Blood Glucose Control in Type 1 Diabetes With a Bihormonal Bionic Endocrine Pancreas
Open Access
- 13 October 2012
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 35 (11), 2148-2155
- https://doi.org/10.2337/dc12-0071
Abstract
OBJECTIVE: To test whether safe and effective glycemic control could be achieved in type 1 diabetes using a bihormonal bionic endocrine pancreas driven by a continuous glucose monitor in experiments lasting more than two days and including six high-carbohydrate meals and exercise as challenges to glycemic control. RESEARCH DESIGN AND METHODS: Six subjects with type 1 diabetes and no endogenous insulin secretion participated in two 51-h experiments. Blood glucose was managed with a bionic endocrine pancreas controlling subcutaneous delivery of insulin and glucagon with insulin pumps. A partial meal-priming bolus of insulin (0.035 units/kg/meal, then 0.05 units/kg/meal in repeat experiments) was administered at the beginning of each meal (on average 78 ± 12 g of carbohydrates per meal were consumed). Plasma glucose (PG) control was evaluated with a reference quality measurement on venous blood every 15 min. RESULTS: The overall mean PG was 158 mg/dL, with 68% of PG values in the range of 70–180 mg/dL. There were no significant differences in mean PG between larger and smaller meal-priming bolus experiments. Hypoglycemia (PG <70 mg/dL) was rare, with eight incidents during 576 h of closed-loop control (0.7% of total time). During 192 h of nighttime control, mean PG was 123 mg/dL, with 93% of PG values in the range of 70–180 mg/dL and only one episode of mild hypoglycemia (minimum PG 62 mg/dL). CONCLUSIONS: A bihormonal bionic endocrine pancreas achieved excellent glycemic control with minimal hypoglycemia over the course of two days of continuous use despite high-carbohydrate meals and exercise. A trial testing a wearable version of the system under free-living conditions is justified.Keywords
This publication has 17 references indexed in Scilit:
- The Effect of Insulin Feedback on Closed Loop Glucose ControlJournal of Clinical Endocrinology & Metabolism, 2011
- A Bihormonal Closed-Loop Artificial Pancreas for Type 1 DiabetesScience Translational Medicine, 2010
- Novel Use of Glucagon in a Closed-Loop System for Prevention of Hypoglycemia in Type 1 DiabetesDiabetes Care, 2010
- Standards of Medical Care in Diabetes—2010Diabetes Care, 2010
- Fully Automated Closed-Loop Insulin Delivery Versus Semiautomated Hybrid Control in Pediatric Patients With Type 1 Diabetes Using an Artificial PancreasDiabetes Care, 2008
- Feasibility of Automating Insulin Delivery for the Treatment of Type 1 DiabetesDiabetes, 2006
- Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 DiabetesNew England Journal of Medicine, 2005
- Hypoglycemia in DiabetesDiabetes Care, 2003
- The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes MellitusNew England Journal of Medicine, 1993
- The Clinical Information Value of the Glycosylated Hemoglobin AssayNew England Journal of Medicine, 1984