Effect of Insulin Feedback on Closed-Loop Glucose Control: A Crossover Study

Ruiz, Jessica; Sherr, Jennifer; Cengiz, Eda; Carria, Lori; Roy, Anirban; Voskanyan, Gayane; Tamborlane, William V.; Weinzimer, Stuart A.

doi:10.1177/193229681200600517

Cited by 88 publications

(62 citation statements)

References 13 publications

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“…Here, it is noted only that the use of glucagon does not ensure prevention of hypoglycemia and that repeated use might not be tolerated by all subjects. Generally, the hypoglycemic incidence rate with PID control has gone down as the meal response has improved, with studies by Weinzimer and coauthors 21,22 on the use of PID with insulin feedback (PID IFB ) and the use of PID IFB with or without pramlintide showing zero incidences in what are admittedly small studies.…”

Section: Review Of Available Clinical Datamentioning

confidence: 99%

“…This is interesting insofar many investigators have concluded that meals cannot be controlled without open-loop bolus despite the fact that the initial 2006 PID study 2 did not include meal announcement and showed peak meal responses that were generally within 15-25 mg/dl of those observed in normal glucose-tolerant subjects who consumed the identical diet. 2 While Weinzimer coauthors 21,22 showed the peak response obtained with PID could be improved by giving one-third the normal meal bolus 15 min in advance of the meal, the reliance on meal boluses has steadily declined in subsequent PID studies. 4,5,6 The first report of PID IFB used only a small fixed bolus (2 U for all meals; Figure 3C).…”

Section: Review Of Available Clinical Datamentioning

confidence: 99%

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Algorithms for a Closed-Loop Artificial Pancreas: The Case for Proportional-Integral-Derivative Control

Steil

2013

J Diabetes Sci Technol

106

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Abbreviation: (eCTR) enhanced control-to-range, (IQR) interquartile range, (MPC) model-predictive control, (PID) proportional integral derivative, (PD) pharmacodynamic, (PID IFB ) proportional integral derivative with insulin feedback, (PK) pharmacokinetic, (RLS) recursive least squares, (sCTR) standard control-to-range Journal of Diabetes Science and TechnologyVolume 7, Issue 6, November 2013 © Diabetes Technology Society AbstractClosed-loop insulin delivery continues to be one of most promising strategies for achieving near-normal control of blood glucose levels in individuals with diabetes. Of the many components that need to work well for the artificial pancreas to be advanced into routine use, the algorithm used to calculate insulin delivery has received a substantial amount of attention. Most of that attention has focused on the relative merits of proportionalintegral-derivative versus model-predictive control. A meta-analysis of the clinical data obtained in studies performed to date with these approaches is conducted here, with the objective of determining if there is a trend for one approach to be performing better than the other approach. Challenges associated with implementing each approach are reviewed with the objective of determining how these approaches might be improved. Results of the meta-analysis, which focused predominantly on the breakfast meal response, suggest that to date, the two approaches have performed similarly. However, uncontrolled variables among the various studies, and the possibility that future improvements could still be effected in either approach, limit the validity of this conclusion. It is suggested that a more detailed examination of the challenges associated with implementing each approach be conducted.

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Section: Review Of Available Clinical Datamentioning

confidence: 99%

Section: Review Of Available Clinical Datamentioning

confidence: 99%

Algorithms for a Closed-Loop Artificial Pancreas: The Case for Proportional-Integral-Derivative Control

Steil

2013

J Diabetes Sci Technol

106

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“…The main aim is developing an artificial pancreas that has a low cost to be suitable for patients with type 1diabetes and artificial pancreas should be reliable with small size. There are many control techniques have been utilised for the artificial pancreas, such as PID control [20][21][22][23][24][25], adaptive control [26,27], model-predictive control [28], fuzzy logic control [29,30] and linear -quadratic Gaussian [25,31].…”

Section: Modelling An Artificial Pancreasmentioning

confidence: 99%

Proposed Procedure to Improve Performance of an Artificial Pancreas and Pancreas Transplant: Review

