in 87/318 (27.3%). Myocardial inflammation was seen in 57/87 (65%). LV basal septum was most commonly involved. 44/57 (77%) were started on immunosuppressive therapy after excluding indolent tuberculosis.8 patients died during follow-up with all deaths being sudden in nature. 5/44 (11.3%) had reversal of CHB with resolution of cPET findings.
Conclusion
Significant proportion of young patients with High grade AV block have segmental myocardial inflammation. Immunosuppression helps restore AV conduction in some of these patients. Long-term studies are required to assess adverse impact of inflammation on cardiac contractile function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K V N Moukthika
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - D Krishnappa
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | | | - C Bhole
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - S Deshpande
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - J Roshan
- Christian Medical College, electrophysiology , Vellore , India
| | - A Barthur
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - S Parameshwaran
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - R Mehta
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - D Padmanabhan
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
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Pinsker JE, Dassau E, Deshpande S, Raghinaru D, Buckingham BA, Kudva YC, Laffel LM, Levy CJ, Church MM, Desrochers H, Ekhlaspour L, Kaur RJ, Levister C, Shi D, Lum JW, Kollman C, Doyle FJ. Outpatient Randomized Crossover Comparison of Zone Model Predictive Control Automated Insulin Delivery with Weekly Data Driven Adaptation Versus Sensor-Augmented Pump: Results from the International Diabetes Closed-Loop Trial 4. Diabetes Technol Ther 2022; 24:635-642. [PMID: 35549708 PMCID: PMC9422791 DOI: 10.1089/dia.2022.0084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 02/03/2023]
Abstract
Background: Automated insulin delivery (AID) systems have proven effective in increasing time-in-range during both clinical trials and real-world use. Further improvements in outcomes for single-hormone (insulin only) AID may be limited by suboptimal insulin delivery settings. Methods: Adults (≥18 years of age) with type 1 diabetes were randomized to either sensor-augmented pump (SAP) (inclusive of predictive low-glucose suspend) or adaptive zone model predictive control AID for 13 weeks, then crossed over to the other arm. Each week, the AID insulin delivery settings were sequentially and automatically updated by an adaptation system running on the study phone. Primary outcome was sensor glucose time-in-range 70-180 mg/dL, with noninferiority in percent time below 54 mg/dL as a hierarchical outcome. Results: Thirty-five participants completed the trial (mean age 39 ± 16 years, HbA1c at enrollment 6.9% ± 1.0%). Mean time-in-range 70-180 mg/dL was 66% with SAP versus 69% with AID (mean adjusted difference +2% [95% confidence interval: -1% to +6%], P = 0.22). Median time <70 mg/dL improved from 3.0% with SAP to 1.6% with AID (-1.5% [-2.4% to -0.5%], P = 0.002). The adaptation system decreased initial basal rates by a median of 4% (-8%, 16%) and increased initial carbohydrate ratios by a median of 45% (32%, 59%) after 13 weeks. Conclusions: Automated adaptation of insulin delivery settings with AID use did not significantly improve time-in-range in this very well-controlled population. Additional study and further refinement of the adaptation system are needed, especially in populations with differing degrees of baseline glycemic control, who may show larger benefits from adaptation.
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Affiliation(s)
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Dan Raghinaru
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Bruce A. Buckingham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lori M. Laffel
- Research Division, Joslin Diabetes Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Carol J. Levy
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Hannah Desrochers
- Research Division, Joslin Diabetes Center and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Laya Ekhlaspour
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ravinder Jeet Kaur
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Camilla Levister
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dawei Shi
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - John W. Lum
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
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Ozaslan B, Levy CJ, Kudva YC, Pinsker JE, O'Malley G, Kaur RJ, Castorino K, Levister C, Trinidad MC, Desjardins D, Church MM, Plesser M, McCrady-Spitzer S, Ogyaadu S, Nelson K, Reid C, Deshpande S, Kremers WK, Doyle FJ, Rosenn B, Dassau E. Feasibility of Closed-Loop Insulin Delivery with a Pregnancy-Specific Zone Model Predictive Control Algorithm. Diabetes Technol Ther 2022; 24:471-480. [PMID: 35230138 PMCID: PMC9464083 DOI: 10.1089/dia.2021.0521] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 01/05/2023]
Abstract
Objective: Evaluating the feasibility of closed-loop insulin delivery with a zone model predictive control (zone-MPC) algorithm designed for pregnancy complicated by type 1 diabetes (T1D). Research Design and Methods: Pregnant women with T1D from 14 to 32 weeks gestation already using continuous glucose monitor (CGM) augmented pump therapy were enrolled in a 2-day multicenter supervised outpatient study evaluating pregnancy-specific zone-MPC based closed-loop control (CLC) with the interoperable artificial pancreas system (iAPS) running on an unlocked smartphone. Meals and activities were unrestricted. The primary outcome was the CGM percentage of time between 63 and 140 mg/dL compared with participants' 1-week run-in period. Early (2-h) postprandial glucose control was also evaluated. Results: Eleven participants completed the study (age: 30.6 ± 4.1 years; gestational age: 20.7 ± 3.5 weeks; weight: 76.5 ± 15.3 kg; hemoglobin A1c: 5.6% ± 0.5% at enrollment). No serious adverse events occurred. Compared with the 1-week run-in, there was an increased percentage of time in 63-140 mg/dL during supervised CLC (CLC: 81.5%, run-in: 64%, P = 0.007) with less time >140 mg/dL (CLC: 16.5%, run-in: 30.8%, P = 0.029) and time <63 mg/dL (CLC: 2.0%, run-in:5.2%, P = 0.039). There was also less time <54 mg/dL (CLC: 0.7%, run-in:1.6%, P = 0.030) and >180 mg/dL (CLC: 4.9%, run-in: 13.1%, P = 0.032). Overnight glucose control was comparable, except for less time >250 mg/dL (CLC: 0%, run-in:3.9%, P = 0.030) and lower glucose standard deviation (CLC: 23.8 mg/dL, run-in:42.8 mg/dL, P = 0.007) during CLC. Conclusion: In this pilot study, use of the pregnancy-specific zone-MPC was feasible in pregnant women with T1D. Although the duration of our study was short and the number of participants was small, our findings add to the limited data available on the use of CLC systems during pregnancy (NCT04492566).
