title: Multinight "bedside" closed-loop control for patients with type 1 diabetes.
abstract: BACKGROUND
  Studies of closed-loop control (CLC) systems have improved glucose levels in patients with type 1 diabetes. In this study we test a new CLC concept aiming to "reset" the patient overnight to near-normoglycemia each morning, for several consecutive nights.
  
  
  METHODS
  Ten insulin pump users with type 1 diabetes (mean age, 46.4±8.5 years) were enrolled in a two-center (in the United States and Italy) randomized crossover trial comparing 5 consecutive nights of CLC (23:00-07:00 h) in an outpatient setting versus sensor-augmented insulin pump therapy of the same duration at home. Primary end points included time spent in 80-140 mg/dL as measured by continuous glucose monitoring overnight and fasting blood glucose distribution at 7:00 h.
  
  
  RESULTS
  Compared with sensor-augmented pump therapy, CLC improved significantly time spent between 80 and 140 mg/dL (54.5% vs. 32.2%; P<0.001) and between 70 and 180 mg/dL (85.4% vs. 59.1%; P<0.001); CLC reduced the mean glucose level at 07:00 h (119.3 vs. 152.9 mg/dL; P<0.001) and overnight mean glucose level (139.0 vs. 170.3 mg/dL; P<0.001) using a marginally lower amount of insulin (6.1 vs. 6.8 units; P=0.1). Tighter overnight control led to improved daytime control on the next day: the overnight/next-day control correlation was r=0.52, P<0.01.
  
  
  CONCLUSIONS
  Multinight CLC of insulin delivery (artificial pancreas) results in significant improvement in morning and overnight glucose levels and time in target range, with the potential to improve daytime control when glucose levels were "reset" to near-normoglycemia each morning.
authors.affiliation: 1 Center for Diabetes Technology, University of Virginia , Charlottesville, Virginia.
authors.forename: Sue A
authors.initials: SA
authors.lastname: Brown
authors.forename: Boris P
authors.initials: BP
authors.lastname: Kovatchev
authors.forename: Marc D
authors.initials: MD
authors.lastname: Breton
authors.forename: Stacey M
authors.initials: SM
authors.lastname: Anderson
authors.forename: Patrick
authors.initials: P
authors.lastname: Keith-Hynes
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Patek
authors.forename: Boyi
authors.initials: B
authors.lastname: Jiang
authors.forename: Najib
authors.initials: N
authors.lastname: Ben Brahim
authors.forename: Paul
authors.initials: P
authors.lastname: Vereshchetin
authors.forename: Daniela
authors.initials: D
authors.lastname: Bruttomesso
authors.forename: Angelo
authors.initials: A
authors.lastname: Avogaro
authors.forename: Simone
authors.initials: S
authors.lastname: Del Favero
authors.forename: Federico
authors.initials: F
authors.lastname: Boscari
authors.forename: Silvia
authors.initials: S
authors.lastname: Galasso
authors.forename: Roberto
authors.initials: R
authors.lastname: Visentin
authors.forename: Marco
authors.initials: M
authors.lastname: Monaro
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000379:methods / Q000706:statistics & numerical data; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D055870:Drug Chronotherapy; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D007558:Italy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin