scholarly journals Survey about do-it-yourself closed loop systems in the treatment of diabetes in Germany

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243465
Author(s):  
Anna Laura Herzog ◽  
Jonas Busch ◽  
Christoph Wanner ◽  
Holger K. von Jouanne-Diedrich
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Closed Loop ◽  
Artificial Pancreas ◽  
Direct Interaction ◽  
Loop System ◽  
Closed Loop System ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Do It Yourself

Continuous glucose monitoring (CGM) improves treatment with lower blood glucose levels and less patient effort. In combination with continuous insulin application, glycemic control improves and hypoglycemic episodes should decrease. Direct feedback of CGM to continuous subcutaneous insulin application, using an algorithm is called a closed-loop (CL) artificial pancreas system. Commercial devices stop insulin application by predicting hypoglycemic blood glucose levels through direct interaction between the sensor and pump. The prediction is usually made for about 30 minutes and insulin delivery is restarted at the previous level if a rise in blood glucose is predicted within the next 30 minutes (hybrid closed loop system, HCL this is known as a predictive low glucose suspend system (PLGS)). In a fully CL system, sensor and pump communicate permanently with each other. Hybrid closed-loop (HCL) systems, which require the user to estimate the meal size and provide a meal insulin basis, are commercially available in Germany at the moment. These systems result in fewer hyperglycemic and hypoglycemic episodes with improved glucose control. Open source initiatives have provided support by building do-it-yourself CL (DIYCL) devices for automated insulin application since 2014, and are used by a tech-savvy subgroup of patients. The first commercial hybrid CL system has been available in Germany since September 2019. We surveyed 1054 patients to determine which devices are currently used, which features would be in demand by potential users, and the benefits of DIYCL systems. 9.7% of these used a DIYCL system, while 50% would most likely trust these systems but more than 85% of the patients would use a commercial closed loop system, if available. The DIYCL users had a better glucose control regarding their time in range (TIR) and glycated hemoglobin (HbA1c).

scholarly journals Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes

2019 ◽  
Vol 40 (6) ◽  
pp. 1521-1546 ◽  
Author(s):  
Rayhan A Lal ◽  
Laya Ekhlaspour ◽  
Korey Hood ◽  
Bruce Buckingham
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Diabetes Management ◽  
Artificial Pancreas ◽  
Loop System ◽  
Closed Loop Control ◽  
Closed Loop System ◽  
Loop Control

Abstract Recent, rapid changes in the treatment of type 1 diabetes have allowed for commercialization of an “artificial pancreas” that is better described as a closed-loop controller of insulin delivery. This review presents the current state of closed-loop control systems and expected future developments with a discussion of the human factor issues in allowing automation of glucose control. The goal of these systems is to minimize or prevent both short-term and long-term complications from diabetes and to decrease the daily burden of managing diabetes. The closed-loop systems are generally very effective and safe at night, have allowed for improved sleep, and have decreased the burden of diabetes management overnight. However, there are still significant barriers to achieving excellent daytime glucose control while simultaneously decreasing the burden of daytime diabetes management. These systems use a subcutaneous continuous glucose sensor, an algorithm that accounts for the current glucose and rate of change of the glucose, and the amount of insulin that has already been delivered to safely deliver insulin to control hyperglycemia, while minimizing the risk of hypoglycemia. The future challenge will be to allow for full closed-loop control with minimal burden on the patient during the day, alleviating meal announcements, carbohydrate counting, alerts, and maintenance. The human factors involved with interfacing with a closed-loop system and allowing the system to take control of diabetes management are significant. It is important to find a balance between enthusiasm and realistic expectations and experiences with the closed-loop system.

scholarly journals The mathematician's control toolbox for management of type 1 diabetes

2014 ◽  
Vol 4 (5) ◽  
pp. 20140042 ◽  
Author(s):  
Marie Csete ◽  
John Doyle
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Feedback Loop ◽  
Artificial Pancreas ◽  
Glucagon Release ◽  
Control Engineering ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Physiological Feedback

Blood glucose levels are controlled by well-known physiological feedback loops: high glucose levels promote insulin release from the pancreas, which in turn stimulates cellular glucose uptake. Low blood glucose levels promote pancreatic glucagon release, stimulating glycogen breakdown to glucose in the liver. In healthy people, this control system is remarkably good at maintaining blood glucose in a tight range despite many perturbations to the system imposed by diet and fasting, exercise, medications and other stressors. Type 1 diabetes mellitus (T1DM) results from loss of the insulin-producing cells of the pancreas, the beta cells. These cells serve as both sensor (of glucose levels) and actuator (insulin/glucagon release) in a control physiological feedback loop. Although the idea of rebuilding this feedback loop seems intuitively easy, considerable control mathematics involving multiple types of control schema were necessary to develop an artificial pancreas that still does not function as well as evolved control mechanisms. Here, we highlight some tools from control engineering used to mimic normal glucose control in an artificial pancreas, and the constraints, trade-offs and clinical consequences inherent in various types of control schemes. T1DM can be viewed as a loss of normal physiologic controls, as can many other disease states. For this reason, we introduce basic concepts of control engineering applicable to understanding pathophysiology of disease and development of physiologically based control strategies for treatment.

scholarly journals Day and night glucose control using a hybrid closed loop system for the management of type 1 diabetes