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Affiliation(s)
- Basak Ozaslan
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Carol J. Levy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Grenye O'Malley
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Camilla Levister
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Mitchell Plesser
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Selassie Ogyaadu
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kristen Nelson
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | | | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | | | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts, USA
| | - Barak Rosenn
- Robert Wood Johnson Barnabas Health, New Brunswick, New Jersey, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts, USA
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Kaur RJ, Deshpande S, Pinsker JE, Gilliam WP, McCrady-Spitzer S, Zaniletti I, Desjardins D, Church MM, Doyle III FJ, Kremers WK, Dassau E, Kudva YC. Outpatient Randomized Crossover Automated Insulin Delivery Versus Conventional Therapy with Induced Stress Challenges. Diabetes Technol Ther 2022; 24:338-349. [PMID: 35049354 PMCID: PMC9271334 DOI: 10.1089/dia.2021.0436] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Automated insulin delivery (AID) systems have not been evaluated in the context of psychological and pharmacological stress in type 1 diabetes. Our objective was to determine glycemic control and insulin use with Zone Model Predictive Control (zone-MPC) AID system enhanced for states of persistent hyperglycemia versus sensor-augmented pump (SAP) during outpatient use, including in-clinic induced stress. Materials and Methods: Randomized, crossover, 2-week trial of zone-MPC AID versus SAP in 14 adults with type 1 diabetes. In each arm, each participant was studied in-clinic with psychological stress induction (Trier Social Stress Test [TSST] and Socially Evaluated Cold Pressor Test [SECPT]), followed by pharmacological stress induction with oral hydrocortisone (total four sessions per participant). The main outcomes were 2-week continuous glucose monitor percent time in range (TIR) 70-180 mg/dL, and glucose and insulin outcomes during and overnight following stress induction. Results: During psychological stress, AID decreased glycemic variability percentage by 13.4% (P = 0.009). During pharmacological stress, including the following overnight, there were no differences in glucose outcomes and total insulin between AID and physician-assisted SAP. However, with AID total user-requested insulin was lower by 6.9 U (P = 0.01) for pharmacological stress. Stress induction was validated by changes in heart rate and salivary cortisol levels. During the 2-week AID use, TIR was 74.4% (vs. SAP 63.1%, P = 0.001) and overnight TIR was 78.3% (vs. SAP 63.1%, P = 0.004). There were no adverse events. Conclusions: Zone-MPC AID can reduce glycemic variability and the need for user-requested insulin during pharmacological stress and can improve overall glycemic outcomes. Clinical Trial Identifier NCT04142229.
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Affiliation(s)
- Ravinder Jeet Kaur
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | | | | | - Shelly McCrady-Spitzer
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Isabella Zaniletti
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Donna Desjardins
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Francis J. Doyle III
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Walter K. Kremers
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
- Address correspondence to: Yogish C. Kudva, MBBS, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester MN 55902, USA
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15
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Guo P, Rivera DE, Dong Y, Deshpande S, Savage JS, Hohman EE, Pauley AM, Leonard KS, Downs DS. Optimizing behavioral interventions to regulate gestational weight gain with sequential decision policies using hybrid model predictive control. Comput Chem Eng 2022; 160. [PMID: 35342207 PMCID: PMC8951772 DOI: 10.1016/j.compchemeng.2022.107721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Excessive gestational weight gain is a significant public health concern that has been the recent focus of control systems-based interventions. Healthy Mom Zone (HMZ) is an intervention study that aims to develop and validate an individually-tailored and "intensively adaptive" intervention to manage weight gain for pregnant women with overweight or obesity using control engineering approaches. This paper presents how Hybrid Model Predictive Control (HMPC) can be used to assign intervention dosages and consequently generate a prescribed intervention with dosages unique to each individuals needs. A Mixed Logical Dynamical (MLD) model enforces the requirements for categorical (discrete-level) doses of intervention components and their sequential assignment into mixed-integer linear constraints. A comprehensive system model that integrates energy balance and behavior change theory, using data from one HMZ participant, is used to illustrate the workings of the HMPC-based control system for the HMZ intervention. Simulations demonstrate the utility of HMPC as a means for enabling optimized complex interventions in behavioral medicine, and the benefits of a HMPC framework in contrast to conventional interventions relying on "IF-THEN" decision rules.
