title: Effectiveness of a Predictive Algorithm in the Prevention of Exercise-Induced Hypoglycemia in Type 1 Diabetes.
abstract: Sensor-augmented pump therapy (SAPT) with a predictive algorithm to suspend insulin delivery has the potential to reduce hypoglycemia, a known obstacle in improving physical activity in patients with type 1 diabetes. The predictive low glucose management (PLGM) system employs a predictive algorithm that suspends basal insulin when hypoglycemia is predicted. The aim of this study was to determine the efficacy of this algorithm in the prevention of exercise-induced hypoglycemia under in-clinic conditions.
  
  
  
  This was a randomized, controlled cross-over study in which 25 participants performed 2 consecutive sessions of 30 min of moderate-intensity exercise while on basal continuous subcutaneous insulin infusion on 2 study days: a control day with SAPT alone and an intervention day with SAPT and PLGM. The predictive algorithm suspended basal insulin when sensor glucose was predicted to be below the preset hypoglycemic threshold in 30 min. We tested preset hypoglycemic thresholds of 70 and 80 mg/dL. The primary outcome was the requirement for hypoglycemia treatment (symptomatic hypoglycemia with plasma glucose <63 mg/dL or plasma glucose <50 mg/dL) and was compared in both control and intervention arms.
  
  
  
  Results were analyzed in 19 participants. In the intervention arm with both thresholds, only 6 participants (32%) required treatment for hypoglycemia compared with 17 participants (89%) in the control arm (P = 0.003). In participants with a 2-h pump suspension on intervention days, the plasma glucose was 84 ± 12 and 99 ± 24 mg/dL at thresholds of 70 and 80 mg/dL, respectively.
  
  
  
  SAPT with PLGM reduced the need for hypoglycemia treatment after moderate-intensity exercise in an in-clinic setting.
authors: 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: Mary B
authors: MB
authors: Abraham
authors: 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: Raymond
authors: R
authors: Davey
authors: 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: Michael J
authors: MJ
authors: O'Grady
authors: 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: Trang T
authors: TT
authors: Ly
authors: 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: Nirubasini
authors: N
authors: Paramalingam
authors: 4 School of Sport Science, Exercise and Health, The University of Western Australia , Perth, Australia .
authors: Paul A
authors: PA
authors: Fournier
authors: 5 Medtronic MiniMed , Northridge, California.
authors: Anirban
authors: A
authors: Roy
authors: 5 Medtronic MiniMed , Northridge, California.
authors: Benyamin
authors: B
authors: Grosman
authors: 5 Medtronic MiniMed , Northridge, California.
authors: Natalie
authors: N
authors: Kurtz
authors: 6 Department of Endocrinology and Diabetes, Women's and Children's Hospital , Adelaide, Australia .
authors: Janice M
authors: JM
authors: Fairchild
authors: 7 Department of Endocrinology and Diabetes, John Hunter Children's Hospital , Newcastle, Australia .
authors: Bruce R
authors: BR
authors: King
authors: 8 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, The University of Sydney , Sydney, Australia .
authors: Geoffrey R
authors: GR
authors: Ambler
authors: 9 Department of Endocrinology and Diabetes, Royal Children's Hospital , Melbourne, Australia .
authors: Fergus
authors: F
authors: Cameron
authors: 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: Timothy W
authors: TW
authors: Jones
authors: 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: Elizabeth A
authors: EA
authors: Davis
mesh_terms: D000293:Adolescent; D000465:Algorithms; D029681:Arabidopsis Proteins; D001786:Blood Glucose / Q000032:analysis; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D019753:Intramolecular Lyases; D008297:Male; D055815:Young Adult
chemical_list: D029681:Arabidopsis Proteins; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D019753:Intramolecular Lyases; C000611451:CHIL protein, Arabidopsis