Feasibility Studies of an Insulin-Only Bionic Pancreas in a Home-Use Setting. (November 2019)

• Record Type: Journal Article
• Authors: Ekhlaspour, Laya; Nally, Laura M.; El-Khatib, Firas H.; Ly, Trang T.; Clinton, Paula; Frank, Eliana; Tanenbaum, Molly L.; Hanes, Sarah J.; Selagamsetty, Rajendranath R.; Hood, Korey; Damiano, Edward R.; Buckingham, Bruce A.
• Is Part Of: Journal of diabetes science and technology. Volume 13:Number 6(2019:Nov.)
• Page Start: 1001
• Page End: 1007
• Publication Date: 2019-11
• Subjects: type 1 diabetes -- artificial pancreas -- closed-loop system -- bionic pancreas; Diabetes -- Periodicals; Medical technology -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1177/1932296819872225
• Languages: English
• ISSNs: 1932-2968

Abstract

Background: We tested the safety and performance of the "insulin-only" configuration of the bionic pancreas (BP) closed-loop blood-glucose control system in a home-use setting to assess glycemic outcomes using different static and dynamic glucose set-points. Method: This is an open-label non-randomized study with three consecutive intervention periods. Participants had consecutive weeks of usual care followed by the insulin-only BP with (1) an individualized static set-point of 115 or 130 mg/dL and (2) a dynamic set-point that automatically varied within 110 to 130 mg/dL, depending on hypoglycemic risk. Human factors (HF) testing was conducted using validated surveys. The last five days of each study arm were used for data analysis. Results: Thirteen participants were enrolled with a mean age of 28 years, mean A1c of 7.2%, and mean daily insulin dose of 0.6 U/kg (0.4-1.0 U/kg). The usual care arm had an average glucose of 145 ± 20 mg/dL, which increased in the static set-point arm (159 ± 8 mg/dL, P = .004) but not in the dynamic set-point arm (154 ± 10 mg/dL, P = ns). There was no significant difference in time spent in range (70-180 mg/dL) among the three study arms. There was less time <70 mg/dL with both the static (1.8% ± 1.4%, P = .009) and dynamic set-point (2.7±1.5, P = .051) arms compared to the usual-care arm (5.5% ± 4.2%). HF testing demonstrated preliminary user satisfaction and no increased risk of diabetes burden or distress. Conclusions: The insulin-only configuration of the BP using either static or dynamic set-points and initialized only with body weight performed similarly to other published insulin-only systems.