The Clinical Case for the Integration of a Ketone Sensor as Part of a Closed Loop Insulin Pump System
Abstract
Closed loop (CL) systems deliver insulin with a rapid onset and offset in action. Although favorable overall, the absence of a long-acting insulin increases the risk of diabetic ketoacidosis (DKA) which can occur with insulin delivery failure, acute illness, low carbohydrate diets, sodium glucose-linked transporter inhibitors, and high intensity exercise. A CL system relying entirely on interstitial glucose measurements may not provide an alert for DKA and many people with type 1 diabetes (T1D) do not carry a blood ketone meter and test-strips. Ketone sensing is theoretically feasible. A multianalyte platform incorporating a ketone sensor could provide an additional CL input without an increase in burden for the person with T1D, warning of impending DKA to allow remedial action to be taken. We outline the clinical case for inclusion of continuous ketone sensing as part of future CL systems.
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Hybrid Closed Loop systems that might decrease the risk of DKA were not standard features of CSII treatment at the time of study inclusion.
“Hybrid Closed Loop systems that might decrease the risk of DKA were not standard features of CSII treatment at the time of study inclusion. 22 , 23 , 26”
Cites
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Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes
Bergenstal, R. M., Garg, S., Weinzimer, S. A., Buckingham, B. A., Bode, B. W., Tamborlane, W. V., & Kaufman, F. R. (2016) · JAMA · doi:10.1001/jama.2016.11708 · Cited by 644 · see citing works
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Stewart, Z. A., Wilinska, M. E., Hartnell, S., O’Neil, L. K., Rayman, G., Scott, E. M., Barnard, K., Farrington, C., Hovorka, R., & Murphy, H. R. (2018) · Diabetes Care · doi:10.2337/dc17-2534 · Cited by 168 · see citing works
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Wersäll, J. H., Adolfsson, P., Forsander, G., & Hanas, R. (2022) · Pediatric Diabetes · doi:10.1111/pedi.13377 · Cited by 21 · see citing works
- Authors
- Lee, M. H., Paldus, B., Krishnamurthy, B., McAuley, S. A., Shah, R., Jenkins, A. J., & O’Neal, D. N.
- Affiliations
- Department of Medicine, University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
- Percusense, Valencia, CA, USA
- ORCID
- McAuley, Sybil A.
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2019-01-10
- Volume
- 13
- Issue
- 5
- Pages
- 967-973
- ISSN
- 1932-2968
- Cited by
- 20
- References
- 4
- Language
- en
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