A Controlled Study of the Effectiveness of an Adaptive Closed-Loop Algorithm to Minimize Corticosteroid-Induced Stress Hyperglycemia in Type 1 Diabetes
Open accessAbstract
To be effective in type 1 diabetes, algorithms must be able to limit hyperglycemic excursions resulting from medical and emotional stress. We tested an algorithm that estimates insulin sensitivity at regular intervals and continually adjusts gain factors of a fading memory proportional-derivative (FMPD) algorithm. In order to assess whether the algorithm could appropriately adapt and limit the degree of hyperglycemia, we administered oral hydrocortisone repeatedly to create insulin resistance. We compared this indirect adaptive proportional-derivative (APD) algorithm to the FMPD algorithm, which used fixed gain parameters. Each subject with type 1 diabetes ( n = 14) was studied on two occasions, each for 33 h. The APD algorithm consistently identified a fall in insulin sensitivity after hydrocortisone. The gain factors and insulin infusion rates were appropriately increased, leading to satisfactory glycemic control after adaptation (premeal glucose on day 2, 148 ± 6 mg/dl). After sufficient time was allowed for adaptation, the late postprandial glucose increment was significantly lower than when measured shortly after the onset of the steroid effect. In addition, during the controlled comparison, glycemia was significantly lower with the APD algorithm than with the FMPD algorithm. No increase in hypoglycemic frequency was found in the APD-only arm. An afferent system of duplicate amperometric sensors demonstrated a high degree of accuracy; the mean absolute relative difference of the sensor used to control the algorithm was 9.6 ± 0.5%. We conclude that an adaptive algorithm that frequently estimates insulin sensitivity and adjusts gain factors is capable of minimizing corticosteroid-induced stress hyperglycemia.
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Cites
Nonlinear model predictive control of glucose concentration in subjects with type 1 diabetes
Hovorka, R., Canonico, V., Chassin, L. J., Haueter, U., Massi-Benedetti, M., Federici, M. O., Pieber, T. R., Schaller, H. C., Schaupp, L., Vering, T., et al. (2004) · Physiological Measurement · doi:10.1088/0967-3334/25/4/010 · Cited by 1,274 · see citing works
<i>In Silico</i> Preclinical Trials: A Proof of Concept in Closed-Loop Control of Type 1 Diabetes
Kovatchev, B. P., Breton, M., Dalla Man, C., & Cobelli, C. (2009) · Journal of Diabetes Science and Technology · doi:10.1177/193229680900300106 · Cited by 760 · see citing works
Glucocorticoids and insulin resistance: old hormones, new targets
ANDREWS, R. C., & WALKER, B. R. (1999) · Clinical Science · doi:10.1042/cs0960513 · Cited by 731 · see citing works
RIZZA, R. A., MANDARINO, L. J., & GERICH, J. E. (1982) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-54-1-131 · Cited by 696 · see citing works
WEINZIMER, S. A., Steil, G. M., Swan, K. L., Dziura, J., Kurtz, N., & Tamborlane, W. V. (2008) · Diabetes Care · doi:10.2337/dc07-1967 · Cited by 567 · see citing works
Wound healing and diabetes mellitus
Greenhalgh, D. G. (2003) · Clinics in Plastic Surgery · doi:10.1016/s0094-1298(02)00066-4 · Cited by 510 · see citing works
A Bihormonal Closed-Loop Artificial Pancreas for Type 1 Diabetes
El-Khatib, F. H., Russell, S. J., Nathan, D. M., Sutherlin, R. G., & Damiano, E. R. (2010) · Science Translational Medicine · doi:10.1126/scitranslmed.3000619 · Cited by 403 · see citing works
Model Predictive Control of Type 1 Diabetes: An <i>in Silico</i> Trial
Magni, L., Raimondo, D. M., Bossi, L., Dalla Man, C., De Nicolao, G., Kovatchev, B., & Cobelli, C. (2007) · Journal of Diabetes Science and Technology · doi:10.1177/193229680700100603 · Cited by 317 · see citing works
MD-Logic Artificial Pancreas System
Atlas, E., Nimri, R., Miller, S., Grunberg, E. A., & Phillip, M. (2010) · Diabetes Care · doi:10.2337/dc09-1830 · Cited by 266 · see citing works
Hann, C. E., Chase, J. G., Lin, J., Lotz, T., Doran, C. V., & Shaw, G. M. (2005) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2004.10.006 · Cited by 251 · see citing works
Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients
Donihi, A. C., Raval, D., Saul, M., Korytkowski, M. T., & DeVita, M. A. (2006) · Endocrine Practice · doi:10.4158/ep.12.4.358 · Cited by 246 · see citing works
Hovorka, R., Kumareswaran, K., Harris, J., Allen, J. M., Elleri, D., Xing, D., Kollman, C., Nodale, M., Murphy, H. R., Dunger, D. B., et al. (2011) · BMJ · doi:10.1136/bmj.d1855 · Cited by 244 · see citing works
Insulin Kinetics in Type-1 Diabetes: Continuous and Bolus Delivery of Rapid Acting Insulin
Wilinska, M. E., Chassin, L. J., Schaller, H. C., Schaupp, L., Pieber, T. R., & Hovorka, R. (2004) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2004.839639 · Cited by 236 · see citing works
Novel Use of Glucagon in a Closed-Loop System for Prevention of Hypoglycemia in Type 1 Diabetes
Castle, J. R., Engle, J. M., Youssef, J. E., Massoud, R. G., Yuen, K. C. J., Kagan, R., & Ward, W. K. (2010) · Diabetes Care · doi:10.2337/dc09-2254 · Cited by 232 · see citing works
Self-citationPrognostic value of admission plasma glucose and HbA1c in acute myocardial infarction
Hadjadj, S., Coisne, D., Mauco, G., Ragot, S., Duengler, F., Sosner, P., Torremocha, F., Herpin, D., & Maréchaud, R. (2004) · Diabetic Medicine · doi:10.1111/j.1464-5491.2004.01112.x · Cited by 149 · see citing works
Validation of a model-based virtual trials method for tight glycemic control in intensive care
Chase, J. G., Suhaimi, F. M., Penning, S., Preiser, J., Compte, A. J. L., Lin, J., Pretty, C. G., Shaw, G. M., Moorhead, K. T., & Desaive, T. (2010) · BioMedical Engineering OnLine · doi:10.1186/1475-925x-9-84 · Cited by 123 · see citing works
Alford, F., Beck-Nielsen, H., Ward, G. M., & Henriksen, J. E. (1997) · Diabetologia · doi:10.1007/s001250050847 · Cited by 115 · see citing works
Optimal $H^infty$ Insulin Injection Control for Blood Glucose Regulation in Diabetic Patients
Chee, F., Savkin, A. V., Fernando, T. L., et al. (2005) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2005.855727 · Cited by 103 · see citing works
An Insulin Infusion Advisory System Based on Autotuning Nonlinear Model-Predictive Control
Zarkogianni, K., Vazeou, A., Mougiakakou, S. G., Prountzou, A., & Nikita, K. S. (2011) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2011.2157823 · Cited by 79 · see citing works
Kinetics of dexamethasone-induced alterations of glucose metabolism in healthy humans
Schneiter, P., & Tappy, L. (1998) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1998.275.5.e806 · Cited by 77 · see citing works
Mauseth, R. S., Wang, Y., Dassau, E., et al. (2010) · Journal of Diabetes Science and Technology · doi:10.1177/193229681000400422 · Cited by 67 · see citing works
Causes and consequences of hyperglycemia in critical illness
Falciglia, M. (2007) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0b013e3281a3bf0a · Cited by 56 · see citing works
Impaired wound healing in patients with diabetes
King, L. (2001) · Nursing Standard · doi:10.7748/ns2001.06.15.38.39.c3039 · Cited by 54 · see citing works
Effect of Hyperglycemia on Stroke Outcomes
Levetan, C. S. (2004) · Endocrine Practice · doi:10.4158/ep.10.s2.34 · Cited by 52 · see citing works
Factors Influencing the Effectiveness of Glucagon for Preventing Hypoglycemia
Castle, J. R., Engle, J. M., Youssef, J. E., Massoud, R. G., & Ward, W. K. (2010) · Journal of Diabetes Science and Technology · doi:10.1177/193229681000400603 · Cited by 47 · see citing works
Self-citationNeural network modeling and control of type 1 diabetes mellitus
Jabali, A. K. (2004) · Bioprocess and Biosystems Engineering · doi:10.1007/s00449-004-0363-3 · Cited by 47 · see citing works
A model of the endogenous glucose balance incorporating the characteristics of glucose transporters
Arleth, T., Andreassen, S., Federici, M. O., & Benedetti, M. M. (2000) · Computer Methods and Programs in Biomedicine · doi:10.1016/s0169-2607(00)00069-9 · Cited by 40 · see citing works
Venkatesan, N., Lim, J., Bouch, C., Marciano, D. K., & Davidson, M. B. (1996) · Metabolism · doi:10.1016/s0026-0495(96)90205-x · Cited by 39 · see citing works
