Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control‐based fully‐automated artificial pancreas in patients with type 1 diabetes: a pilot study

Abstract

Aims To compare intraperitoneal (IP) to subcutaneous (SC) insulin delivery in an artificial pancreas (AP). Research design and methods Ten adults with type 1 diabetes participated in a non-randomized, non-blinded sequential AP study using the same SC glucose sensing and Zone Model Predictive Control (ZMPC) algorithm adjusted for insulin clearance. On first admission, subjects underwent closed-loop control with SC delivery of a fast-acting insulin analogue for 24 hours. Following implantation of a DiaPort IP insulin delivery system, the identical 24-hour trial was performed with IP regular insulin delivery. The clinical protocol included 3 unannounced meals with 70, 40 and 70 g carbohydrate, respectively. Primary endpoint was time spent with blood glucose (BG) in the range of 80 to 140 mg/dL (4.4–7.7 mmol/L). Results Percent of time spent within the 80 to 140 mg/dL range was significantly higher for IP delivery than for SC delivery: 39.8 ± 7.6 vs 25.6 ± 13.1 (P = .03). Mean BG (mg/dL) and percent of time spent within the broader 70 to 180 mg/dL range were also significantly better for IP insulin: 151.0 ± 11.0 vs 190.0 ± 31.0 (P = .004) and 65.7 ± 9.2 vs 43.9 ± 14.7 (P = .001), respectively. Superiority of glucose control with IP insulin came from the reduced time spent in hyperglycaemia (>180 mg/dL: 32.4 ± 8.9 vs 53.5 ± 17.4, P = .014; >250 mg/dL: 5.9 ± 5.6 vs 23.0 ± 11.3, P = .0004). Higher daily doses of insulin (IU) were delivered with the IP route (43.7 ± 0.1 vs 32.3 ± 0.1, P < .001) with no increased percent time spent <70 mg/dL (IP: 2.5 ± 2.9 vs SC: 4.1 ± 5.3, P = .42). Conclusions Glycaemic regulation with fully-automated AP delivering IP insulin was superior to that with SC insulin delivery. This pilot study provides proof-of-concept for an AP system combining a ZMPC algorithm with IP insulin delivery.

Decision Support Systems and Closed Loop

“…Prior studies using IP insulin delivery have shown promising results (17), particularly trying to improve upon the difficult challenge of preventing postprandial hyperglycemia since SC insulin delivery is often too slow to prevent elevated peak glucose levels after meals. In this study, the authors developed a new model of insulin delivery for the IP space based on canine data, S-60 NIMRI ET AL.…”

Development and in silico validation of the PID-algorithm for the artificial pancreas with intraperitoneal insulin delivery

“…Одним из вариантов решения данной проблемы рас-сматривают использование альтернативных способов доставки инсулина в тело, в том числе -постоянную внутривенную или интраперитонеальную инфузию [5]. Интраперитонеальная (ИП) инфузия инсулина [6] раз-рабатывается с 70-х гг.…”

Role of Automated Insulin Delivery (Artificial Pancreas) in Islet Transplantation: An In Silico Assessment

“…A major objective of the in silico modeling described in the previous section is the development of a versatile platform to design, test, and validate closed-loop algorithms assisting islet transplantation patients with their residual exogenous insulin needs. Although AID can be implemented by intravenous [58] or intraperitoneal [59] routes, here we discuss subcutaneous insulin delivery given its benefits and reliability in an outpatient setting.…”