title: Use of an artificial pancreas among adolescents for a missed snack bolus and an underestimated meal bolus.
abstract: OBJECTIVE
  The objective of this study was to evaluate the safety and performance of the artificial pancreas (AP) in adolescents with type 1 diabetes (T1D) following insulin omission for food.
  
  
  METHODS
  In a randomized, cross-over trial, adolescents with T1D aged 13-18 yr were enrolled in a randomized, cross-over trial. On separate days, received either usual care (UC) through their home insulin pump or used an AP system (Diabetes Assistant platform, continuous glucose monitor, and insulin pump). Approximately 1 h after admission, participants in both groups received an unannounced snack of 30 g carbohydrate, and 4 h later they received an 80 g lunch, for which both groups only received 75% of the calculated insulin dose to cover carbohydrates. On the UC day (but not the AP day), they received their full high blood glucose (BG) correction factor at lunch. Each admission lasted approximately 8 h.
  
  
  RESULTS
  A total of 16 participants completed the trial. On the AP day (compared to UC), mean BG was lower (197 ± 10 vs. 235 ± 14 mg/dL) and time in range 70-180 mg/dL was higher (43% ± 7 vs. 19% ± 7) (both p < 0.05) overall; these results held in the time following the snack and meal (also p < 0.05). During the trial, there were no differences between groups in the rate of hypoglycemia <70 mg/dL.
  
  
  CONCLUSIONS
  The AP provided improvements in short-term glycemic control without increases in hypoglycemia following missed insulin for food in adolescents. Thus, the AP partly compensates for missed insulin boluses for food, a common occurrence in adolescent diabetes care. Further testing is needed in longer-term settings.
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Cherñavvsky
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.|Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: DeBoer
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Keith-Hynes
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Benton
authors.initials: B
authors.lastname: Mize
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: McElwee
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.|Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Demartini
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Spencer F
authors.initials: SF
authors.lastname: Dunsmore
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Wakeman
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Boris P
authors.initials: BP
authors.lastname: Kovatchev
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Breton
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D062407:Meals; D019397:Pancreas, Artificial / Q000706:statistics & numerical data*; D019518:Postprandial Period; D062410:Snacks; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: adolescent; artificial pancreas; closed-loop control; snacking; type 1 diabetes