Prevention of Nocturnal Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension

Buckingham, Bruce; Chase, H. Peter; Dassau, Eyal; Cobry, Erin; Clinton, Paula; Gage, Victoria; Caswell, Kimberly; Wilkinson, John; Cameron, Fraser; Lee, Hyunjin; Bequette, B. Wayne; Doyle, Francis J.

doi:10.2337/dc09-2303

Cited by 169Diabetes Management and ResearchDiabetes and associated disordersDiabetes Management and Education

Prevention of Nocturnal Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension

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Buckingham, Bruce, Chase, H. Peter, Dassau, Eyal, Cobry, Erin, Clinton, Paula, Gage, Victoria, Caswell, Kimberly, Wilkinson, John +4 more·2010·Diabetes Care

DOI 10.2337/dc09-2303PMC PMC2858164

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Abstract

OBJECTIVE: The aim of this study was to develop a partial closed-loop system to safely prevent nocturnal hypoglycemia by suspending insulin delivery when hypoglycemia is predicted in type 1 diabetes. RESEARCH DESIGN AND METHODS: Forty subjects with type 1 diabetes (age range 12–39 years) were studied overnight in the hospital. For the first 14 subjects, hypoglycemia (<60 mg/dl) was induced by gradually increasing the basal insulin infusion rate (without the use of pump shutoff algorithms). During the subsequent 26 patient studies, pump shutoff occurred when either three of five (n = 10) or two of five (n = 16) algorithms predicted hypoglycemia based on the glucose levels measured with the FreeStyle Navigator (Abbott Diabetes Care). RESULTS: The standardized protocol induced hypoglycemia on 13 (93%) of the 14 nights. With use of a voting scheme that required three algorithms to trigger insulin pump suspension, nocturnal hypoglycemia was prevented during 6 (60%) of 10 nights. When the voting scheme was changed to require only two algorithms to predict hypoglycemia to trigger pump suspension, hypoglycemia was prevented during 12 (75%) of 16 nights. In the latter study, there were 25 predictions of hypoglycemia because some subjects had multiple hypoglycemic events during a night, and hypoglycemia was prevented for 84% of these events. CONCLUSIONS: Using algorithms to shut off the insulin pump when hypoglycemia is predicted, it is possible to prevent hypoglycemia on 75% of nights (84% of events) when it would otherwise be predicted to occur.

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When comparing the safety and efficacy of overnight closed-loop delivery of insulin with conventional insulin-pump therapy in adults with type 1 diabetes, closed-loop delivery improved overnight control of glycaemia and reduced the risk of nocturnal hypoglycaemia.
“when comparing the safety and efficacy of overnight closed-loop delivery of insulin with conventional insulin-pump therapy in adults with type 1 diabetes, closed-loop delivery improved overnight control of glycaemia and reduced the risk of nocturnal hypoglycaemia.98,99”
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Prevention of nocturnal hypoglycemia using predictive alarm algorithms and insulin pump suspension, Diabetes Care 33 (5
Buckingham, B. A., Chase, H. P., Wilkinson, J., Bequette, B. W., & Doyle, F. J., III (2010)
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Preventing Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension
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Outpatient Safety Assessment of an In-Home Predictive Low-Glucose Suspend System with Type 1 Diabetes Subjects at Elevated Risk of Nocturnal Hypoglycemia
Buckingham, B. A., Cameron, F., Calhoun, P. M., Maahs, D. M., Wilson, D. M., Chase, H. P., Bequette, B. W., Lum, J. W., Sibayan, J., Beck, R. W., et al. (2013) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2013.0040 · Cited by 103 · see citing works
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A Randomized Trial of a Home System to Reduce Nocturnal Hypoglycemia in Type 1 Diabetes Diabetes Care 2014;37:1885–1891 | DOI: 10.2337/dc13-2159 OBJECTIVE
(2016)
A Randomized Trial of a Home System to Reduce Nocturnal Hypoglycemia in Type 1 Diabetes
Maahs, D. M., Calhoun, P. M., Buckingham, B. A., Chase, H. P., HRAMIAK, I. M., Lum, J. W., Cameron, F., Bequette, B. W., Aye, T., Paul, T., et al. (2014) · Diabetes Care · doi:10.2337/dc13-2159 · Cited by 160 · see citing works
Self-citation

Authors: Buckingham, B., Chase, H. P., Dassau, E., Cobry, E., Clinton, P., Gage, V., Caswell, K., Wilkinson, J., Cameron, F., Lee, H., Bequette, B. W., & Doyle, F. J.
Affiliations: Stanford Medicine (US)
University of Colorado Anschutz (US)
University of California, Santa Barbara (US)
Stanford University (US)
Rensselaer Polytechnic Institute (US)
Corresponding author: Chase, H. Peter
ORCID: Buckingham, Bruce
Dassau, Eyal
Cobry, Erin
Caswell, Kimberly
Lee, Hyunjin
Bequette, B. Wayne
Doyle, Francis J.
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2010-03-03
Volume: 33
Issue: 5
Pages: 1013-1017
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc09-2303
PMC: PMC2858164
OpenAlex: W1986471579
Cited by: 169
References: 29
Citations by year: 2025: 3 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 8 · 2019: 10 · 2018: 13 · 2017: 13 · 2016: 14 · 2015: 11 · 2014: 16 · 2013: 19 · 2012: 28
FWCI: 16.22
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/3.0/ (vor, 4196 d)
Locations: Diabetes Care (publishedVersion, cc-by-nc-nd)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085628)
National Center for Research Resources (5M01 RR00069, RR 000051, M-01 RR 00070, M01RR000051, M01RR000070, M01RR000069)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords: nocturnal hypoglycemia, type 1 diabetes, continuous glucose monitoring, hypoglycemia prevention
MeSH terms: Adolescent, Adult, Algorithms, Blood Glucose, Child, Circadian Rhythm, Diabetes Mellitus, Type 1, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Ketones, Predictive Value of Tests, Young Adult, Clinical Alarms

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Prevention of Nocturnal Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension

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