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Use of an artificial pancreas among adolescents for a missed snack bolus and an underestimated meal bolus
Author(s) -
Cherñavvsky Daniel R,
DeBoer Mark D,
KeithHynes Patrick,
Mize Benton,
McElwee Molly,
Demartini Susan,
Dunsmore Spencer F,
Wakeman Christian,
Kovatchev Boris P,
Breton Marc D
Publication year - 2016
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12230
Subject(s) - medicine , glycemic , type 1 diabetes , hypoglycemia , insulin pump , insulin , bolus (digestion) , meal , randomized controlled trial , diabetes mellitus , type 2 diabetes , anesthesia , pediatrics , endocrinology
Objective The objective of this study was to evaluate the safety and performance of the artificial pancreas ( AP ) in adolescents with type 1 diabetes ( T1D ) following insulin omission for food. Research design and methods In a randomized, cross‐over trial, adolescents with T1D aged 13–18 yr were enrolled in a randomized, cross‐over trial. On separate days, received either usual care ( UC ) through their home insulin pump or used an AP system (Diabetes Assistant platform, continuous glucose monitor, and insulin pump). Approximately 1 h after admission, participants in both groups received an unannounced snack of 30 g carbohydrate, and 4 h later they received an 80 g lunch, for which both groups only received 75% of the calculated insulin dose to cover carbohydrates. On the UC day (but not the AP day), they received their full high blood glucose ( BG ) correction factor at lunch. Each admission lasted approximately 8 h. Results A total of 16 participants completed the trial. On the AP day (compared to UC ), mean BG was lower (197 ± 10 vs. 235 ± 14 mg/ dL ) and time in range 70–180 mg/ dL was higher (43% ± 7 vs. 19% ± 7) (both p < 0.05) overall; these results held in the time following the snack and meal (also p < 0.05). During the trial, there were no differences between groups in the rate of hypoglycemia <70 mg/ dL . Conclusions The AP provided improvements in short‐term glycemic control without increases in hypoglycemia following missed insulin for food in adolescents. Thus, the AP partly compensates for missed insulin boluses for food, a common occurrence in adolescent diabetes care. Further testing is needed in longer‐term settings.