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16
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Ozaslan B, Deshpande S, Doyle FJ, Dassau E. Zone-MPC Automated Insulin Delivery Algorithm Tuned for Pregnancy Complicated by Type 1 Diabetes. Front Endocrinol (Lausanne) 2022; 12:768639. [PMID: 35392357 PMCID: PMC8982146 DOI: 10.3389/fendo.2021.768639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 08/31/2021] [Accepted: 12/30/2021] [Indexed: 01/13/2023] Open
Abstract
Type 1 diabetes (T1D) increases the risk for pregnancy complications. Increased time in the pregnancy glucose target range (63-140 mg/dL as suggested by clinical guidelines) is associated with improved pregnancy outcomes that underscores the need for tight glycemic control. While closed-loop control is highly effective in regulating blood glucose levels in individuals with T1D, its use during pregnancy requires adjustments to meet the tight glycemic control and changing insulin requirements with advancing gestation. In this paper, we tailor a zone model predictive controller (zone-MPC), an optimization-based control strategy that uses model predictions, for use during pregnancy and verify its robustness in-silico through a broad range of scenarios. We customize the existing zone-MPC to satisfy pregnancy-specific glucose control objectives by having (i) lower target glycemic zones (i.e., 80-110 mg/dL daytime and 80-100 mg/dL overnight), (ii) more assertive correction bolus for hyperglycemia, and (iii) a control strategy that results in more aggressive postprandial insulin delivery to keep glucose within the target zone. The emphasis is on leveraging the flexible design of zone-MPC to obtain a controller that satisfies glycemic outcomes recommended for pregnancy based on clinical insight. To verify this pregnancy-specific zone-MPC design, we use the UVA/Padova simulator and conduct in-silico experiments on 10 subjects over 13 scenarios ranging from scenarios with ideal metabolic and treatment parameters for pregnancy to extreme scenarios with such parameters that are highly deviant from the ideal. All scenarios had three meals per day and each meal had 40 grams of carbohydrates. Across 13 scenarios, pregnancy-specific zone-MPC led to a 10.3 ± 5.3% increase in the time in pregnancy target range (baseline zone-MPC: 70.6 ± 15.0%, pregnancy-specific zone-MPC: 80.8 ± 11.3%, p < 0.001) and a 10.7 ± 4.8% reduction in the time above the target range (baseline zone-MPC: 29.0 ± 15.4%, pregnancy-specific zone-MPC: 18.3 ± 12.0, p < 0.001). There was no significant difference in the time below range between the controllers (baseline zone-MPC: 0.5 ± 1.2%, pregnancy-specific zone-MPC: 3.5 ± 1.9%, p = 0.1). The extensive simulation results show improved performance in the pregnancy target range with pregnancy-specific zone MPC, suggest robustness of the zone-MPC in tight glucose control scenarios, and emphasize the need for customized glucose control systems for pregnancy.
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Affiliation(s)
| | | | | | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, United States
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17
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Deshpande S, Podder T, Zhang Y, Zheng Y, Grubb W, Kharouta M, Linden P, Biswas T. Tumor Control and Survival Outcomes Based on Maximum Standardized Uptake Value on FDG-PET/CT in T1-2 NSCLC Treated With SBRT. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Aiello EM, Deshpande S, Ozaslan B, Wolkowicz KL, Dassau E, Pinsker JE, Doyle FJ. Review of Automated Insulin Delivery Systems for Individuals with Type 1 Diabetes: Tailored Solutions for Subpopulations. Curr Opin Biomed Eng 2021; 19. [PMID: 34368518 DOI: 10.1016/j.cobme.2021.100312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Automated insulin delivery (AID) systems have proven safe and effective in improving glycemic outcomes in individuals with type 1 diabetes (T1D). Clinical evaluation of this technology has progressed to large randomized, controlled outpatient studies and recent commercial approval of AID systems for children and adults. However, several challenges remain in improving these systems for different subpopulations (e.g., young children, athletes, pregnant women, seniors and those with hypoglycemia unawareness). In this review, we highlight the requirements and challenges in AID design for selected subpopulations, and discuss current advances from recent clinical studies.
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Affiliation(s)
- Eleonora M Aiello
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Basak Ozaslan
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | - Kelilah L Wolkowicz
- Department of Mechanical Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
| | | | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Avenue, Boston, Massachusetts 02134, USA.,Sansum Diabetes Research Institute, Santa Barbara, CA
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19
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Masieh D, Deshpande S, Nisar MK. AB0610 NORMOCALCAEMIC HYPERPARATHYROIDISM AND BONE HEALTH – WORSE THAN ANTICIPATED? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Since the formal recognition of normocalcaemic hyperparathyroidism (nHPT) as a distinct entity in 2008, several studies have been published describing the characteristics of these individuals. Controversy exists regarding diagnostics and the role of parathyroidectomy in such cases. A chief reason for lack of consensus is the disagreement among experts regarding the potential complications and a bias towards perhaps benign nature of this condition.Objectives:In order to understand the challenges posed by this cohort, we aim to characterise these patients at presentation to our metabolic bone diseases unit with a focus on bone health.Methods:We interrogated our departmental database and undertook retrospective analysis of all patients presenting to metabolic bone service at our large university teaching hospital with a catchment population of 350,000. Individuals were included in the survey based on criteria of Vit D >70 nmol/L, normal calcium (2.20-2.60 mmol/L), eGFR>60ml/min and PTH >6.9 pmol/L measured twice at least three months apart.Results:Over six months review period, of 134 referrals, 42 (31%) were identified with nHPT. Follow up duration was two years. Mean age was 60 years (25-86). 38 (90%) were women with 31 (81%) post menopause. 34 (80%) were of Caucasian descent. All had comorbidities with median of five (1-14). Polypharmacy (>4 prescribed medicines) was common (36/42, 85%) with mean of seven prescribed medications (0-22). Mean Vit D was 88 (70.4-133.6), calcium 2.43 (2.26-2.58), creatinine 69.8 (48-115) and PTH 8.8 (7.2-14.2). Ten (24%) had already had fragility fractures with mean of two (0-4). 21 had DXA scan with mean T score of -3.78 (-2.1 - -6.0). 13/21(31%) had osteoporosis. Oral and IV bisphosphonates, denosumab and teriparatide were prescribed to 12 (28.5%), 14 (33%), 4 (10%) and one patient respectively.Conclusion:Our study suggests high prevalence of nHPT among patients referred to metabolic bone service with confirmed bone health issues. Nearly a third of patients have nHPT in this secondary care setting and a quarter have already suffered fragility fractures. These patients carry high comorbidity, polypharmacy and osteoporosis burden. Management of such patients is challenging owing to complex interplay of various ailments. Bone active agents are required for nearly two-thirds of this group. Though the natural course of nHPT is an area of active research, our data adds to the growing body of evidence that this is not a benign condition with particularly high fracture burden and poor bone quality. nHPT is perhaps responsible for the onset and progression of the similar osseous complications as described in classical PHPT. Further longitudinal studies are required to help devise best management plan to mitigate against the skeletal encumbrance of nHPT.Disclosure of Interests:None declared.
