controlled insulin delivery: combining technology with treatment

Conditions: Diabetes Mellitus, Type 1

Summary: hypothesis: closed-loop control systems for an artificial pancreas using multi-parametric model predictive control can be developed and evaluated safely in patients with type 1 diabetes mellitus (t1dm) to control blood glucose concentrations. this study seeks to combine real-time continuous glucose sensing with automated insulin delivery in a closed-loop system that will achieve euglycemia in patients with t1dm. the end result of this line of research will be an artificial pancreas that will provide around-the-clock glucose regulation through controlled insulin delivery in response to detected patterns of change in glucose levels.

the goal of the jdrf artificial pancreas project is to produce an autonomous artificial pancreas that can safely and effectively regulate glycemia in people with type 1 diabetes mellitus. in our work, this fully automated closed-loop system combines a subcutaneous continuous glucose monitor (cgm) and a continuous subcutaneous insulin infusion (csii) pump with a sophisticated control algorithm. this is a proof-of-concept study to demonstrate that the controller could bring the patient back to a relatively normal glucose concentration after an unannounced meal and from mild hyperglycemia. once the system is initiated, all insulin delivery is calculated automatically. there was no outside intervention either by the subject or medical personnel. an artificial pancreas system that aims at replicating normal beta-cell function by using the subcutaneous-subcutaneous (sc-sc) route needs to address inherent delays in both glucose sensing and insulin delivery. our strategic approach is that a closed-loop system should operate safely without any knowledge of meals or other disturbances. we have developed the artificial pancreas system (aps©) and used it to clinically evaluate a control strategy that allows efficient glycemic control without any a priori meal information. the artificial pancreas device uses the artificial pancreas system (aps©) platform with the omnipod insulin pump, the dexcom seven plus cgm and a multi-parametric model predictive control algorithm (mpmpc) with an insulin-on-board (iob) safety constraint.

Eligibility criteria:
inclusion criteria: 1. willing to sign the consent form 2. type 1 diabetes for at least 1 year prior to the study 3. using continuous subcutaneous insulin infusion pump 4. above 21 years of age 5. willing to follow the study requirements exclusion criteria: 1. allergy to the sensor or to one of its components 2. psychiatric disorders 3. reported diabetic ketoacidosis within last 3 months 4. abnormal liver function (transaminase \> 2 times the upper limit of normal) 5. heart failure 6. any carcinogenic disease 7. any other chronic abnormality 8. unwilling to perform or to follow the research protocol 9. participation in any other study concurrent with the proposed study 10. creatinine concentration above the upper limit of normal for age and sex 11. active coronary artery disease 12. active gastroparesis 13. history of uncontrolled seizures 14. pregnancy 15. untreated adrenal insufficiency 16. hypokalemia 17. uncontrolled thyroid disease. 18. condition, which in the opinion of the investigator, would interfere with patient safety

Keywords: diabetes mellitus closed loop artificial pancreas