Adding Heart Rate Signal to a Control-to-Range Artificial Pancreas System Improves the Protection Against Hypoglycemia During Exercise in Type 1 Diabetes
Open accessAbstract
Background: We present a clinical trial establishing the feasibility of a control-to-range (CTR) closed-loop system informed by heart rate (HR) and assess the effect of HR information added to CTR on the risk for hypoglycemia during and after exercise. Subjects and Methods: Twelve subjects with type 1 diabetes (five men, seven women; weight, 68.9±3.1 kg; age, 38±3.3 years; glycated hemoglobin, 6.9±0.2%) participated in a randomized crossover clinical trial comparing CTR versus CTR+HR in two 26-h admissions, each including 30 min of mild exercise. The CTR algorithm was implemented in the DiAs portable artificial pancreas platform based on an Android ® (Google, Mountainview, CA) smartphone. We assessed blood glucose (BG) decline during exercise, the Low BG Index (LBGI) (a measure of hypoglycemic risk), number of hypoglycemic episodes (BG <70 mg/dL) and overall glucose control (percentage time within the target range 70 mg/dL≤BG≤180 mg/dL). Results: Using HR to inform the CTR algorithm reduced significantly the BG decline during exercise ( P =0.022), indicated marginally lower LBGI ( P =0.3) and fewer hypoglycemic events during exercise (none vs. two events; P =0.16), and resulted in overall higher percentage time within the target range (81% vs. 75%; P =0.2). LBGI and average BG remained unchanged overall, during recovery, and overnight. Conclusions: HR-informed closed-loop control can be implemented in a portable artificial pancreas. Although closed loop has been shown to reduce hypoglycemia, adding HR signal may further limit the risk for hypoglycemia during and immediately after exercise. The most prominent effect of adding HR information is reduced BG decline during exercise, without deterioration of overall glycemic control.
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Automated insulin delivery systems can potentially modify insulin dosing in response to activity monitors to reduce the risk or severity of exercise-induced hypoglycemia in people living with type 1 diabetes.
“Automated insulin delivery systems can potentially modify insulin dosing in response to activity monitors to reduce the risk (or severity) of exercise-induced hypoglycemia in people living with type 1 diabetes [7-10].”
From Accuracy of Wrist-Worn Activity Monitors During Common Daily Physical Activities and Types of Structured Exercise: Evaluation Study (2018) · cites this paper as [10]
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- Authors
- Breton, M. D., Brown, S. A., Karvetski, C. H., Kollar, L., Topchyan, K. A., Anderson, S. M., & Kovatchev, B. P.
- Affiliations
- University of Virginia (US)
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2014-08
- Volume
- 16
- Issue
- 8
- Pages
- 506-511
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- PMC
- PMC4116126
- OpenAlex
- W2333815048
- Cited by
- 128
- References
- 30
- Citations by year
- 2025: 10 · 2024: 4 · 2023: 6 · 2022: 9 · 2021: 9 · 2020: 9 · 2019: 19 · 2018: 17 · 2017: 18 · 2016: 11 · 2015: 14 · 2014: 2
- FWCI
- 12.06
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Insulet Corporation
- Dexcom
- National Institutes of Health
- University of California, Santa Barbara
- National Institute of Diabetes and Digestive and Kidney Diseases (R21DK085641)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, artificial pancreas, heart rate, hypoglycemia prevention, physical activity, low blood glucose index, glycemic control
- MeSH terms
- Adult, Algorithms, Blood Glucose, Diabetes Mellitus, Type 1, Feasibility Studies, Female, Heart Rate, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Monitoring, Physiologic, Pilot Projects, Exercise, Treatment Outcome, Cross-Over Studies, Pancreas, Artificial
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