2015 ◽  
Vol 2015 (S1) ◽  
Author(s):  
Martin de Bock ◽  
Anirban Roy ◽  
Julie Dart ◽  
Barry Keenan ◽  
Elizabeth Davis ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Loop System ◽  
Closed Loop System

scholarly journals Dual-hormone closed loop system using a liquid stable glucagon formulation versus insulin-only closed loop system compared to a predictive low glucose suspend system: an open label, outpatient, single center, crossover, randomized control trial

2020 ◽  
Author(s):  
Leah M. Wilson ◽  
Peter G. Jacobs ◽  
Katrina L. Ramsey ◽  
Navid Resalat ◽  
Ravi Reddy ◽  
...  
Keyword(s):  
Closed Loop ◽  
Artificial Pancreas ◽  
Loop System ◽  
Target Range ◽  
Closed Loop Control ◽  
Closed Loop System ◽  
Entire Study ◽  
Loop Control ◽  
Study Duration ◽  
Low Glucose

<b>Objective: </b>To assess the efficacy and feasibility of a dual-hormone closed loop system with insulin and a novel liquid stable glucagon formulation compared with an insulin-only closed loop system and a predictive low glucose suspend system. <p><b>Research Design and Methods:</b> In a 76-hour, randomized, crossover, outpatient study, 23 participants with type 1 diabetes used three modes of the Oregon Artificial Pancreas system: (1) dual-hormone (DH) closed loop control, (2) insulin-only single-hormone (SH) closed loop control and (3) predictive low glucose suspend (PLGS). The primary endpoint was percent time in hypoglycemia (<70 mg/dL) from start of in-clinic aerobic exercise (45mins at 60% VO<sub>2max</sub>) to 4 hours after.</p> <p><b>Results:</b> DH reduced hypoglycemia compared with SH during and after exercise (DH 0.0% [0.0-4.2], SH 8.3% [0.0-12.5], p=0.025). There was an increased time in hyperglycemia (>180mg/dL) during and after exercise for DH vs SH (20.8% DH vs. 6.3% SH, p=0.038). Mean glucose during the entire study duration was: DH 159.2, SH 151.6, PLGS 163.6 mg/dL. Across the entire study duration, DH resulted in 7.5% more time in target range (70-180 mg/dL) compared with the PLGS system (71.0% vs. 63.4%, p=0.044). For the entire study duration, DH had 28.2% time in hyperglycemia versus 25.1% for SH (p=0.044) and 34.7% for PLGS (p=0.140). Four participants experienced nausea related to glucagon leading 3 to withdraw from the study. </p> <p><b>Conclusions:</b> The glucagon formulation demonstrated feasibility in a closed loop system. The dual-hormone system reduced hypoglycemia during and after exercise with some increase in hyperglycemia.</p>

scholarly journals Correlation Between Blood Glucose Control And Decrease Of Peripheral Vascularization In Diabetes Mellitus Patient

2018 ◽  
Vol 4 (1) ◽  
pp. 18
Author(s):  
Fitria Endah Janitra ◽  
Dinda Sandika
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glucose Control ◽  
Diabetes Management ◽  
Blood Glucose Control ◽  
Nursing Intervention ◽  
Tissue Ischemia ◽  
Control Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels

Introduction: Diabetes mellitus (DM) is a metabolic disorder characterized by elevated blood glucose levels. Chronic complications of DM affect coronary circulation, peripheral vascularization, and blood vessels of the brain. Decrease in peripheral vascularization increases the risk of tissue ischemia and weakens functional status, therefore it is necessary to control blood glucose levels. Islam teaches to its believers to control their diet, where diet is one of the four pillars of diabetes management. Methodology: this is analytic descriptive research with cross sectional methods in 67 respondents taken by consecutive sampling technique. Results: There was a significant correlation within blood glucose control and decreased peripheral vascularization in DM patients (p-value 0.010). Discussion: need further research regarding nursing intervention to control blood glucose.

Continuous Post-operative Blood Glucose Monitoring and Control Using a Closed-loop System in Patients Undergoing Hepatic Resection

2007 ◽  
Vol 53 (5) ◽  
pp. 1405-1410 ◽  
Author(s):  
Takehiro Okabayashi ◽  
Kazuhiro Hnazaki ◽  
Isao Nishimori ◽  
Takeki Sugimoto ◽  
Hiromichi Maeda ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Hepatic Resection ◽  
Closed Loop ◽  
Glucose Monitoring ◽  
Loop System ◽  
Blood Glucose Monitoring ◽  
Monitoring And Control ◽  
Closed Loop System ◽  
And Control

Changes in corneal and lens autofluorescence and blood glucose levels in diabetics: parameters of blood glucose control

1997 ◽  
Vol 16 (6) ◽  
pp. 534-538 ◽  
Author(s):  
Fumihiko Mori ◽  
Satoshi Ishiko ◽  
Tohru Abiko ◽  
Norihiko Kitaya ◽  
Yuji Kato ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Glucose Levels ◽  
Blood Glucose Levels

Glucose Control in Adults with Type 1 Diabetes Using a Medtronic Prototype Enhanced-Hybrid Closed-Loop System: A Feasibility Study

2019 ◽  
Vol 21 (9) ◽  
pp. 499-506 ◽  
Author(s):  
Melissa H. Lee ◽  
Sara Vogrin ◽  
Barbora Paldus ◽  
Hannah M. Jones ◽  
Varuni Obeyesekere ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Feasibility Study ◽  
Glucose Control ◽  
Closed Loop ◽  
Loop System ◽  
Closed Loop System ◽  
System A
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