title: Prevention of Insulin-Induced Hypoglycemia in Type 1 Diabetes with Predictive Low Glucose Management System.
abstract: Sensor-augmented pump therapy (SAPT) with algorithms to predict impending low blood glucose and suspend insulin delivery has the potential to reduce hypoglycemia exposure. The aim of this study was to determine whether predictive low glucose management (PLGM) system is effective in preventing insulin-induced hypoglycemia in controlled experiments.
  
  
  
  Two protocols were used to induce hypoglycemia in an in-clinic environment. (A) Insulin bolus: Insulin was administered as a manual bolus through the pump. (B) Increased basal insulin: Hypoglycemia was induced by increasing basal rates overnight to 180%. For both protocols, participants were randomized and studied on 2 separate days; a control day with SAPT alone and an intervention day with SAPT and PLGM activated. The predictive algorithm was programmed to suspend basal insulin infusion when sensor glucose was predicted to be <80 mg/dL in 30 min. The primary outcome was the requirement for hypoglycemia treatment (symptomatic hypoglycemia or plasma glucose <50 mg/dL) and was compared in both control and intervention arms.
  
  
  
  With insulin bolus, 24/28 participants required hypoglycemia treatment with SAPT alone compared to 5/28 participants when PLGM was activated (P ≤ 0.001). With increased basal rates, all the eight SAPT-alone participants required treatment for hypoglycemia compared to only one with SAPT and PLGM. There was no post pump-suspend hyperglycemia with insulin bolus (P = 0.4) or increased basal rates (P = 0.69) in participants with 2-h pump suspension on intervention days.
  
  
  
  SAPT with PLGM reduced the requirement for hypoglycemia treatment following insulin-induced hypoglycemia in an in-clinic setting.
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .|2 School of Paediatrics and Child Health, The University of Western Australia , Perth, Australia .
authors.forename: Mary B
authors.initials: MB
authors.lastname: Abraham
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .|3 Telethon Kids Institute, The University of Western Australia , Perth, Australia .
authors.forename: Martin
authors.initials: M
authors.lastname: de Bock
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .|3 Telethon Kids Institute, The University of Western Australia , Perth, Australia .
authors.forename: Nirubasini
authors.initials: N
authors.lastname: Paramalingam
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Grady
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .|2 School of Paediatrics and Child Health, The University of Western Australia , Perth, Australia .|3 Telethon Kids Institute, The University of Western Australia , Perth, Australia .
authors.forename: Trang T
authors.initials: TT
authors.lastname: Ly
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .
authors.forename: Carly
authors.initials: C
authors.lastname: George
authors.affiliation: 4 Medtronic MiniMed , Northridge, California.
authors.forename: Anirban
authors.initials: A
authors.lastname: Roy
authors.affiliation: 4 Medtronic MiniMed , Northridge, California.
authors.forename: Glenn
authors.initials: G
authors.lastname: Spital
authors.affiliation: 5 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead-The University of Sydney , Sydney, Australia .
authors.forename: Sophy
authors.initials: S
authors.lastname: Karula
authors.affiliation: 5 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead-The University of Sydney , Sydney, Australia .
authors.forename: Kristine
authors.initials: K
authors.lastname: Heels
authors.affiliation: 6 Department of Endocrinology and Diabetes, Royal Children's Hospital , Melbourne, Australia .
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gebert
authors.affiliation: 7 Department of Endocrinology and Diabetes, Women's and Children's Hospital , Adelaide, Australia .
authors.forename: Jan M
authors.initials: JM
authors.lastname: Fairchild
authors.affiliation: 8 Department of Endocrinology and Diabetes, John Hunter Children's Hospital , Newcastle, Australia .
authors.forename: Bruce R
authors.initials: BR
authors.lastname: King
authors.affiliation: 5 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead-The University of Sydney , Sydney, Australia .
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Ambler
authors.affiliation: 6 Department of Endocrinology and Diabetes, Royal Children's Hospital , Melbourne, Australia .
authors.forename: Fergus
authors.initials: F
authors.lastname: Cameron
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .|2 School of Paediatrics and Child Health, The University of Western Australia , Perth, Australia .|3 Telethon Kids Institute, The University of Western Australia , Perth, Australia .
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Davis
authors.affiliation: 1 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia .|2 School of Paediatrics and Child Health, The University of Western Australia , Perth, Australia .|3 Telethon Kids Institute, The University of Western Australia , Perth, Australia .
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects*; D007659:Ketones / Q000097:blood; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007659:Ketones