title: Overnight glucose control with an automated, unified safety system in children and adolescents with type 1 diabetes at diabetes camp.
abstract: OBJECTIVE
  To determine the safety and efficacy of an automated unified safety system (USS) in providing overnight closed-loop (OCL) control in children and adolescents with type 1 diabetes attending diabetes summer camps.
  
  
  METHODS
  The Diabetes Assistant (DIAS) USS used the Dexcom G4 Platinum glucose sensor (Dexcom) and t:slim insulin pump (Tandem Diabetes Care). An initial inpatient study was completed for 12 participants to evaluate safety. For the main camp study, 20 participants with type 1 diabetes were randomized to either OCL or sensor-augmented therapy (control conditions) per night over the course of a 5- to 6-day diabetes camp.
  
  
  RESULTS
  Subjects completed 54 OCL nights and 52 control nights. On an intention-to-treat basis, with glucose data analyzed regardless of system status, the median percent time in range, from 70-150 mg/dL, was 62% (29, 87) for OCL nights versus 55% (25, 80) for sensor-augmented pump therapy (P = 0.233). A per-protocol analysis allowed for assessment of algorithm performance. The median percent time in range, from 70-150 mg/dL, was 73% (50, 89) for OCL nights (n = 41) versus 52% (24, 83) for control conditions (n = 39) (P = 0.037). There was less time spent in the hypoglycemic range <50, <60, and <70 mg/dL during OCL compared with the control period (P = 0.019, P = 0.009, and P = 0.023, respectively).
  
  
  CONCLUSIONS
  The DIAS USS algorithm is effective in improving time spent in range as well as reducing nocturnal hypoglycemia during the overnight period in children and adolescents with type 1 diabetes in a diabetes camp setting.
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CASchool of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Trang T
authors.initials: TT
authors.lastname: Ly
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Breton
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Keith-Hynes
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Daniel
authors.initials: D
authors.lastname: De Salvo
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Paula
authors.initials: P
authors.lastname: Clinton
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Kari
authors.initials: K
authors.lastname: Benassi
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
authors.forename: Benton
authors.initials: B
authors.lastname: Mize
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chernavvsky
authors.affiliation: Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, Montpellier, France.
authors.forename: Jéróme
authors.initials: J
authors.lastname: Place
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Darrell M
authors.initials: DM
authors.lastname: Wilson
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
authors.forename: Boris P
authors.initials: BP
authors.lastname: Kovatchev
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA buckingham@stanford.edu.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Buckingham
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001331:Automation; D015374:Biosensing Techniques / Q000295:instrumentation*; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation; D002165:Camping; D002648:Child; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems / Q000009:adverse effects; D057194:Intention to Treat Analysis; D008297:Male; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin