Overnight closed-loop control improves glycemic control in a multicenter study of adults with type 1 diabetes

Sue A. Brown, Marc D. Breton, Stacey M. Anderson, Laura Kollar, Patrick Keith-Hynes, Carol J. Levy, David W. Lam, Camilla Levister, Nihat Baysal, Yogish C. Kudva, Ananda Basu, Vikash Dadlani, Ling Hinshaw, Shelly McCrady-Spitzer, Daniela Bruttomesso, Roberto Visentin, Silvia Galasso, Simone Del Favero, Yenny Leal, Federico BoscariAngelo Avogaro, Claudio Cobelli, Boris P. Kovatchev

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Context: Closed-loop control (CLC) for the management of type 1 diabetes (T1D) is a novel method for optimizing glucose control, and strategies for individualized implementation are being developed. Objective: To analyze glycemic control in an overnight CLC system designed to “reset” the patient to near-normal glycemic targets every morning. Design: Randomized, crossover, multicenter clinical trial. Participants: Forty-four subjects with T1D requiring insulin pump therapy. Intervention: Sensor-augmented pump therapy (SAP) at home vs 5 nights of CLC (active from 23:00 to 07:00) in a supervised outpatient setting (research house or hotel), with a substudy of 5 nights of CLC subsequently at home. Main Outcome Measure: The percentage of time spent in the target range (70 to 180 mg/dL measured using a continuous glucose monitor). Results: Forty subjects (age, 45.5 6 9.5 years; hemoglobin A1c, 7.4% 6 0.8%) completed the study. The time in the target range (70 to 180 mg/dL) significantly improved in CLC vs SAP over 24 hours (78.3% vs 71.4%; P = 0.003) and overnight (85.7% vs 67.6%; P, 0.001). The time spent in a hypoglycemic range (,70 mg/dL) decreased significantly in the CLC vs SAP group over 24 hours (2.5% vs 4.3%; P = 0.002) and overnight (0.9% vs 3.2%; P, 0.001). The mean glucose level at 07:00 was lower with CLC than with SAP (123.7 vs 145.3 mg/dL; P, 0.001). The substudy at home, involving 10 T1D subjects, showed similar trends with an increased time in target (70 to 180 mg/dL) overnight (75.2% vs 62.2%; P = 0.07) and decreased time spent in the hypoglycemic range (,70 mg/dL) overnight in CLC vs SAP (0.6% vs 3.7%; P = 0.03). Conclusion: Overnight-only CLC increased the time in the target range over 24 hours and decreased the time in hypoglycemic range over 24 hours in a supervised outpatient setting. A pilot extension study at home showed a similar nonsignificant trend.

Original languageEnglish (US)
Pages (from-to)3674-3682
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number10
DOIs
StatePublished - Oct 2017

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Fingerprint Dive into the research topics of 'Overnight closed-loop control improves glycemic control in a multicenter study of adults with type 1 diabetes'. Together they form a unique fingerprint.

  • Cite this

    Brown, S. A., Breton, M. D., Anderson, S. M., Kollar, L., Keith-Hynes, P., Levy, C. J., Lam, D. W., Levister, C., Baysal, N., Kudva, Y. C., Basu, A., Dadlani, V., Hinshaw, L., McCrady-Spitzer, S., Bruttomesso, D., Visentin, R., Galasso, S., Del Favero, S., Leal, Y., ... Kovatchev, B. P. (2017). Overnight closed-loop control improves glycemic control in a multicenter study of adults with type 1 diabetes. Journal of Clinical Endocrinology and Metabolism, 102(10), 3674-3682. https://doi.org/10.1210/jc.2017-00556