title: Day and night home closed-loop insulin delivery in adults with type 1 diabetes: three-center randomized crossover study.
abstract: OBJECTIVE
  To evaluate the feasibility of day and night closed-loop insulin delivery in adults with type 1 diabetes under free-living conditions.
  
  
  METHODS
  Seventeen adults with type 1 diabetes on insulin pump therapy (means ± SD age 34 ± 9 years, HbA1c 7.6 ± 0.8%, and duration of diabetes 19 ± 9 years) participated in an open-label multinational three-center crossover study. In a random order, participants underwent two 8-day periods (first day at the clinical research facility followed by 7 days at home) of sensor-augmented insulin pump therapy (SAP) or automated closed-loop insulin delivery. The primary end point was the time when sensor glucose was in target range between 3.9 and 10.0 mmol/L during the 7-day home phase.
  
  
  RESULTS
  During the home phase, the percentage of time when glucose was in target range was significantly higher during closed-loop compared with SAP (median 75% [interquartile range 61-79] vs. 62% [53-70], P = 0.005). Mean glucose (8.1 vs. 8.8 mmol/L, P = 0.027) and time spent above target (P = 0.013) were lower during closed loop, while time spent below target was comparable (P = 0.339). Increased time in target was observed during both daytime (P = 0.017) and nighttime (P = 0.013).
  
  
  CONCLUSIONS
  Compared with SAP, 1 week of closed-loop insulin delivery at home reduces mean glucose and increases time in target without increasing the risk of hypoglycemia in adults with relatively well-controlled type 1 diabetes.
authors: Wellcome Trust-Medical Research Clinical Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.Department of Diabetes and Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, U.K.
authors: Lalantha
authors: L
authors: Leelarathna
authors: Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors: Sibylle
authors: S
authors: Dellweg
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Julia K
authors: JK
authors: Mader
authors: Wellcome Trust-Medical Research Clinical Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.
authors: Janet M
authors: JM
authors: Allen
authors: Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors: Carsten
authors: C
authors: Benesch
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Werner
authors: W
authors: Doll
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Martin
authors: M
authors: Ellmerer
authors: Department of Diabetes and Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, U.K.
authors: Sara
authors: S
authors: Hartnell
authors: Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors: Lutz
authors: L
authors: Heinemann
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Harald
authors: H
authors: Kojzar
authors: Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors: Lucy
authors: L
authors: Michalewski
authors: Wellcome Trust-Medical Research Clinical Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.
authors: Marianna
authors: M
authors: Nodale
authors: Wellcome Trust-Medical Research Clinical Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.Department of Diabetes and Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, U.K.
authors: Hood
authors: H
authors: Thabit
authors: Wellcome Trust-Medical Research Clinical Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.
authors: Malgorzata E
authors: ME
authors: Wilinska
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Thomas R
authors: TR
authors: Pieber
authors: Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors: Sabine
authors: S
authors: Arnolds
authors: Wellcome Trust-Medical Research Clinical Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.Department of Diabetes and Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, U.K.
authors: Mark L
authors: ML
authors: Evans
authors: Wellcome Trust-Medical Research Clinical Institute of Metabolic Science, University of Cambridge, Cambridge, U.K. rh347@cam.ac.uk.
authors: Roman
authors: R
authors: Hovorka
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin