Advanced Closed-Loop Control System Improves Postprandial Glycemic Control Compared With a Hybrid Closed-Loop System Following Unannounced Meal
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Abstract
Objective Meals are a major hurdle to glycemic control in type 1 diabetes (T1D). Our objective was to test a fully automated closed-loop control (CLC) system in the absence of announcement of carbohydrate ingestion among adolescents with T1D, who are known to commonly omit meal announcement. Research design and methods Eighteen adolescents with T1D (age 15.6 ± 1.7 years; HbA1c 7.4 ± 1.5%; 9 females/9 males) participated in a randomized crossover clinical trial comparing our legacy hybrid CLC system (Unified Safety System Virginia [USS]-Virginia) with a novel fully automated CLC system (RocketAP) during two 46-h supervised admissions (each with one announced and one unannounced dinner), following 2 weeks of data collection. Primary outcome was the percentage time-in-range 70-180 mg/dL (TIR) following the unannounced meal, with secondary outcomes related to additional continuous glucose monitoring-based metrics. Results Both TIR and time-in-tight-range 70-140 mg/dL (TTR) were significantly higher using RocketAP than using USS-Virginia during the 6 h following the unannounced meal (83% [interquartile range 64-93] vs. 53% [40-71]; P = 0.004 and 49% [41-59] vs. 27% [22-36]; P = 0.002, respectively), primarily driven by reduced time-above-range (TAR >180 mg/dL: 17% [1.3-34] vs. 47% [28-60]), with no increase in time-below-range (TBR Conclusions A new fully automated CLC system with automatic prandial dosing was proven to be safe and feasible and outperformed our legacy USS-Virginia…
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A fully automated AID system equipped with a meal detection algorithm is considered the ultimate solution to addressing the missed meal insulin boluses, and investigational systems have already shown substantial progress in this field.
“A fully automated AID system equipped with a meal detection algorithm is considered the ultimate solution to addressing the missed meal insulin boluses, and investigational systems have already shown substantial progress in this field.107”
From The future of type 1 diabetes therapy (2025) · cites this paper as [107]
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- Authors
- Garcia-Tirado, J., Diaz, J. L., Esquivel-Zuniga, R., Koravi, C. L. K., Corbett, J. P., Dawson, M., Wakeman, C., Barnett, C. L., Oliveri, M. C., Myers, H., Krauthause, K., Breton, M. D., & DeBoer, M. D.
- Affiliations
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
- University of Virginia (US)
- Corresponding author
- DeBoer, Mark D.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-08-16
- Volume
- 44
- Issue
- 10
- Pages
- 2379-2387
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W3195008427
- Cited by
- 52
- References
- 33
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 7 · 2023: 14 · 2022: 11
- FWCI
- 5.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- 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, feedback control, hybrid closed-loop system, postprandial glucose control, adolescents, time in range, time above range, time below range, insulin delivery, continuous glucose monitoring, hypoglycemia, hyperglycemia
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