Application of Zone Model Predictive Control Artificial Pancreas During Extended Use of Infusion Set and Sensor: A Randomized Crossover-Controlled Home-Use Trial

• Published in: Diabetes care Vol. 40; no. 8; pp. 1096 - 1102
• Main Authors: Forlenza, Gregory P, Deshpande, Sunil, Ly, Trang T, Howsmon, Daniel P, Cameron, Faye, Baysal, Nihat, Mauritzen, Eric, Marcal, Tatiana, Towers, Lindsey, Bequette, B Wayne, Huyett, Lauren M, Pinsker, Jordan E, Gondhalekar, Ravi, Doyle, 3rd, Francis J, Maahs, David M, Buckingham, Bruce A, Dassau, Eyal
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.08.2017
• Subjects: Adolescent; Adult; Adults; Blood Glucose - metabolism; Clinical trials; Cross-Over Studies; Diabetes; Diabetes Mellitus, Type 1 - therapy; Emerging Technologies and Therapeutics; Environmental monitoring; Evidence-based medicine; Female; Glucose; Glycated Hemoglobin - metabolism; Glycemic index; Humans; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; Insulin Infusion Systems; Male; Mathematical models; Outpatients; Pancreas; Pancreas, Artificial; Predictive control; Randomization; Remote monitoring; Research design; Safety; SAP protein; Smartphone; Therapy; Young Adult
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc17-0500

As artificial pancreas (AP) becomes standard of care, consideration of extended use of insulin infusion sets (IIS) and continuous glucose monitors (CGMs) becomes vital. We conducted an outpatient randomized crossover study to test the safety and efficacy of a zone model predictive control (zone-MPC)-based AP system versus sensor augmented pump (SAP) therapy in which IIS and CGM failures were provoked via extended wear to 7 and 21 days, respectively. A smartphone-based AP system was used by 19 adults (median age 23 years [IQR 10], mean 8.0 ± 1.7% HbA ) over 2 weeks and compared with SAP therapy for 2 weeks in a crossover, unblinded outpatient study with remote monitoring in both study arms. AP improved percent time 70-140 mg/dL (48.1 vs. 39.2%; = 0.016) and time 70-180 mg/dL (71.6 vs. 65.2%; = 0.008) and decreased median glucose (141 vs. 153 mg/dL; = 0.036) and glycemic variability (SD 52 vs. 55 mg/dL; = 0.044) while decreasing percent time <70 mg/dL (1.3 vs. 2.7%; = 0.001). AP also improved overnight control, as measured by mean glucose at 0600 h (140 vs. 158 mg/dL; = 0.02). IIS failures (1.26 ± 1.44 vs. 0.78 ± 0.78 events; = 0.13) and sensor failures (0.84 ± 0.6 vs. 1.1 ± 0.73 events; = 0.25) were similar between AP and SAP arms. Higher percent time in closed loop was associated with better glycemic outcomes. Zone-MPC significantly and safely improved glycemic control in a home-use environment despite prolonged CGM and IIS wear. This project represents the first home-use AP study attempting to provoke and detect component failure while successfully maintaining safety and effective glucose control.