Impact of glucocorticoids on insulin resistance in the critically ill
Pretty, C. G., Chase, J. G., Lin, J., Shaw, G. M., Compte, A. L., Razak, N. N. A., & Parente, J. D. (2010) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2010.08.004 · Cited by 36 · see citing works
Dassau, E., Palerm, C. C., Zisser, H., Buckingham, B. A., Jovanovič, L., & Doyle, F. J. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2008.0055 · Cited by 35 · see citing works
Wilinska, M. E., Chassin, L. J., & Hovorka, R. (2008) · Journal of Diabetes Science and Technology · doi:10.1177/193229680800200311 · Cited by 31 · see citing works
Evidence-based insulin treatment in type 1 diabetes mellitus
Jacobsen, I. B., Henriksen, J. E., Nielsen, O. H., Vach, W., & Beck‐Nielsen, H. (2009) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2009.05.020 · Cited by 29 · see citing works
Development of a Clinical Type 1 Diabetes Metabolic System Model and in Silico Simulation Tool
Wong, X., Chase, J., Hann, C., Lotz, T., Lin, J., Compte, A. L. L., & Shaw, G. (2008) · Journal of Diabetes Science and Technology · doi:10.1177/193229680800200312 · Cited by 28 · see citing works
Amrein, K., Ellmerer, M., Hovorka, R., Kachel, N., Parcz, D., Korsatko, S., Smolle, K., Perl, S., Bock, G., Doll, W., et al. (2010) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2009.0147 · Cited by 26 · see citing works
Quiroz, G., & Femat, R. (2010) · Journal of Theoretical Biology · doi:10.1016/j.jtbi.2009.11.015 · Cited by 23 · see citing works
Youssef, J. E., Castle, J. R., Engle, J. M., Massoud, R. G., & Ward, W. K. (2010) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2010.0020 · Cited by 17 · see citing works
Self-citationIn Silico Simulation of Long-Term Type 1 Diabetes Glycemic Control Treatment Outcomes
Wong, X., Chase, J. G., Hann, C. E., Lotz, T., Lin, J., Compte, A. J. L., & Shaw, G. M. (2008) · Journal of Diabetes Science and Technology · doi:10.1177/193229680800200313 · Cited by 8 · see citing works
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Ward, W. K., Castle, J. R., & Youssef, J. E. (2011) · Journal of Diabetes Science and Technology · doi:10.1177/193229681100500608 · Cited by 36 · see citing works
Self-citationKatz, A., Shulkin, A., Housni, A., Roy‐Fleming, A., Rabasa‐Lhoret, R., Yale, J., Tsoukas, M. A., Peters, T. M., & Brazeau, A. (2026) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.70465 · Cited by 3 · see citing works
“El Youssef et al. 37 conducted a randomised, crossover study in 14 adults to evaluate the effect of oral hydrocortisone on a HCL system.”
- Authors
- Youssef, J. E., Castle, J. R., Branigan, D. L., Massoud, R. G., Breen, M. E., Jacobs, P. G., Bequette, B. W., & Ward, W. K.
- Affiliations
- Oregon Health & Science University (US)
- Legacy Health (US)
- Jacobs Technologies, Portland Oregon
- Rensselaer Polytechnic Institute (US)
- Corresponding author
- Ward, W. Kenneth
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2011-11
- Volume
- 5
- Issue
- 6
- Pages
- 1312-1326
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC3262697
- OpenAlex
- W2007814859
- Cited by
- 42
- References
- 37
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2022: 4 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 2 · 2015: 5 · 2014: 9 · 2013: 4 · 2012: 3
- Type
- conference abstract
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k23dk090133-03)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23-DK-090133, T32DK007674)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, corticosteroid-induced hyperglycemia, stress hyperglycemia, artificial pancreas, cortisol, insulin resistance, glycemic control, hypoglycemia, amperometric glucose sensor, insulin infusion rate
- MeSH terms
- Adrenal Cortex Hormones, Adult, Aged, Algorithms, Blood Glucose, Diabetes Mellitus, Type 1, Female, Humans, Hydrocortisone, Hyperglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Middle Aged, Sensitivity and Specificity, Stress, Psychological, Young Adult
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