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  • Anticipation of Historical ...
    Garcia-Tirado, Jose; Brown, Sue A; Laichuthai, Nitchakarn; Colmegna, Patricio; Koravi, Chaitanya L K; Ozaslan, Basak; Corbett, John P; Barnett, Charlotte L; Pajewski, Michael; Oliveri, Mary C; Myers, Helen; Breton, Marc D

    Diabetes technology & therapeutics, 04/2021, Letnik: 23, Številka: 4
    Journal Article

    Physical activity is a major challenge to glycemic control for people with type 1 diabetes. Moderate-intensity exercise often leads to steep decreases in blood glucose and hypoglycemia that closed-loop control systems have so far failed to protect against, despite improving glycemic control overall. Fifteen adults with type 1 diabetes (42 ± 13.5 years old; hemoglobin A 6.6% ± 1.0%; 10F/5M) participated in a randomized crossover clinical trial comparing two hybrid closed-loop (HCL) systems, a state-of-the-art hybrid model predictive controller and a modified system designed to anticipate and detect unannounced exercise (APEX), during two 32-h supervised admissions with 45 min of planned moderate activity, following 4 weeks of data collection. Primary outcome was the number of hypoglycemic episodes during exercise. Continuous glucose monitor (CGM)-based metrics and hypoglycemia are also reported across the entire admissions. The APEX system reduced hypoglycemic episodes overall (9 vs. 33;  = 0.02), during exercise (5 vs. 13;  = 0.04), and in the 4 h following (2 vs. 11;  = 0.02). Overall CGM median percent time <70 mg/dL decreased as well (0.3% vs. 1.6%;  = 0.004). This protection was obtained with no significant increase in time >180 mg/dL (18.5% vs. 16.6%,  = 0.15). Overnight control was notable for both systems with no hypoglycemia, median percent in time 70-180 mg/dL at 100% and median percent time 70-140 mg/dL at ∼96% for both. A new closed-loop system capable of anticipating and detecting exercise was proven to be safe and feasible and outperformed a state-of-the-art HCL, reducing participants' exposure to hypoglycemia during and after moderate-intensity physical activity. ClinicalTrials.gov NCT03859401.