title: Outpatient safety assessment of an in-home predictive low-glucose suspend system with type 1 diabetes subjects at elevated risk of nocturnal hypoglycemia.
abstract: OBJECTIVE
  Nocturnal hypoglycemia is a common problem with type 1 diabetes. In the home setting, we conducted a pilot study to evaluate the safety of a system consisting of an insulin pump and continuous glucose monitor communicating wirelessly with a bedside computer running an algorithm that temporarily suspends insulin delivery when hypoglycemia is predicted.
  
  
  METHODS
  After the run-in phase, a 21-night randomized trial was conducted in which each night was randomly assigned 2:1 to have either the predictive low-glucose suspend (PLGS) system active (intervention night) or inactive (control night). Three predictive algorithm versions were studied sequentially during the study for a total of 252 intervention and 123 control nights. The trial included 19 participants 18-56 years old with type 1 diabetes (hemoglobin A1c level of 6.0-7.7%) who were current users of the MiniMed Paradigm® REAL-Time Revel™ System and Sof-sensor® glucose sensor (Medtronic Diabetes, Northridge, CA).
  
  
  RESULTS
  With the final algorithm, pump suspension occurred on 53% of 77 intervention nights. Mean morning glucose level was 144±48 mg/dL on the 77 intervention nights versus 133±57 mg/dL on the 37 control nights, with morning blood ketones >0.6 mmol/L following one intervention night. Overnight hypoglycemia was lower on intervention than control nights, with at least one value ≤70 mg/dL occurring on 16% versus 30% of nights, respectively, with the final algorithm.
  
  
  CONCLUSIONS
  This study demonstrated that the PLGS system in the home setting is safe and feasible. The preliminary efficacy data appear promising with the final algorithm reducing nocturnal hypoglycemia by almost 50%.
authors.affiliation: Stanford University, Stanford, CA, USA. buckingham@stanford.edu
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Buckingham
authors.forename: Fraser
authors.initials: F
authors.lastname: Cameron
authors.forename: Peter
authors.initials: P
authors.lastname: Calhoun
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.forename: Darrell M
authors.initials: DM
authors.lastname: Wilson
authors.forename: H Peter
authors.initials: HP
authors.lastname: Chase
authors.forename: B Wayne
authors.initials: BW
authors.lastname: Bequette
authors.forename: John
authors.initials: J
authors.lastname: Lum
authors.forename: Judy
authors.initials: J
authors.lastname: Sibayan
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007332:Insulin Infusion Systems / Q000009:adverse effects*; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000009:adverse effects* / Q000295:instrumentation; D010865:Pilot Projects; D019095:Point-of-Care Systems; D012306:Risk; D012890:Sleep; D014481:United States / Q000453:epidemiology; D059015:Wireless Technology; D055815:Young Adult