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Day-and-Night Closed-Loop Glucose Control in Patients With Type 1 Diabetes Under Free-Living Conditions: Results of a Single-Arm 1-Month Experience Compared With a Previously Reported Feasibility Study of Evening and Night at Home

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Renard, Eric, Farret, Anne, Kropff, Jort, Bruttomesso, Daniela, Messori, Mirko, Place, Jerome, Visentin, Roberto, Calore, Roberta +13 more·2016·Diabetes Care
DOI 10.2337/dc16-0008
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Abstract

OBJECTIVE: After testing of a wearable artificial pancreas (AP) during evening and night (E/N-AP) under free-living conditions in patients with type 1 diabetes (T1D), we investigated AP during day and night (D/N-AP) for 1 month. RESEARCH DESIGN AND METHODS: Twenty adult patients with T1D who completed a previous randomized crossover study comparing 2-month E/N-AP versus 2-month sensor augmented pump (SAP) volunteered for 1-month D/N-AP nonrandomized extension. AP was executed by a model predictive control algorithm run by a modified smartphone wirelessly connected to a continuous glucose monitor (CGM) and insulin pump. CGM data were analyzed by intention-to-treat with percentage time-in-target (3.9–10 mmol/L) over 24 h as the primary end point. RESULTS: Time-in-target (mean ± SD, %) was similar over 24 h with D/N-AP versus E/N-AP: 64.7 ± 7.6 vs. 63.6 ± 9.9 (P = 0.79), and both were higher than with SAP: 59.7 ± 9.6 (P = 0.01 and P = 0.06, respectively). Time below 3.9 mmol/L was similarly and significantly reduced by D/N-AP and E/N-AP versus SAP (both P < 0.001). SD of blood glucose concentration (mmol/L) was lower with D/N-AP versus E/N-AP during whole daytime: 3.2 ± 0.6 vs. 3.4 ± 0.7 (P = 0.003), morning: 2.7 ± 0.5 vs. 3.1 ± 0.5 (P = 0.02), and afternoon: 3.3 ± 0.6 vs. 3.5 ± 0.8 (P = 0.07), and was lower with D/N-AP versus SAP over 24 h: 3.1 ± 0.5 vs. 3.3 ± 0.6 (P = 0.049). Insulin delivery (IU) over 24 h was higher with D/N-AP and SAP than with E/N-AP: 40.6 ± 15.5 and 42.3 ± 15.5 vs. 36.6 ± 11.6 (P = 0.03 and P = 0.0004, respectively). CONCLUSIONS: D/N-AP and E/N-AP both achieved better glucose control than SAP under free-living conditions. Although time in the different glycemic ranges was similar between D/N-AP and E/N-AP, D/N-AP further reduces glucose variability.

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  • In July 2016, Diabetes Care published a symposium featuring several outpatient AID studies using DiAs running in two different in silico designed algorithm configurations.

    “In July 2016, Diabetes Care published a symposium, 129 which featured several outpatient AID studies using DiAs running in two different in silico designed algorithm configurations.[123][124][125]”

    From Developing the UVA/Padova Type 1 Diabetes Simulator: Modeling, Validation, Refinements, and Utility (2023) · cites this paper as [124]

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Authors
Renard, E., Farret, A., Kropff, J., Bruttomesso, D., Messori, M., Place, J., Visentin, R., Calore, R., Toffanin, C., Di Palma, F., Lanzola, G., Magni, P., Boscari, F., Galasso, S., Avogaro, A., Keith-Hynes, P., Kovatchev, B., Del Favero, S., Cobelli, C., Magni, L., & DeVries, J. H.
Affiliations
  • Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital; INSERM Clinical Investigation Centre 1411; Institute of Functional Genomics, CNRS UMR 5203, INSERM U1191, University of Montpellier, Montpellier, France
  • Centre National de la Recherche Scientifique (FR)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • University of Padua (IT)
  • University of Pavia (IT)
  • Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
  • University of Virginia (US)
  • Department of Information Engineering, University of Padova, Padova, Italy
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2016-04-17
Volume
39
Issue
7
Pages
1151-1160
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc16-0008
OpenAlex
W2346512890
Cited by
104
References
26
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 11 · 2019: 16 · 2018: 20 · 2017: 22 · 2016: 8
FWCI
22.14
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/site/license (vor, 259 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Padua Research Archive (University of Padova) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • HAL (submittedVersion)
Funders
European Commission, Framework Program 7 (FP7-ICT-2009-4 grant number 247138)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 1 diabetes, closed-loop glucose control, model predictive control, continuous glucose monitoring, insulin pump, sensor-augmented pump, time in target, hypoglycemia, blood glucose variability, free-living conditions, smartphone control, insulin delivery, insulin resistance
MeSH terms
Adult, Algorithms, Blood Glucose, Circadian Rhythm, Diabetes Mellitus, Type 1, Feasibility Studies, Female, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Middle Aged, Social Conditions, Blood Glucose Self-Monitoring, Cross-Over Studies, Pancreas, Artificial, Young Adult

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