title: Multicenter closed-loop/hybrid meal bolus insulin delivery with type 1 diabetes.
abstract: BACKGROUND
  This study evaluated meal bolus insulin delivery strategies and associated postprandial glucose control while using an artificial pancreas (AP) system.
  
  
  METHODS
  This study was a multicenter trial in 53 patients, 12-65 years of age, with type 1 diabetes for at least 1 year and use of continuous subcutaneous insulin infusion for at least 6 months. Four different insulin bolus strategies were assessed: standard bolus delivered with meal (n=51), standard bolus delivered 15 min prior to meal (n=40), over-bolus of 30% delivered with meal (n=40), and bolus purposely omitted (n=46). Meal carbohydrate (CHO) intake was 1 g of CHO/kg of body weight up to a maximum of 100 g for the first three strategies or up to a maximum of 50 g for strategy 4.
  
  
  RESULTS
  Only three of 177 meals (two with over-bolus and one with standard bolus 15 min prior to meal) had postprandial blood glucose values of <60 mg/dL. Postprandial hyperglycemia (blood glucose level >180 mg/dL) was prolonged for all four bolus strategies but was shorter for the over-bolus (41% of the 4-h period) than the two standard bolus strategies (73% for each). Mean postprandial blood glucose level was 15.9 mg/dL higher for the standard bolus with meal compared with the prebolus (baseline-adjusted, P=0.07 for treatment effect over the 4-h period).
  
  
  CONCLUSIONS
  The AP handled the four bolus situations safely, but at the expense of having elevated postprandial glucose levels in most subjects. This was most likely secondary to suboptimal performance of the algorithm.
authors.affiliation: 1 Barbara Davis Center for Childhood , Aurora, Colorado.
authors.forename: H Peter
authors.initials: HP
authors.lastname: Chase
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Doyle
authors.forename: Howard
authors.initials: H
authors.lastname: Zisser
authors.forename: Eric
authors.initials: E
authors.lastname: Renard
authors.forename: Revital
authors.initials: R
authors.lastname: Nimri
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Buckingham
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.forename: Stacey
authors.initials: S
authors.lastname: Anderson
authors.forename: Lalo
authors.initials: L
authors.lastname: Magni
authors.forename: John
authors.initials: J
authors.lastname: Lum
authors.forename: Peter
authors.initials: P
authors.lastname: Calhoun
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004040:Dietary Carbohydrates / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000378:metabolism*; D007332:Insulin Infusion Systems; D008297:Male; D062407:Meals; D008875:Middle Aged; D019397:Pancreas, Artificial; D010349:Patient Compliance; D019518:Postprandial Period; D014481:United States
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007004:Hypoglycemic Agents