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20
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Deshpande S, Manoharan R, Mitra S. Exogenous β-cyclocitral treatment primes tomato plants against drought by inducing tolerance traits, independent of abscisic acid. Plant Biol (Stuttg) 2021; 23 Suppl 1:170-180. [PMID: 33175459 DOI: 10.1111/plb.13210] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/20/2020] [Indexed: 05/25/2023]
Abstract
Drought is the most devastating stress for crops. Intensity and duration of drought determine the magnitude of plant damage; similarly, plant ability to counteract drought determines its tolerance capacity. Recent studies revealed that exogenous apocarotenoid treatment confers abiotic stress tolerance to plants. However, much less is known about the role of β-cyclocitral (βCC), the major apocarotenoid, in drought tolerance. Here, we demonstrate βCC's role in improving plants' tolerance against drought stress. Tomato (Solanum lycopersicum L.) plants were independently treated with water and βCC and grown under either water-limited or irrigated conditions. The βCC-treated drought-exposed (BD) and βCC-treated irrigated (BH) plants were analysed for the major drought tolerance associated traits; water-treated drought-exposed (CD) and water-treated irrigated plants (CH) were used as controls. On exposure to drought, unlike controls, βCC-treated plants showed no wilting, higher RWC and stomatal conductance, unchanged ABA levels and stomatal closure. The BD plants had increased photosynthesis, chlorophyll content and enhanced root, but not shoot, growth. In addition, βCC treatment enhanced proline accumulation and activity of SOD in both drought-exposed and well irrigated plants. Taken together, βCC was identified as a potential candidate that improves tomato osmolyte accumulation and superoxide elimination, independent of ABA, and prepares the plant for upcoming drought stress. Our results suggest that βCC can be used to prime crops against drought stress.
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Affiliation(s)
- S Deshpande
- Department of Botany, Savitribai Phule Pune University (Formerly University of Pune), Pune, India
| | - R Manoharan
- Department of Botany, Savitribai Phule Pune University (Formerly University of Pune), Pune, India
| | - S Mitra
- Department of Botany, Savitribai Phule Pune University (Formerly University of Pune), Pune, India
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21
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Deshpande S, Krishnan R, Logan M, Mizzoni C, Kobylecky E, Dalle Fusine I, Lum R, Rhodes C, Pigeau G. Development and qualification of a standardized flow cytometry panel for the characterization of car-t cell products across sites. Cytotherapy 2021. [DOI: 10.1016/s1465324921006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Trivedi J, Alsoufi B, Slaughter M, Deshpande S, Das B. Outcomes of ECMO versus VAD in Children with Congenital Heart Disease as a Bridge to Transplant in Recent Era: Analysis from United Network for Organ Sharing Database. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cescon M, Deshpande S, Nimri R, Doyle Iii FJ, Dassau E. Using Iterative Learning for Insulin Dosage Optimization in Multiple-Daily-Injections Therapy for People With Type 1 Diabetes. IEEE Trans Biomed Eng 2021; 68:482-491. [PMID: 32746043 DOI: 10.1109/tbme.2020.3005622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this work, we design iterative algorithms for the delivery of long-acting (basal) and rapid-acting (bolus) insulin, respectively, for people with type 1 diabetes (T1D) on multiple-daily-injections (MDIs) therapy using feedback from self-monitoring of blood glucose (SMBG) measurements. METHODS Iterative learning control (ILC) updates basal therapy consisting of one long-acting insulin injection per day, while run-to-run (R2R) adapts meal bolus therapy via the update of the mealtime-specific insulin-to-carbohydrate ratio (CR). Updates are due weekly and are based upon sparse SMBG measurements. RESULTS Upon termination of the 20 weeks long in-silico trial, in a scenario characterized by meal carbohydrate (CHO) normally distributed with mean μ = [50, 75, 75] grams and standard deviation σ = [5, 7, 7] grams, our strategy produced statistically significant improvements in time in range (70--180) [mg/dl], from 66.9(33.1) % to 93.6(6.7) %, p = 0.02. CONCLUSIONS Iterative learning shows potential to improve glycemic regulation over time by driving blood glucose closer to the recommended glycemic targets. SIGNIFICANCE Decision support systems (DSSs) and automated therapy advisors such as the one proposed here are expected to improve glycemic outcomes reducing the burden on patients on MDI therapy.
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Pinsker JE, Deshpande S, McCrady-Spitzer S, Church MM, Kaur RJ, Perez J, Desjardins D, Piper M, Reid C, Doyle FJ, Kudva YC, Dassau E. Use of the Interoperable Artificial Pancreas System for Type 1 Diabetes Management During Psychological Stress. J Diabetes Sci Technol 2021; 15:184-185. [PMID: 32783473 PMCID: PMC7783021 DOI: 10.1177/1932296820948566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/29/2023]
Affiliation(s)
| | - Sunil Deshpande
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | | | - Jimena Perez
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | | | - Molly Piper
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - Corey Reid
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Francis J. Doyle
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Eyal Dassau
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Joslin Diabetes Center, Boston, MA, USA
- Eyal Dassau, PhD, Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford St., Rm. 317, Cambridge, MA 02138, USA.
