Overnight closed-loop insulin delivery in young people with type 1 diabetes:a free-living, randomized clinical trial

Hovorka, Roman, Elleri, Daniela, Thabit, Hood, Allen, Janet M, Leelarathna, Lalantha, El-Khairi, Ranna, Kumareswaran, Kavita, Caldwell, Karen, Calhoun, Peter, Kollman, Craig, Murphy, Helen R, Acerini, Carlo L, Wilinska, Malgorzata E, Nodale, Marianna and Dunger, David B (2014) Overnight closed-loop insulin delivery in young people with type 1 diabetes:a free-living, randomized clinical trial. Diabetes Care, 37 (5). pp. 1204-1211. ISSN 0149-5992

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Abstract

OBJECTIVE: To evaluate feasibility, safety, and efficacy of overnight closed-loop insulin delivery in free-living youth with type 1 diabetes.  RESEARCH DESIGN AND METHODS: Overnight closed loop was evaluated at home by 16 pump-treated adolescents with type 1 diabetes aged 12-18 years. Over a 3-week period, overnight insulin delivery was directed by a closed-loop system, and on another 3-week period sensor-augmented therapy was applied. The order of interventions was random. The primary end point was time when adjusted sensor glucose was between 3.9 and 8.0 mmol/L from 2300 to 0700 h.  RESULTS: Closed loop was constantly applied over at least 4 h on 269 nights (80%); sensor data were collected over at least 4 h on 282 control nights (84%). Closed loop increased time spent with glucose in target by a median 15% (interquartile range -9 to 43; P < 0.001). Mean overnight glucose was reduced by a mean 14 (SD 58) mg/dL (P < 0.001). Time when glucose was <70 mg/dL was low in both groups, but nights with glucose <63 mg/dL for at least 20 min were less frequent during closed loop (10 vs. 17%; P = 0.01). Despite lower total daily insulin doses by a median 2.3 (interquartile range -4.7 to 9.3) units (P = 0.009), overall 24-h glucose was reduced by a mean 9 (SD 41) mg/dL (P = 0.006) during closed loop.  CONCLUSIONS: Unsupervised home use of overnight closed loop in adolescents with type 1 diabetes is safe and feasible. Glucose control was improved during the day and night with fewer episodes of nocturnal hypoglycemia.

Item Type: Article
Additional Information: Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 01 Apr 2016 10:11
Last Modified: 17 Mar 2020 21:40
URI: https://ueaeprints.uea.ac.uk/id/eprint/58033
DOI: 10.2337/dc13-2644

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