title: Single- and Dual-Hormone Artificial Pancreas for Overnight Glucose Control in Type 1 Diabetes.
abstract: BACKGROUND
  The added benefit of glucagon in artificial pancreas systems for overnight glucose control in type 1 diabetes has not been fully explored.
  
  
  OBJECTIVE
  The objective of the study was to compare the efficacy of dual-hormone (insulin and glucagon) artificial pancreas, single-hormone (insulin alone) artificial pancreas, and conventional insulin pump therapy.
  
  
  METHODS
  This study was a three-center, three-arm, open-label, randomized, crossover controlled trial involving three interventions, each applied over a night after a high carbohydrate/high fat meal and a second after exercise to mimic real-life glycemic excursions.
  
  
  METHODS
  The study was conducted in a home setting.
  
  
  METHODS
  Twenty-eight type 1 diabetes participants (21 adults and seven adolescents) participated in the study.
  
  
  METHODS
  Dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional pump therapy was activated from 9:00 PM to 7:00 AM.
  
  
  RESULTS
  The main outcome was a proportion of time in target (4-8 mmol/L) by continuous glucose monitoring from 11:00 PM to 7:00 AM. Analysis was by intention to treat.
  
  
  RESULTS
  The median (interquartile range) percentage of time-in-target glucose range was 47% (36%-71%) for conventional therapy, higher on both single-hormone (76% [65%-91%], P < .001) and dual-hormone artificial pancreas (81 [68%-93%], P < .001). The median (interquartile range) time spent below 4 mmol/L was 14% (4%-28%) for conventional therapy, lower on both single-hormone (5% [0%-13%], P = .004) and dual-hormone artificial pancreas (1% [0%-8%], P < .001). There were 14 hypoglycemic events on conventional therapy compared with six incidences on the single-hormone artificial pancreas (P = .059) and three incidences on the dual-hormone artificial pancreas (P = .017). None of these outcomes differed significantly between single- and dual-hormone configurations.
  
  
  CONCLUSIONS
  Single- and dual-hormone artificial pancreas systems both provided better glucose control than conventional therapy. Although the dual-hormone configuration did not increase overnight time-in-target glucose levels, an effect on lowering hypoglycemia risk cannot be ruled out.
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Haidar
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Rémi
authors.initials: R
authors.lastname: Rabasa-Lhoret
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Laurent
authors.initials: L
authors.lastname: Legault
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Leif E
authors.initials: LE
authors.lastname: Lovblom
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Rohan
authors.initials: R
authors.lastname: Rakheja
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Virginie
authors.initials: V
authors.lastname: Messier
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Émilie
authors.initials: É
authors.lastname: D'Aoust
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: C Marcelo
authors.initials: CM
authors.lastname: Falappa
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Tara
authors.initials: T
authors.lastname: Justice
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Andrej
authors.initials: A
authors.lastname: Orszag
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Holly
authors.initials: H
authors.lastname: Tschirhart
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Maryse
authors.initials: M
authors.lastname: Dallaire
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Martin
authors.initials: M
authors.lastname: Ladouceur
authors.affiliation: Institut de Recherches Cliniques de Montréal (A.H., R.R.-L., R.R., V.M., M.D.), Montréal, Québec, Canada H2W 1R7; Division of Experimental Medicine (A.H., R.R.-L.), McGill University, Montréal, Québec, Canada H9X 3V9; Department of Nutrition (R.R.-L.), Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Montréal Diabetes Research Centre (R.R.-L.), Montréal, Québec, Canada H2X 0A9; Montréal Children's Hospital (L.L.), McGill University Health Centre. Montréal, Québec, Canada H4A 3J1; Lunenfeld-Tanenbaum Research Institute (L.E.L., C.M.F., T.J., A.O., H.T., B.A.P.), Mt Sinai Hospital, Toronto, Ontario, Canada M5T 3L9; Hôpital Maisonneuve-Rosemont (É.D.), Montréal, Québec, Canada H1T 3W5; Centre de Recherche (M.L.), Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W 1T8; Division of Endocrinology and Metabolism (B.A.P.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D016503:Drug Delivery Systems; D015444:Exercise / Q000502:physiology; D005260:Female; D005934:Glucagon / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019397:Pancreas, Artificial; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D007004:Hypoglycemic Agents; D007328:Insulin; D005934:Glucagon