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Deshpande S, Pinsker JE, Church MM, Piper M, Andre C, Massa J, Doyle III FJ, Eisenberg DM, Dassau E. Randomized Crossover Comparison of Automated Insulin Delivery Versus Conventional Therapy Using an Unlocked Smartphone with Scheduled Pasta and Rice Meal Challenges in the Outpatient Setting. Diabetes Technol Ther 2020; 22:865-874. [PMID: 32319791 PMCID: PMC7757622 DOI: 10.1089/dia.2020.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/27/2022]
Abstract
Background: Automated Insulin Delivery (AID) hybrid closed-loop systems have not been well studied in the context of prescribed meals. We evaluated performance of our interoperable artificial pancreas system (iAPS) in the at-home setting, running on an unlocked smartphone, with scheduled meal challenges in a randomized crossover trial. Methods: Ten adults with type 1 diabetes completed 2 weeks of AID-based control and 2 weeks of conventional therapy in random order where they consumed regular pasta or extra-long grain white rice as part of a complete dinner meal on six different occasions in both arms (each meal thrice in random order). Surveys assessed satisfaction with AID use. Results: Postprandial differences in conventional therapy were 10,919.0 mg/dL × min (95% confidence interval [CI] 3190.5-18,648.0, P = 0.009) for glucose area under the curve (AUC) and 40.9 mg/dL (95% CI 4.6-77.3, P = 0.03) for peak continuous glucose monitor glucose, with rice showing greater increases than pasta. White rice resulted in a lower estimate over pasta by a factor of 0.22 (95% CI 0.08-0.63, P = 0.004) for AUC under 70 mg/dL. These glycemic differences in both meal types were reduced under AID-based control and were not statistically significant, where 0-2 h insulin delivery decreased by 0.45 U for pasta (P = 0.001) and by 0.27 U for white rice (P = 0.01). Subjects reported high overall satisfaction with the iAPS. Conclusions: The AID system running on an unlocked smartphone improved postprandial glucose control over conventional therapy in the setting of challenging meals in the outpatient setting. Clinical Trial Registry: clinicaltrials.gov NCT03767790.
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Affiliation(s)
- Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | | | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Molly Piper
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Camille Andre
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Jennifer Massa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Francis J. Doyle III
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - David M. Eisenberg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
- Joslin Diabetes Center, Boston, Massachusetts, USA
- Address correspondence to: Eyal Dassau, PhD, Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford St., Rm. 317, Cambridge, MA 02138, USA
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Hinduja RH, Kannan V, Anand V, Bajpai R, Deshpande S, Naidu S, Chauhan K, Umbarkar P, Kabre R, Alurkar P. PO-0971: Factors predicting magnitude of heart dose reduction with DIBH-RT in left breast cancers. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Deshpande S, Naidu S, Chavan K, Kannan V. PO-1396: Dosimetric comparison of AAA and Acuros XB algorithm for breast DIBH VMAT treatment. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Townsend M, Karamlou T, Boyle G, Feingold B, Daly K, Deshpande S, Auerbach S, Worley S, Liu W, Saarel E, Amdani S. Brighter Future for Children with Congenital Heart Disease Requiring Heart Transplantation? A UNOS Registry Analysis over the Last Three Decades. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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29
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Yo S, Wimaleswaran H, Deshpande S, Cheung T, Buzacott H, Serraglio C, Wong AM, Landry S, Thomson L, Edwards B, Mansfield D, Joosten S, Hamilton G. Sleeping position during unattended home polysomnography compared to habitual sleeping position and the potential impact on measured sleep apnea severity. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Redkar S, Redkar V, Redkar S, Inamdar M, Inamdar A, Jagtap M, Khanolkar D, Shradhha R, Kulkarni S, Deshpande S. Clinical interventions to manage sleep apnea in patients with stroke: Systematic review and meta analysis of the ongoing clinical trials. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Deshpande S, Grubb W, Kharouta M, Sun A, Podder T, Zhang Y, Zheng Y, Linden P, Towe C, Perry Y, Machtay M, Biswas T. Predictors of Radiation Pneumonitis after Lung SBRT for Early Stage Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Zavitsanou S, Massa J, Deshpande S, Pinsker JE, Church MM, Andre C, Doyle III FJ, Michelson A, Creason J, Dassau E, Eisenberg DM. The Effect of Two Types of Pasta Versus White Rice on Postprandial Blood Glucose Levels in Adults with Type 1 Diabetes: A Randomized Crossover Trial. Diabetes Technol Ther 2019; 21:485-492. [PMID: 31225739 PMCID: PMC6708265 DOI: 10.1089/dia.2019.0109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Indexed: 12/11/2022]
Abstract
Background: Food choices are essential to successful glycemic control for people with diabetes. We compared the impact of three carbohydrate-rich meals on the postprandial glycemic response in adults with type 1 diabetes (T1D). Methods: We performed a randomized crossover study in 12 adults with T1D (age 58.7 ± 14.2 years, baseline hemoglobin A1c 7.5% ± 1.3%) comparing the postprandial glycemic response to three meals using continuous glucose monitoring: (1) "higher protein" pasta containing 10 g protein/serving, (2) regular pasta with 7 g protein/serving, and (3) extra-long grain white rice. All meals contained 42 g carbohydrate; were served with homemade tomato sauce, green salad, and balsamic dressing; and were repeated twice in random order. After their insulin bolus, subjects were observed in clinic for 5 h. Linear mixed effects models were used to assess the glycemic response. Results: Compared with white rice, peak glucose levels were significantly lower for higher protein pasta (-32.6 mg/dL; 95% CI -48.4 to -17.2; P < 0.001) and regular pasta (-43.2 mg/dL, 95% CI -58.7 to -27.7; P < 0.001). The difference between the two types of pastas did not reach statistical significance (-11 mg/dL; 95% CI -24.1 to 3.4; P = 0.17). Total glucose area under the curve was also significantly higher for white rice compared with both pastas (P < 0.001 for both comparisons). Conclusions: This exploratory study concluded that different food types of similar macronutrient content (e.g., rice and pasta) generate significantly different postprandial glycemic responses in persons with T1D. These results provide useful insights into the impact of food choices on and optimization of glucose control. Clinical Trial Registry: clinicaltrials.gov NCT03362151.
