المؤلفون: Capel Flores, Ismael

المساهمون: University/Department: Universitat Autònoma de Barcelona. Departament de Medicina

مرشدي الرسالة: Rigla Cros, Mercedes, Segura, Ferran

المصدر: TDX (Tesis Doctorals en Xarxa)

مصطلحات موضوعية: Diabetis mellitus, Pàncrees artificial, Páncreas artificial, Artificial pancreas, Insulina, Insulin, Ciències de la Salut

الوصف: La diabetes mellitus tipo 1 implica una deficiencia completa de la secreción nativa de insulina y su tratamiento fundamental, hasta la fecha, es la sustitución de esta secreción con insulina exógena de la forma más fisiológica posible. Los tratamientos actuales son imperfectos y necesitan ser optimizados. En este sentido, la integración de sensores continuos de glucosa con algoritmos que decidan la dosis óptima de insulina a administrar y bombas de infusión continua subcutánea de insulina, constituyendo un sistema de páncreas artificial, puede suponer una mejoría muy significativa de las opciones terapéuticas disponibles hasta el momento. Se han propuesto diferentes algoritmos de control para páncreas artificial pero no existe un gold standard. El Grupo de Bioingeniería y Telemedicina de la Universidad Politécnica de Madrid junto al Servicio de Endocrinología del Hospital Universitari Parc Taulí han desarrollado un algoritmo para páncreas artificial denominado Predictive Rule-Based Algorithm (pRBA). Este algoritmo parte de la pauta de insulina habitual, con bomba de infusión continua, del paciente y le aplica una serie de reglas que optimizan continuamente la dosis en base a la predicción que realiza una red neuronal artificial. Se trata de un sistema híbrido que automatiza totalmente el control basal o nocturno pero que requiere de aviso de las ingestas. El objetivo principal de la investigación expuesta en esta tesis doctoral fue la validación clínica inicial, en medio hospitalario, del controlador pRBA. Para ello se ha llevado a cabo un ensayo clínico aleatorizado y cruzado en el que 10 pacientes con diabetes tipo 1 han pasado 2 noches no consecutivas en el hospital; una con su pauta habitual de bomba (noche control) y otra bajo el control del pRBA (noche experimental). El periodo de control automatizado fue de las 22:00 a las 10:00h del día siguiente, incluyendo el control nocturno y el control prandial del desayuno. El contralador pRBA ha demostrado que es capaz de mantener a los pacientes mayor tiempo en glucemia objetivo (3,9-8,0 mmol/l) durante el periodo nocturno (00:00-08:00h) que la pauta de tratamiento habitual (95,8 % [73-100] versus 66.6% [8,3-75]; p<0,05). Así mismo ha demostrado conseguir un menor porcentaje de tiempo en hipoglucemia (<3,9 mmol/l) en el mismo periodo (0,0 [0,0-0,0] versus 4,2 [0,0-21]; p<0,05) y reducir la variabilidad glucémica (HBGI 1,60 versus 3,95; p<0,05). En relación al control prandial del desayuno no se han observado diferencias significativas entre el periodo experimental y control (porcentaje de tiempo entre 3,9-10 mmol/l en el periodo 08:00-10:00h 50,0% [50,0-100] versus 58,3% [29,1-87,5]; p n.s.). Como conclusión de la investigación expuesta en esta tesis podemos establecer que el controlador pRBA se muestra eficaz y seguro para el control nocturno de pacientes con diabetes tipo 1, pero que no muestra ventajas evidentes para el control prandial. Debe optimizarse el controlador prandial y poder testar el algoritmo en condiciones más reales antes de plantear su uso clínico ordinario.

الوصف (مترجم): Type 1 diabetes mellitus implies a complete deficiency of native insulin secretion and its fundamental treatment, to date, is the replacement of this secretion with exogenous insulin as physiologically as possible. Current treatments are imperfect and need to be optimized. Integration of continuous glucose sensors with algorithms that decide the optimal dose of insulin to be administered and continuous subcutaneous insulin infusion pumps, constituting an artificial pancreas system, may imply a very significant improvement in the therapeutic options available until the moment. Different control algorithms have been proposed for artificial pancreas but there is no gold standard. Our research team, integrated by Grupo de Bioingeniería y Telemedicina (GBT) - Universidad Politécnica de Madrid, together with the Endocrinology Department of Parc Taulí University Hospital-UAB, has developed an artificial pancreas algorithm called Predictive Rule-Based Algorithm (pRBA). This algorithm starts from the patient's usual insulin regimen, with a continuous infusion pump, and applies a series of rules that continuously optimize the dose based on the prediction of an artificial neural network. It is a hybrid system that fully automates basal or night control but requires notification of intakes. The main objective of the research presented in this doctoral thesis was the initial clinical validation, in hospital setting, of the pRBA controller. For this, a randomized and cross-over trial has been carried out in which 10 patients with type 1 diabetes have spent 2 non consecutive nights in the hospital; one with his/her usual pump pattern (night control) and another under the control of pRBA (experimental night). The automated control period lasted from 22:00 to 10:00 on the following day, including night control and prandial breakfast control. pRBA algorithm has been shown to be able to keep patients longer on target glycemia (3.9-8.0 mmol/l) during the night time period (00:00-08:00) than the usual treatment regimen (95.8% [73-100] versus 66.6% [8.3-75], p <0.05). It has also been shown to achieve a lower percentage of time in hypoglycemia (<3.9 mmol/l) in the same period (0.0 [0.0-0.0] versus 4.2 [0.0-21]; p <0.05) and reduced glycemic variability (HBGI 1.60 versus 3.95, p <0.05). Regarding to breakfast prandial control, no significant differences were observed between the experimental and control periods (percentage of time between 3.9-10 mmol/l in the period 08:00-10:00h 50,0% [50,0- 100] versus 58.3% [29.1-87.5]; p ns). As a conclusion of the research exposed in this thesis we can establish that the pRBA controller is shown to be effective and safe for the nocturnal control of patients with type 1 diabetes, but does not show significant advantages for the prandial control. The prandial controller must be optimized and the algorithm should be tested under more real conditions before its usual clinical use is raised.

وصف الملف: application/pdf

الوصول الحر: http://hdl.handle.net/10803/457142Test

المؤلفون: Charlotte L, van Veldhuisen, Anouk E J, Latenstein, Helga, Blauw, Lyan B, Vlaskamp, Michel, Klaassen, Daan J, Lips, Bert A, Bonsing, Erwin, van der Harst, Martijn W J, Stommel, Marco J, Bruno, Hjalmar C, van Santvoort, Casper H J, van Eijck, Susan, van Dieren, Olivier R, Busch, Marc G, Besselink, J Hans, DeVries, Ralph, de Vries

المصدر: JAMA surgery. 157(10)

مصطلحات موضوعية: Adult, Blood Glucose, Male, Pancreas, Artificial, Cross-Over Studies, Blood Glucose Self-Monitoring, Penicillin G, Middle Aged, Glucagon, Hypoglycemia, Diabetes Mellitus, Type 1, Pancreatectomy, Quality of Life, Humans, Insulin, Female

الوصف: Glucose control in patients after total pancreatectomy is problematic because of the complete absence of α- and β-cells, leading to impaired quality of life. A novel, bihormonal artificial pancreas (BIHAP), using both insulin and glucagon, may improve glucose control, but studies in this setting are lacking.To assess the efficacy and safety of the BIHAP in patients after total pancreatectomy.This randomized crossover clinical trial compared the fully closed-loop BIHAP with current diabetes care (ie, insulin pump or pen therapy) in 12 adult outpatients after total pancreatectomy. Patients were recruited between August 21 and November 16, 2020. This first-in-patient study began with a feasibility phase in 2 patients. Subsequently, 12 patients were randomly assigned to 7-day treatment with the BIHAP (preceded by a 5-day training period) followed by 7-day treatment with current diabetes care, or the same treatments in reverse order. Statistical analysis was by Wilcoxon signed rank and Mann-Whitney U tests, with significance set at a 2-sided P.05.The primary outcome was the percentage of time spent in euglycemia (70-180 mg/dL [3.9-10 mmol/L]) as assessed by continuous glucose monitoring.In total, 12 patients (7 men and 3 women; median [IQR] age, 62.5 [43.1-74.0] years) were randomly assigned, of whom 3 did not complete the BIHAP phase and 1 was replaced. The time spent in euglycemia was significantly higher during treatment with the BIHAP (median, 78.30%; IQR, 71.05%-82.61%) than current diabetes care (median, 57.38%; IQR, 52.38%-81.35%; P = .03). In addition, the time spent in hypoglycemia (70 mg/dL [3.9 mmol/L]) was lower with the BIHAP (median, 0.00% [IQR, 0.00%-0.07%] vs 1.61% [IQR, 0.80%-3.81%]; P = .004). No serious adverse events occurred.Patients using the BIHAP after total pancreatectomy experienced an increased percentage of time in euglycemia and a reduced percentage of time in hypoglycemia compared with current diabetes care, without apparent safety risks. Larger randomized trials, including longer periods of treatment and an assessment of quality of life, should confirm these findings.trialregister.nl Identifier: NL8871.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::7eec82f5b6c697daed8a63fdf8fd7502Test
https://pubmed.ncbi.nlm.nih.gov/36069829Test

المؤلفون: Gregory P. Forlenza, Rayhan A. Lal

المصدر: Diabetes Technol Ther

مصطلحات موضوعية: Blood Glucose, Pancreas, Artificial, Medical Laboratory Technology, Endocrinology, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Endocrinology, Diabetes and Metabolism, Humans, Hypoglycemic Agents, Insulin, Review Article

الوصف: Combining technologies including rapid insulin analogs, insulin pumps, continuous glucose monitors, and control algorithms has allowed for the creation of automated insulin delivery (AID) systems. These systems have proven to be the most effective technology for optimizing metabolic control and could hold the key to broadly achieving goal-level glycemic control for people with type 1 diabetes. The use of AID has exploded in the past several years with several options available in the United States and even more in Europe. In this article, we review the largest studies involving these AID systems, and then examine future directions for AID with an emphasis on usability.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4a1ca51960f38abcd665c72f939836b5Test
https://pubmed.ncbi.nlm.nih.gov/35099302Test

المؤلفون: Emilia Fushimi, Hernan De Battista, Fabricio Garelli

المصدر: IEEE Journal of Biomedical and Health Informatics. 26:4743-4750

مصطلحات موضوعية: Blood Glucose, Pancreas, Artificial, Health Informatics, Glucagon, Hypoglycemia, Computer Science Applications, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Health Information Management, Humans, Hypoglycemic Agents, Insulin, Electrical and Electronic Engineering, Algorithms

الوصف: Artificial pancreas (AP) algorithms can be divided into single-hormone (SH) and dual-hormone (DH). SH algorithms regulate glycemia using insulin as their control input. On the other hand, DH algorithms also use glucagon to counteract insulin. While SH-AP systems are already commercially available, DH-AP systems are still in an earlier research phase. DH-AP systems have been questioned since the added complexity of glucagon infusion does not always guarantee hypoglycemia prevention and might significantly raise insulin delivery. In this work, a DH multicontroller is proposed based on a SH linear quadratic gaussian (LQG) algorithm with an additional LQG controller to deliver glucagon. This strategy has a switched structure that allows activating one of the following three controllers when necessary: a conservative insulin LQG controller to modulate basal delivery ( K

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::46db54e23da33837025c08430725e0cdTest
https://doi.org/10.1109/jbhi.2022.3182581Test

المؤلفون: Mohamadreza Homayounzade

المصدر: IET Systems Biology. 16:157-172

مصطلحات موضوعية: Blood Glucose, Pancreas, Artificial, Diabetes Mellitus, Type 1, Modeling and Simulation, Genetics, Humans, Insulin, Cell Biology, Molecular Biology, Algorithms, Biotechnology

الوصف: In practice, there are many physical systems that can have only positive inputs, such as physiological systems. Most conventional control methods cannot ensure that the main system input is positive. A positive input observer-based controller is designed for an intravenous glucose tolerance test model of type 1 diabetes mellitus (T1DM). The backstepping (BS) approach is employed to design the feedback controller for artificial pancreas (AP) systems, based on the Extended Bergman's Minimal Model (EBMM). The EBMM represents the T1DM in terms of the blood glucose concentration (BGC), insulin concentration, and plasma level and the disturbance of insulin during medication due to either meal intake or burning sugar by doing some physical exercise. The insulin concentration and plasma level are estimated using observers, and these estimations are applied as feedback to the controller. The asymptotic stability of the observer-based controller is proved using the Lyapunov theorem. Moreover, it is proved that the system is bounded input-bounded output (BIBO) stable in the presence of uncertainties generated by uncertain parameters and external disturbance. For realistic situations, we consider only the BGC to be available for measurement and additionally inter-and intra-patient variability of system parameters is considered.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7dad5df39a1cdd948aedad4d96d560acTest
https://doi.org/10.1049/syb2.12049Test

المؤلفون: Pallavi Sachdeva, Ashrit R. M., Rahul Shukla, Ashish Sahani

المصدر: Journal of Medical Engineering & Technology. 46:693-702

مصطلحات موضوعية: Pancreas, Artificial, Blood Glucose, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Biomedical Engineering, Humans, Insulin, Hypoglycemic Agents, General Medicine, Regenerative Medicine

