Prevention of Nocturnal Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension
Open Access
- 3 March 2010
- journal article
- clinical trial
- Published by American Diabetes Association in Diabetes Care
- Vol. 33 (5), 1013-1017
- https://doi.org/10.2337/dc09-2303
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.Keywords
This publication has 28 references indexed in Scilit:
- Blunted Counterregulatory Hormone Responses to Hypoglycemia in Young Children and Adolescents With Well-Controlled Type 1 DiabetesDiabetes Care, 2009
- A Tale of Two Compartments: Interstitial Versus Blood Glucose MonitoringDiabetes Technology & Therapeutics, 2009
- Is an Automatic Pump Suspension Feature Safe for Children with Type 1 Diabetes? An Exploratory Analysis with a Closed-Loop SystemDiabetes Technology & Therapeutics, 2009
- Preventing Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump SuspensionDiabetes Technology & Therapeutics, 2009
- Duration of Nocturnal Hypoglycemia Before SeizuresDiabetes Care, 2008
- Continuous Glucose Monitoring and Intensive Treatment of Type 1 DiabetesNew England Journal of Medicine, 2008
- Comment on: Thallas-Bonke et al. (2008) Inhibition of NADPH Oxidase Prevents Advanced Glycation End Product–Mediated Damage in Diabetic Nephropathy Through a Protein Kinase C-α–Dependent Pathway: Diabetes 57:460–469, 2008Diabetes, 2008
- Prevention of Hypoglycemia During Exercise in Children With Type 1 Diabetes by Suspending Basal InsulinDiabetes Care, 2006
- The degree/rapidity of the metabolic deterioration following interruption of a continuous subcutaneous insulin infusion is influenced by the prevailing blood glucose LevelJournal of Clinical Endocrinology & Metabolism, 1996
- Metabolic Alterations After a Two-hour Nocturnal Interruption of a Continuous Subcutaneous Insulin InfusionDiabetes Care, 1984