title: Automated hybrid closed-loop control with a proportional-integral-derivative based system in adolescents and adults with type 1 diabetes: individualizing settings for optimal performance.
abstract: Automated insulin delivery systems, utilizing a control algorithm to dose insulin based upon subcutaneous continuous glucose sensor values and insulin pump therapy, will soon be available for commercial use. The objective of this study was to determine the preliminary safety and efficacy of initialization parameters with the Medtronic hybrid closed-loop controller by comparing percentage of time in range, 70-180 mg/dL (3.9-10 mmol/L), mean glucose values, as well as percentage of time above and below target range between sensor-augmented pump therapy and hybrid closed-loop, in adults and adolescents with type 1 diabetes.
  
  
  
  We studied an initial cohort of 9 adults followed by a second cohort of 15 adolescents, using the Medtronic hybrid closed-loop system with the proportional-integral-derivative with insulin feed-back (PID-IFB) algorithm. Hybrid closed-loop was tested in supervised hotel-based studies over 4-5 days.
  
  
  
  The overall mean percentage of time in range (70-180 mg/dL, 3.9-10 mmol/L) during hybrid closed-loop was 71.8% in the adult cohort and 69.8% in the adolescent cohort. The overall percentage of time spent under 70 mg/dL (3.9 mmol/L) was 2.0% in the adult cohort and 2.5% in the adolescent cohort. Mean glucose values were 152 mg/dL (8.4 mmol/L) in the adult cohort and 153 mg/dL (8.5 mmol/L) in the adolescent cohort.
  
  
  
  Closed-loop control using the Medtronic hybrid closed-loop system enables adaptive, real-time basal rate modulation. Initializing hybrid closed-loop in clinical practice will involve individualizing initiation parameters to optimize overall glucose control.
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA.|School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Trang T
authors.initials: TT
authors.lastname: Ly
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Weinzimer
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sherr
authors.affiliation: Medtronic MiniMed, Northridge, CA, USA.
authors.forename: Anirban
authors.initials: A
authors.lastname: Roy
authors.affiliation: Medtronic MiniMed, Northridge, CA, USA.
authors.forename: Benyamin
authors.initials: B
authors.lastname: Grosman
authors.affiliation: Medtronic MiniMed, Northridge, CA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Cantwell
authors.affiliation: Medtronic MiniMed, Northridge, CA, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Kurtz
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Carria
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Laurel
authors.initials: L
authors.lastname: Messer
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Rie
authors.initials: R
authors.lastname: von Eyben
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Buckingham
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D002138:Calibration; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / 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; D019397:Pancreas, Artificial / Q000009:adverse effects; D057285:Precision Medicine; D040521:Subcutaneous Tissue / Q000187:drug effects* / Q000378:metabolism; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose
keywords: artificial pancreas; continuous glucose monitoring; hybrid closed loop; type 1 diabetes