1. The artificial pancreas: evaluating risk of hypoglycaemia following errors that can be expected with prolonged at-home use.
- Author
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Wolpert H, Kavanagh M, Atakov-Castillo A, and Steil GM
- Subjects
- Academic Medical Centers, Adult, Aged, Blood Glucose analysis, Boston epidemiology, Calibration, Circadian Rhythm, Combined Modality Therapy adverse effects, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 1 diet therapy, Diet, Diabetic, Humans, Hyperglycemia prevention & control, Hypoglycemia epidemiology, Hypoglycemia etiology, Male, Meals, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Reproducibility of Results, Risk, Diabetes Mellitus, Type 1 drug therapy, Hypoglycemia prevention & control, Insulin Infusion Systems adverse effects, Pancreas, Artificial adverse effects, Patient Compliance, Postoperative Complications prevention & control, Self Care
- Abstract
Aims: Artificial pancreas systems show benefit in closely monitored at-home studies, but may not have sufficient power to assess safety during infrequent, but expected, system or user errors. The aim of this study was to assess the safety of an artificial pancreas system emulating the β-cell when the glucose value used for control is improperly calibrated and participants forget to administer pre-meal insulin boluses., Methods: Artificial pancreas control was performed in a clinic research centre on three separate occasions each lasting from 10 p.m. to 2 p.m. Sensor glucose values normally used for artificial pancreas control were replaced with scaled blood glucose values calculated to be 20% lower than, equal to or 33% higher than the true blood glucose. Safe control was defined as blood glucose between 3.9 and 8.3 mmol/l., Results: Artificial pancreas control resulted in fasting scaled blood glucose values not different from target (6.67 mmol/l) at any scaling factor. Meal control with scaled blood glucose 33% higher than blood glucose resulted in supplemental carbohydrate to prevent hypoglycaemia in four of six participants during breakfast, and one participant during the night. In all instances, scaled blood glucose reported blood glucose as safe., Conclusions: Outpatient trials evaluating artificial pancreas performance based on sensor glucose may not detect hypoglycaemia when sensor glucose reads higher than blood glucose. Because these errors are expected to occur, in-hospital artificial pancreas studies using supplemental carbohydrate in anticipation of hypoglycaemia, which allow safety to be assessed in a controlled non-significant environment should be considered as an alternative. Inpatient studies provide a definitive alternative to model-based computer simulations and can be conducted in parallel with closely monitored outpatient artificial pancreas studies used to assess benefit., (© 2015 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)
- Published
- 2016
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