RT Journal Article
SR Electronic
T1 Prevention of Nocturnal Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP 1013
OP 1017
DO 10.2337/dc09-2303
VO 33
IS 5
A1 Buckingham, Bruce
A1 Chase, H. Peter
A1 Dassau, Eyal
A1 Cobry, Erin
A1 Clinton, Paula
A1 Gage, Victoria
A1 Caswell, Kimberly
A1 Wilkinson, John
A1 Cameron, Fraser
A1 Lee, Hyunjin
A1 Bequette, B. Wayne
A1 Doyle, Francis J.
YR 2010
UL http://care.diabetesjournals.org/content/33/5/1013.abstract
AB OBJECTIVE The aim of this study was to develop a partial closed-loop system to safely prevent nocturnal hypoglycemia by suspending insulin delivery when hypoglycemia is predicted in type 1 diabetes. RESEARCH DESIGN AND METHODS Forty subjects with type 1 diabetes (age range 12–39 years) were studied overnight in the hospital. For the first 14 subjects, hypoglycemia (<60 mg/dl) was induced by gradually increasing the basal insulin infusion rate (without the use of pump shutoff algorithms). During the subsequent 26 patient studies, pump shutoff occurred when either three of five (n = 10) or two of five (n = 16) algorithms predicted hypoglycemia based on the glucose levels measured with the FreeStyle Navigator (Abbott Diabetes Care). RESULTS The standardized protocol induced hypoglycemia on 13 (93%) of the 14 nights. With use of a voting scheme that required three algorithms to trigger insulin pump suspension, nocturnal hypoglycemia was prevented during 6 (60%) of 10 nights. When the voting scheme was changed to require only two algorithms to predict hypoglycemia to trigger pump suspension, hypoglycemia was prevented during 12 (75%) of 16 nights. In the latter study, there were 25 predictions of hypoglycemia because some subjects had multiple hypoglycemic events during a night, and hypoglycemia was prevented for 84% of these events. CONCLUSIONS Using algorithms to shut off the insulin pump when hypoglycemia is predicted, it is possible to prevent hypoglycemia on 75% of nights (84% of events) when it would otherwise be predicted to occur. © 2010 by the American Diabetes Association.