Algaddafi¹,

Ali²

2017

J Diabetes Metab

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Diabetes is a lifelong condition with no cure. Diabetes has a serious effect on the patient, especially pregnant women that may cause problems, whether overdose or low of the insulin in the blood stream. The patient must use insulin whether by pumping as in the artificial pancreas (closed loop) or by injecting insulin manual (opened loop). However, every method has its own advantages and disadvantages, e.g. the opened loop system for artificial pancreas may have a risk during the night when the patient sleep. On the other hand, the closed loop can administer insulin and glucose at the right time with the right amount. However, the artificial pancreas is not available yet and it required more improvement to be reliable. The algorithm of artificial pancreas consists of measuring glucose in the blood of a patient by using glucose sensor and sends a signal to an insulin pump to adjust basal insulin rated according to the desired amount of insulin that the patient need. This procedure required devices with the patient; however, some patient may be advised to have a pancreas transplant.This paper reviews the current publication of an artificial pancreas and proposed a method to improve the control of an artificial pancreas. History of diabetes is described in this paper with a critical review of current studies. Also, it has tested pre-diabetes for pregnant women. The obtain results show that in breakfast the sugar level is increased high with random changing, hence based on the test, some foods should be ignored in breakfast, while other food recommended.

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“…The glucose data were transmitted every minute via radiofrequency signaling. A laptop with the Control Tool software version 5.1, which uses Medtronic external Physiological Insulin Delivery (ePID) algorithm 5 with the Insulin Feedback (IFB) 10 feature, provided the automated insulin delivery during the CL phase and collected the glucose sensor data during the open-loop phase of the study. Although 2 Medtronic Sof-sensors were used, control of the CL software was set by the researcher to the sensor, which performed better and was switched to the other sensor as deemed necessary.…”

Section: Study Proceduresmentioning

confidence: 99%

Role of Glucagon-Like Peptide-1 Analogue Versus Amylin as an Adjuvant Therapy in Type 1 Diabetes in a Closed Loop Setting With ePID Algorithm

Renukuntla

Ramchandani

Trast

et al. 2014

J Diabetes Sci Technol

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Postprandial hyperglycemia due to paradoxical hyperglucagonemia is a major challenge of diabetes treatment despite the use of the artificial pancreas. We postulated that adjunctive therapy with pramlintide or exenatide would attenuate hyperglycemia in the postprandial phase through glucagon suppression, thereby optimizing the functioning of the closed-loop (CL) system. Subjects with type 1 diabetes (T1DM) on insulin pump therapy were recruited to participate in a 27-hour hospitalized admission on 3 occasions (2-4 weeks apart) and placed on the insulin delivery via CL system in random order to receive (1) insulin alone (control), (2) exenatide 2.5 µg + insulin, (3) pramlintide 30 µg + insulin. Medications were given prior to lunch and dinner, which was a standardized meal of 60 grams of carbohydrates. Insulin delivery was as per the ePID algorithm via the Medtronic CL system and continuous subcutaneous glucose monitoring via Medtronic Sof-sensors. Ten subjects age 23 ± 1 years with a HbA1c of 7.29 ± 0.3% (56 ± 1 mmol/mol) and duration of T1DM 10.6 ± 2.0 years participated in the 3-part study. Exenatide was found to be significantly better in attenuating postprandial hyperglycemia as compared to insulin monotherapy (P < .03) and pramlintide (P > .05). Glucagon suppression was statistically significant with exenatide (P < .03) as compared to pramlintide. Insulin requirements were lower with adjunctive therapy, but statistically insignificant. Insulin monotherapy results in postprandial hyperglycemia in T1DM in the CL setting and adjunctive therapy with exenatide reduces postprandial hyperglycemia effectively and should be considered as adjunctive therapy in T1DM.

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Effect of Insulin Feedback on Closed-Loop Glucose Control: A Crossover Study

Cited by 88 publications

References 13 publications

Algorithms for a Closed-Loop Artificial Pancreas: The Case for Proportional-Integral-Derivative Control

Algorithms for a Closed-Loop Artificial Pancreas: The Case for Proportional-Integral-Derivative Control

Proposed Procedure to Improve Performance of an Artificial Pancreas and Pancreas Transplant: Review

Role of Glucagon-Like Peptide-1 Analogue Versus Amylin as an Adjuvant Therapy in Type 1 Diabetes in a Closed Loop Setting With ePID Algorithm

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