الوصف: Diabetes mellitus is one of the fastest-growing lifestyle disorders in the world. While numerous regimes have been developed to manage diabetes, there continue to be high numbers of diabetes-related deaths worldwide. The review gives a brief introduction to the pathology and aetiology of the disorder, different solutions developed over time with their advantages and disadvantages, and highlights the technological components and challenges of the latest technologies: artificial pancreas and regenerative medicine. The study is restricted to a set of high-quality publications from the last decade.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::25e5428539fe2e4ed6d124c7522eace8Test
https://doi.org/10.1080/03091902.2022.2095049Test

المؤلفون: Basak Ozaslan, Carol J. Levy, Yogish C. Kudva, Jordan E. Pinsker, Grenye O'Malley, Ravinder Jeet Kaur, Kristin Castorino, Camilla Levister, Mari Charisse Trinidad, Donna Desjardins, Mei Mei Church, Mitchell Plesser, Shelly McCrady-Spitzer, Selassie Ogyaadu, Kristen Nelson, Corey Reid, Sunil Deshpande, Walter K. Kremers, Francis J. Doyle, Barak Rosenn, Eyal Dassau

المصدر: Diabetes Technol Ther

مصطلحات موضوعية: Adult, Blood Glucose, Pancreas, Artificial, Endocrinology, Diabetes and Metabolism, Infant, Pilot Projects, Original Articles, Medical Laboratory Technology, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Endocrinology, Pregnancy, Insulin, Regular, Human, Feasibility Studies, Humans, Hypoglycemic Agents, Insulin, Female, Algorithms

الوصف: OBJECTIVE: Evaluating the feasibility of closed-loop insulin delivery with a zone model predictive control (zone-MPC) algorithm designed for pregnancy complicated by type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Pregnant women with T1D from 14 to 32 weeks gestation already using continuous glucose monitor (CGM) augmented pump therapy were enrolled in a 2-day multicenter supervised outpatient study evaluating pregnancy-specific zone-MPC based closed-loop control (CLC) with the interoperable artificial pancreas system (iAPS) running on an unlocked smartphone. Meals and activities were unrestricted. The primary outcome was the CGM percentage of time between 63 and 140 mg/dL compared with participants' 1-week run-in period. Early (2-h) postprandial glucose control was also evaluated. RESULTS: Eleven participants completed the study (age: 30.6 ± 4.1 years; gestational age: 20.7 ± 3.5 weeks; weight: 76.5 ± 15.3 kg; hemoglobin A1c: 5.6% ± 0.5% at enrollment). No serious adverse events occurred. Compared with the 1-week run-in, there was an increased percentage of time in 63–140 mg/dL during supervised CLC (CLC: 81.5%, run-in: 64%, P = 0.007) with less time >140 mg/dL (CLC: 16.5%, run-in: 30.8%, P = 0.029) and time 180 mg/dL (CLC: 4.9%, run-in: 13.1%, P = 0.032). Overnight glucose control was comparable, except for less time >250 mg/dL (CLC: 0%, run-in:3.9%, P = 0.030) and lower glucose standard deviation (CLC: 23.8 mg/dL, run-in:42.8 mg/dL, P = 0.007) during CLC. CONCLUSION: In this pilot study, use of the pregnancy-specific zone-MPC was feasible in pregnant women with T1D. Although the duration of our study was short and the number of participants was small, our findings add to the limited data available on the use of CLC systems during pregnancy (NCT04492566).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::876461fc5f351ac86015eb496d6e236aTest
https://doi.org/10.1089/dia.2021.0521Test

المؤلفون: Keren Zhou, Diana Isaacs

المصدر: Current Cardiology Reports. 24:1159-1167

مصطلحات موضوعية: Blood Glucose, Pancreas, Artificial, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Blood Glucose Self-Monitoring, Humans, Hypoglycemic Agents, Insulin, Multicenter Studies as Topic, Prospective Studies, Cardiology and Cardiovascular Medicine

الوصف: Closed-loop insulin pump systems (artificial pancreas) represent the cutting edge of insulin delivery technology. There are only a few systems currently approved for use in the USA: the MiniMed 670G/770G (which share an algorithm), t:slim X2 Control IQ, and the Omnipod 5. We review these systems and look into the future of the technology.All of the approved closed-loop insulin pump systems have demonstrated in multicenter prospective trials improvements in time in range, hemoglobin A1c, and time spent in hypoglycemia. The newer systems have also improved time spent in automation. Comparisons between the systems with regard to glycemic control are difficult to make due to differences in clinical trial design, but there are notable differences in the user experience between systems. The past few years have been a time of exponential development in the field of closed-loop insulin pump systems. However, more research is needed to provide full automation of these systems without any need for information from the user.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::151e52503dd8a299a3cfd07b9df875d8Test
https://doi.org/10.1007/s11886-022-01733-1Test