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Affiliation(s)
- Stamatina Zavitsanou
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Jennifer Massa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
| | | | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Camille Andre
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Francis J. Doyle III
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
| | | | - Jamie Creason
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
- Joslin Diabetes Center, Boston, Massachusetts
| | - David M. Eisenberg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Address correspondence to: David M. Eisenberg, MD, Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, Room 337, Boston, MA 02115
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Mulla C, Zavitsanou S, Laguna Sanz A, Pober D, Richardson L, Deshpande S, Walcott P, Arora I, Newswanger B, Cummins M, Prestrelski S, Doyle F, Dassau E, Patti M. OR22-3 Closed-Loop Glucagon Pump: A Novel and Effective Strategy for Post-Bariatric Hypoglycemia. J Endocr Soc 2019. [PMCID: PMC6555051 DOI: 10.1210/js.2019-or22-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/27/2022] Open
Abstract
Current therapies for post-bariatric hypoglycemia (PBH) are incompletely effective. We previously reported feasibility of an open-loop glucagon system for this challenging syndrome. In this study, patients with PBH were enrolled in a double-masked, placebo-controlled, crossover trial to determine the efficacy of a closed-loop mini-dose glucagon delivery system to reduce severe hypoglycemia after a mixed meal. A novel hypoglycemia detection & mitigation algorithm was embedded in the Artificial Pancreas System connected to a continuous glucose monitor (CGM, Dexcom) driving a patch infusion pump (Insulet) filled with study drug (Xeris liquid glucagon or vehicle). After screening and enrollment, CGM were placed; participants returned after an overnight fast for the 1st of 2 study visits. A liquid mixed meal (Ensure Compact: 64 g CHO, 18 g protein, 236 mL) was consumed, and sensor/plasma glucose were measured serially. The system autonomously delivered up to 2 doses of study drug (300/150 mcg of glucagon or equal volume vehicle) if triggered by the hypoglycemia mitigation algorithm. If plasma glucose fell to <55 mg/dL or neuroglycopenia occurred, rescue IV dextrose was given per protocol. During a 2nd study visit, the protocol was repeated, with pump filled with the other study drug. Twelve participants (11F/1M, age 52+2, postoperative duration 8+1 years, mean+SEM) completed all study visits. In an additional 3 participants, the mixed meal did not trigger either alarm or hypoglycemia, so study drug was not administered, and a second visit was not conducted. For the 12 participants receiving glucagon vs. vehicle during 2 study visits, predictive hypoglycemia alerts prompted automated drug delivery at mean 94+6 vs. 89+5 (p=0.41) minutes post meal, when sensor glucose was 114+7 vs. 121+5 mg/dL (p=0.39). Four participants did not require rescue during either visit; 1 participant required rescue during both visits. Seven participants required rescue glucose after vehicle but not after glucagon (p=0.0082). Similarly, 5 participants had severe hypoglycemia (plasma glucose <55 mg/dL) after vehicle but not after glucagon (p=0.03). Nadir plasma glucose was higher in study visits with glucagon vs. vehicle delivery (67.4±2.7 vs. 58.5±1.9 mg/dL, p=0.004). Glucagon levels were not elevated at time of alert (14.6±1.4 pg/mL) but rose after glucagon delivery (1231±187 vs. vehicle 16 ±1.4 pg/mL at 30 minutes, p = 0.001). No rebound hyperglycemia occurred. Emesis occurred before study drug delivery in 2 visits. Transient pain at infusion site was reported during both glucagon (n=11 of 12) and vehicle (n=10 of 12) study visits. No other adverse advents were observed. Our data demonstrate that a CGM-guided glucagon closed-loop system can detect imminent hypoglycemia and deliver mini-dose glucagon, yielding improvements in post-meal glucose and reducing severe hypoglycemia in patients with PBH.
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Affiliation(s)
| | - Stamatina Zavitsanou
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, United States
| | - Alejandro Laguna Sanz
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, United States
| | - David Pober
- Joslin Diabetes Center, Boston, MA, United States
| | | | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, United States
| | | | - Ipsa Arora
- Joslin Diabetes Center, Boston, MA, United States
| | | | | | | | - Francis Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, United States
| | - Eyal Dassau
- Joslin Diabetes Center, Boston, MA, United States
| | - Mary Patti
- Research Div, Joslin Diabetes Center, Boston, MA, United States
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Callie C, Dinsdale G, Deshpande S, Jameson M. PO-1128 Clinical implementation of deformable image registration (DIR). Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Brace O, Alhujali S, Deshpande S, Vial P, Metcalfe P, Lerch M, Petasecca M, Rosenfeld A. EP-1753 A dual detector system for in-vivo dosimetry: transit dose verification and error identification. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Miller AR, Jackson D, Hui C, Deshpande S, Kuo E, Hamilton GS, Lau KK. Lung nodules are reliably detectable on ultra-low-dose CT utilising model-based iterative reconstruction with radiation equivalent to plain radiography. Clin Radiol 2019; 74:409.e17-409.e22. [PMID: 30832990 DOI: 10.1016/j.crad.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/06/2019] [Indexed: 12/21/2022]
Abstract
AIM To determine if ultra-low-dose (ULD) computed tomography (CT) utilising model-based iterative reconstruction (MBIR) with radiation equivalent to plain radiography allows the detection of lung nodules. MATERIALS AND METHODS Ninety-nine individuals undergoing surveillance of solid pulmonary nodules undertook a low-dose (LD) and ULD CT during the same sitting. Image pairs were read blinded, in random order, and independently by two experienced thoracic radiologists. With LD-CT as the reference standard, the number, size, and location of nodules was compared, and inter-rater agreement was established. RESULTS There was very good inter-rater agreement with regards nodules ≥4mm for both the LD- (k=0.931) and ULD-CT (k=0.869). One hundred and ninety-nine nodules were reported on the LD-CT by both radiologists and 196 reported on the ULD-CT, with no nodules reported only on the ULD-CT. This gives a sensitivity of 98.5% and specificity of 100% for ULD-CT with MBIR. The effective dose of radiation was significantly different between the two scans (p<0.0001), 1.67 mSv for the LD-CT and 0.13 mSv for the ULD-CT. CONCLUSION ULD-CT utilising MBIR and delivering radiation equivalent to plain radiography, allows detection of lung nodules with high sensitivity. The attendant 10-fold reduction in radiation may allow for dramatic reductions in cumulative radiation exposure.
