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Diabetes 55:3344-3350, 2006
DOI: 10.2337/db06-0419
© 2006 by the American Diabetes Association
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Feasibility of Automating Insulin Delivery for the Treatment of Type 1 Diabetes

Garry M. Steil1, Kerstin Rebrin1, Christine Darwin2, Farzam Hariri2, and Mohammed F. Saad3

1 Medtronic MiniMed, Northridge, California
2 David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
3 Departments of Medicine and Preventative Medicine, Stony Brook University, Stony Brook, New York

Address correspondence and reprint requests to Dr. Garry M. Steil, Medtronic MiniMed, 18000 Devonshire St., Northridge, CA 91325. E-mail: garry.steil{at}medtronic.com

Abbreviations: CGMS, continuous glucose monitoring system; CSII, continuous subcutaneous insulin infusion; DIR, daily insulin requirement; FFA, free fatty acid; MAD, mean absolute difference; SG, sensor glucose

An automated closed-loop insulin delivery system based on subcutaneous glucose sensing and subcutaneous insulin delivery was evaluated in 10 subjects with type 1 diabetes (2 men, 8 women, mean [±SD] age 43.4 ± 11.4 years, duration of diabetes 18.2 ± 13.5 years). Closed-loop control was assessed over ~30 h and compared with open-loop control assessed over 3 days. Closed-loop insulin delivery was calculated using a model of the ß-cell’s multiphasic insulin response to glucose. Plasma glucose was 160 ± 66 mg/dl at the start of closed loop and was thereafter reduced to 71 ± 19 by 1:00 P.M. (preprandial lunch). Fasting glucose the subsequent morning on closed loop was not different from target (124 ± 25 vs. 120 mg/dl, respectively; P > 0.05). Mean glucose levels were not different between the open and closed loop (133 ± 63 vs. 133 ± 52 mg/dl, respectively; P > 0.65). However, glucose was within the range 70–180 mg/dl 75% of the time under closed loop versus 63% for open loop. Incidence of biochemical hypoglycemia (blood glucose <60 mg/dl) was similar under the two treatments. There were no episodes of severe hypoglycemia. The data provide proof of concept that glycemic control can be achieved by a completely automated external closed-loop insulin delivery system.


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Copyright © 2006 by the American Diabetes Association.