المؤلفون: Laura Pyle, Tim Vigers, Cari Berget, Darrell M. Wilson, Laurel H. Messer, Rayhan A. Lal, Gregory P. Forlenza, Bruce A. Buckingham, R. Paul Wadwa, Korey K. Hood, Marina Basina, David M. Maahs, Kimberly A. Driscoll

المصدر: Diabetes Technol Ther

مصطلحات موضوعية: Insulin pump, Blood Glucose, Pancreas, Artificial, medicine.medical_specialty, Adolescent, Endocrinology, Diabetes and Metabolism, Logistic regression, Artificial pancreas, External validity, Young Adult, Endocrinology, Insulin Infusion Systems, medicine, Humans, Hypoglycemic Agents, Insulin, Child, Glycemic, Type 1 diabetes, business.industry, Model selection, Blood Glucose Self-Monitoring, Area under the curve, Original Articles, medicine.disease, Medical Laboratory Technology, Diabetes Mellitus, Type 1, Physical therapy, business

الوصف: Background Hybrid Closed Loop (HCL) systems aid individuals with type 1 diabetes in improving glycemic control, however, sustained use over time has not been consistent for all users. This study developed and validated prognostic models for successful 12-month use of the first commercial HCL system based on baseline and 1-month or 3-month data. Methods and materials Data from participants at the Barbara Davis Center (N=85) who began use of the MiniMed 670G HCL were used to develop prognostic models using logistic regression and Lasso model selection. Candidate factors included sex, age, duration of diabetes, baseline HbA1c, race, ethnicity, insurance status, history of insulin pump and continuous glucose monitor use, 1-month or 3-month Auto Mode use, boluses per day, and time in range (70-180 mg/dL; TIR), and scores on behavioral questionnaires. Successful use of HCL was predefined as Auto Mode use ≥60%. The 3-month model was then externally validated against a sample from Stanford University (N=55). Results Factors in the final model included baseline HbA1c, sex, ethnicity, 1-month or 3-month Auto Mode use, Boluses per Day, and TIR. The 1-month and 3-month prognostic models had very good predictive ability with area under the curve values of 0.894 and 0.900, respectively. External validity was acceptable with an area under the curve of 0.717. Conclusions Our prognostic models use clinically accessible baseline and early device-use factors to identify risk for failure to succeed with 670G HCL technology. These models may be useful to develop targeted interventions to promote success with new technologies.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5ea0861287a120c1e0b2328ec5cc6946Test
https://pubmed.ncbi.nlm.nih.gov/34780306Test

المؤلفون: Nwokolo, Munachiso, Hovorka, Roman

المساهمون: Nwokolo, Munachiso [0000-0001-7200-6004], Hovorka, Roman [0000-0003-2901-461X], Apollo - University of Cambridge Repository

المصدر: The Journal of Clinical Endocrinology & Metabolism.

مصطلحات موضوعية: Pancreas, Artificial, Blood Glucose, automated insulin delivery, type 1 diabetes, artificial pancreas, Blood Glucose Self-Monitoring, Endocrinology, Diabetes and Metabolism, Biochemistry (medical), Clinical Biochemistry, Biochemistry, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Endocrinology, Humans, Hypoglycemic Agents, Insulin, hybrid closed-loop

الوصف: Diabetes technologies represent a paradigm shift in type 1 diabetes care. Continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGM) improve glycated hemoglobin (HbA1c) levels, enhance time in optimal glycemic range, limit severe hypoglycemia, and reduce diabetes distress. The artificial pancreas or closed-loop system connects these devices via a control algorithm programmed to maintain target glucose, partially relieving the person living with diabetes of this constant responsibility. Automating insulin delivery reduces the input required from those wearing the device, leading to better physiological and psychosocial outcomes. Hybrid closed-loop therapy systems, requiring user-initiated prandial insulin doses, are the most advanced closed-loop systems commercially available. Fully closed-loop systems, requiring no user-initiated insulin boluses, and dual hormone systems have been shown to be safe and efficacious in the research setting. Clinical adoption of closed-loop therapy remains in early stages despite recent technological advances. People living with diabetes, health care professionals, and regulatory agencies continue to navigate the complex path to equitable access. We review the available devices, evidence, clinical implications, and barriers regarding these innovatory technologies.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ab990951909e6065d6dd0853e7a8ee91Test
https://doi.org/10.1210/clinem/dgad068Test