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Affiliation(s)
- A R Miller
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia; Monash University, Clayton, Victoria, Australia; General Medicine, Monash Health, Clayton, Victoria, Australia.
| | - D Jackson
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - C Hui
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - S Deshpande
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
| | - E Kuo
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
| | - G S Hamilton
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia; Monash University, Clayton, Victoria, Australia
| | - K K Lau
- General Medicine, Monash Health, Clayton, Victoria, Australia; Monash Imaging, Monash Health, Clayton, Victoria, Australia
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37
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Al Nahas K, Cama J, Schaich M, Hammond K, Deshpande S, Dekker C, Ryadnov MG, Keyser UF. A microfluidic platform for the characterisation of membrane active antimicrobials. Lab Chip 2019; 19:837-844. [PMID: 30698187 PMCID: PMC6404476 DOI: 10.1039/c8lc00932e] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/05/2018] [Indexed: 05/21/2023]
Abstract
The spread of bacterial resistance against conventional antibiotics generates a great need for the discovery of novel antimicrobials. Polypeptide antibiotics constitute a promising class of antimicrobial agents that favour attack on bacterial membranes. However, efficient measurement platforms for evaluating their mechanisms of action in a systematic manner are lacking. Here we report an integrated lab-on-a-chip multilayer microfluidic platform to quantify the membranolytic efficacy of such antibiotics. The platform is a biomimetic vesicle-based screening assay, which generates giant unilamellar vesicles (GUVs) in physiologically relevant buffers on demand. Hundreds of these GUVs are individually immobilised downstream in physical traps connected to separate perfusion inlets that facilitate controlled antibiotic delivery. Antibiotic efficacy is expressed as a function of the time needed for an encapsulated dye to leak out of the GUVs as a result of antibiotic treatment. This proof-of-principle study probes the dose response of an archetypal polypeptide antibiotic cecropin B on GUVs mimicking bacterial membranes. The results of the study provide a foundation for engineering quantitative, high-throughput microfluidics devices for screening antibiotics.
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Affiliation(s)
- K. Al Nahas
- Cavendish Laboratory
, Univ. of Cambridge
,
JJ Thomson Avenue
, Cambridge CB3 0HE
, UK
.
| | - J. Cama
- Cavendish Laboratory
, Univ. of Cambridge
,
JJ Thomson Avenue
, Cambridge CB3 0HE
, UK
.
| | - M. Schaich
- Cavendish Laboratory
, Univ. of Cambridge
,
JJ Thomson Avenue
, Cambridge CB3 0HE
, UK
.
| | - K. Hammond
- National Physical Laboratory
,
Hampton Road, Teddington
, Middlesex TW11 0LW
, UK
| | - S. Deshpande
- Kavli Institute of Nanoscience
, Delft Univ. of Technology
,
van der Maasweg 9
, Delft 2629 HZ
, Netherlands
| | - C. Dekker
- Kavli Institute of Nanoscience
, Delft Univ. of Technology
,
van der Maasweg 9
, Delft 2629 HZ
, Netherlands
| | - M. G. Ryadnov
- National Physical Laboratory
,
Hampton Road, Teddington
, Middlesex TW11 0LW
, UK
| | - U. F. Keyser
- Cavendish Laboratory
, Univ. of Cambridge
,
JJ Thomson Avenue
, Cambridge CB3 0HE
, UK
.
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38
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Shah I, Jadhao N, Mali N, Deshpande S, Gogtay N, Thatte U. Pharmacokinetics of isoniazid in Indian children with tuberculosis on daily treatment. Int J Tuberc Lung Dis 2019; 23:52-57. [DOI: 10.5588/ijtld.18.0463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- I. Shah
- Paediatric Tuberculosis Clinic, Department of Paediatrics, B J Wadia Hospital for Children, Mumbai
| | - N. Jadhao
- Paediatric Tuberculosis Clinic, Department of Paediatrics, B J Wadia Hospital for Children, Mumbai
| | - N. Mali
- Department of Clinical Pharmacology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - S. Deshpande
- Department of Clinical Pharmacology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - N. Gogtay
- Department of Clinical Pharmacology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - U. Thatte
- Department of Clinical Pharmacology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
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Deshpande S, Pinsker JE, Zavitsanou S, Shi D, Tompot R, Church MM, Andre C, Doyle FJ, Dassau E. Design and Clinical Evaluation of the Interoperable Artificial Pancreas System (iAPS) Smartphone App: Interoperable Components with Modular Design for Progressive Artificial Pancreas Research and Development. Diabetes Technol Ther 2019; 21:35-43. [PMID: 30547670 PMCID: PMC6350072 DOI: 10.1089/dia.2018.0278] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 01/10/2023]
Abstract
BACKGROUND There is an unmet need for a modular artificial pancreas (AP) system for clinical trials within the existing regulatory framework to further AP research projects from both academia and industry. We designed, developed, and tested the interoperable artificial pancreas system (iAPS) smartphone app that can interface wirelessly with leading continuous glucose monitors (CGM), insulin pump devices, and decision-making algorithms while running on an unlocked smartphone. METHODS After algorithm verification, hazard and mitigation analysis, and complete system verification of iAPS, six adults with type 1 diabetes completed 1 week of sensor-augmented pump (SAP) use followed by 48 h of AP use with the iAPS, a Dexcom G5 CGM, and either a Tandem or Insulet insulin pump in an investigational device exemption study. The AP system was challenged by participants performing extensive walking without exercise announcement to the controller, multiple large meals eaten out at restaurants, two overnight periods, and multiple intentional connectivity interruptions. RESULTS Even with these intentional challenges, comparison of the SAP phase with the AP study showed a trend toward improved time in target glucose range 70-180 mg/dL (78.8% vs. 83.1%; P = 0.31), and a statistically significant reduction in time below 70 mg/dL (6.1% vs. 2.2%; P = 0.03). The iAPS system performed reliably and showed robust connectivity with the peripheral devices (99.8% time connected to CGM and 94.3% time in closed loop) while requiring limited user intervention. CONCLUSIONS The iAPS system was safe and effective in regulating glucose levels under challenging conditions and is suitable for use in unconstrained environments.
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Affiliation(s)
- Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
| | | | - Stamatina Zavitsanou
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Dawei Shi
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
| | | | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Camille Andre
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Sansum Diabetes Research Institute, Santa Barbara, California
- Joslin Diabetes Center, Boston, Massachusetts
- Address correspondence to: Eyal Dassau, PhD, Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Room 317, Cambridge, MA 02138
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40
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Rigby M, Deshpande S, Blair M. Published Mortality Datasets – is Perfection the Enemy of Credibility? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.333] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Rigby
- Imperial College London, London, UK
| | | | - M Blair
- Imperial College London, London, UK
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41
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Rigby M, Greenfield R, Deshpande S, Blair M. Are we Serious – and Ethical – about HPV Vaccination in Europe? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.806] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Rigby
- Imperial College, London, UK
| | | | | | - M Blair
- Imperial College, London, UK
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42
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Rigby M, Greenfield R, Deshpande S, Blair M. Who holds Tetanus Records when they are Needed? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.803] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Rigby
- Imperial College, London, UK
| | | | | | - M Blair
- Imperial College, London, UK
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43
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Venkatesan K, Deshpande S, Anand V, Bajpai R, Naidu S, Babu V, Nagshet S, Mittal V, Deshmane V. Comparison of Heart and Lung Doses in Deep Inspiration Breath Hold Radiation Therapy and Prone Position Radiation Therapy for Whole Breast Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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44
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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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Gambetta K, Wittlieb-Weber C, Bock M, Villa C, Johnson J, Lal A, Schumacher K, Law S, Deshpande S, West S, Friedland-Little J, Lytrivi I, Butts R, Cunningham C, Knecht K, McCullough M. Impact of Genotype on Boys with Duchenne Muscular Dystrophy. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Oar A, Rai R, Jameson M, Deshpande S, Liney G, Juresic E, Veneran J, Dinsdale G, Elwadia D, Kumar S, Lee M. OC-0295: The feasibility of volumetric 4DMRI in upper abdominal radiation therapy treatment planning. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30605-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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47
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Brace O, Alhujaili S, Deshpande S, Vial P, Metcalfe P, Lerch M, Petasecca M, Rosenfeld A. EP-1773: Dual detector prototype for on line dose verification during patient radiotherapy treatment. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Deshpande S, Blake S, Holloway L, Vial P. EP-1791: Evaluation of a water equivalent EPID model for flattening filter free (FFF) beam transit dosimetry. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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49
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Parkes JP, Wood L, Chadburn AJ, Garman E, Abbas R, Modupe A, Whitehead SJ, Ford C, Thomas OL, Chugh S, Deshpande S, Gama R. The effect of the acute phase response on routine laboratory markers of folate and vitamin B12 status. Int J Lab Hematol 2018; 40:e21-e23. [PMID: 29405641 DOI: 10.1111/ijlh.12778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J P Parkes
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - L Wood
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A J Chadburn
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - E Garman
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Abbas
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Modupe
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - S J Whitehead
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C Ford
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - O L Thomas
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - S Chugh
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - S Deshpande
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Gama
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,Research Institute, Healthcare Sciences, Wolverhampton University, Wolverhampton, UK
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50
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Laguna Sanz AJ, Mulla CM, Fowler KM, Cloutier E, Goldfine AB, Newswanger B, Cummins M, Deshpande S, Prestrelski SJ, Strange P, Zisser H, Doyle FJ, Dassau E, Patti ME. Design and Clinical Evaluation of a Novel Low-Glucose Prediction Algorithm with Mini-Dose Stable Glucagon Delivery in Post-Bariatric Hypoglycemia. Diabetes Technol Ther 2018; 20:127-139. [PMID: 29355439 PMCID: PMC5771550 DOI: 10.1089/dia.2017.0298] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/29/2022]
Abstract
BACKGROUND Postbariatric hypoglycemia (PBH) is a complication of bariatric surgery with limited therapeutic options. We developed an event-based system to predict and detect hypoglycemia based on continuous glucose monitor (CGM) data and recommend delivery of minidose liquid glucagon. METHODS We performed an iterative development clinical study employing a novel glucagon delivery system: a Dexcom CGM connected to a Windows tablet running a hypoglycemia prediction algorithm and an Omnipod pump filled with an investigational stable liquid glucagon formulation. Meal tolerance testing was performed in seven participants with PBH and history of neuroglycopenia. Glucagon was administered when hypoglycemia was predicted. Primary outcome measures included the safety and feasibility of this system to predict and prevent severe hypoglycemia. Secondary outcomes included hypoglycemia prediction by the prediction algorithm, minimization of time below hypoglycemia threshold using glucagon, and prevention of rebound hyperglycemia. RESULTS The hypoglycemia prediction algorithm alerted for impending hypoglycemia in the postmeal state, prompting delivery of glucagon (150 μg). After observations of initial incomplete efficacy to prevent hypoglycemia in the first two participants, system modifications were implemented: addition of PBH-specific detection algorithm, increased glucagon dose (300 μg), and a second glucagon dose if needed. These modifications, together with rescue carbohydrates provided to some participants, contributed to progressive improvements in glucose time above the hypoglycemia threshold (75 mg/dL). CONCLUSIONS Preliminary results indicate that our event-based automatic monitoring algorithm successfully predicted likely hypoglycemia. Minidose glucagon therapy was well tolerated, without prolonged or severe hypoglycemia, and without rebound hyperglycemia.
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Affiliation(s)
- Alejandro J. Laguna Sanz
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | | | - Emilie Cloutier
- Research Division, Joslin Diabetes Center, Boston, Massachusetts
| | | | - Brett Newswanger
- Research and Development Xeris Pharmaceuticals, Inc., Austin, Texas
| | - Martin Cummins
- Research and Development Xeris Pharmaceuticals, Inc., Austin, Texas
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | - Poul Strange
- Research and Development Xeris Pharmaceuticals, Inc., Austin, Texas
| | - Howard Zisser
- Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, California
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Research Division, Joslin Diabetes Center, Boston, Massachusetts
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