Artificial Pancreas Project at Cambridge
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Artificial Pancreas Project at Artificial Pancreas Project at Cambridge Cambridge U N IVER SITY O F C AM BR ID G E U N IVER SITY O F C AM BR ID G E R. Hovorka, J.M. Allen, L.J.Chassin, A. De Palma, D. Elleri, J. Harris, J.F. Hayes, T. Hovorka, K. Kumareswaran, A.F. Larsen, J. Mangat, M. Nodale, M.E. Wilinska, C.L. Acerini, D.B.Dunger, M.L. Evans, H.R. Murphy Institute of Metabolic Science, Department of Paediatrics and Department of Medicine, University of Cambridge, United Kingdom Glossary AP - Artificial pancreas CL - Closed-loop system APCam - AP project at Cambridge T1D - Type 1 diabetes CSII - Continuous Subcutaneous Insulin Infusion MPC - Model-Predictive Control Acknowledgements Grateful thanks are due to the many children, young people and adults who have participated in the studies and to the staff of the Wellcome Trust Clinical Research Facility without whose assistance the studies could not have taken place. Thanks also for the support given by JDRF, Diabetes UK, MRC CORD, EFSD and NIHR Cambridge Biomedical Research Centre. References: [1] Hovorka R et al, ADA June 2008 [2] Hovorka R et al, EASD Sept 2008 [3] Hovorka R et al, ATTD Feb 2009 CLOSED LOOP IN CHILDREN CLOSED LOOP IN CHILDREN AUTOMATED CLOSED LOOP IN CHILDREN AUTOMATED CLOSED LOOP IN CHILDREN CLOSED LOOP IN ADULTS CLOSED LOOP IN ADULTS CLOSED LOOP IN PREGNANCY CLOSED LOOP IN PREGNANCY FUTURE : HOME STUDIES FUTURE : HOME STUDIES • The Artificial Pancreas Project started in 2007 and the first three studies evaluated the manual closed loop (CL) in children and adolescents with T1D. Exercise Study Diet Study Paediatric Efficacy Study The first clinical study compared the continuous subcutaneous insulin infusion (CSII) against CL in 12 children and adolescents with T1D. The results showed improved glucose control with CL whilst reducing the risk of hypoglycaemia [1 ] (see figure below). The second study evaluated the performance of the CL system following a rapidly and slowly absorbed large meal. A subset of 6 subjects from the first study participated. The results demonstrated that CL is safe and efficacious in controlling overnight glucose following the ingestion of a large meal irrespective of its composition [2] . The third study tested the CL in post- exercise conditions in 9 subjects. Overnight CL with MPC following afternoon exercise avoids hypoglycaemia and increases time spent in target glucose range twofold [3] . The progression from manual to fully automated CL system is under evaluation in the Wellcome Trust Clinical Research Facility (WTCRF). The aim is to evaluate the safety and efficacy of automated overnight CL when initiated before an evening meal or before bed. • The first CL study in adults is underway. Preliminary analyses demonstrate improved efficacy under CL control, as compared to conventional pump therapy. Having completed almost 100 overnight studies, the research team are focusing on progression to home studies. The first adult and paediatric studies using overnight automated CL in the home setting (prototype pictured) will commence Autumn 2009. • Type 1 Diabetes (T1D) is one of the most common chronic conditions in developed nations. To improve glucose control, quality of life and prevent long term complications, new tools are being developed. • The Artificial Pancreas Project at the University of Cambridge focuses on closed-loop (CL) overnight insulin delivery in people with T1D. • It combines a purpose-made model- predictive control (MPC) algorithm with an off-the-shelf continuous glucose monitor and an insulin pump. OVERVIEW OVERVIEW • Optimising glucose control is particularly challenging in pregnancy. • To inform CL algorithms specific for pregnancy, physiological studies of glucose gut absorption are currently underway. 2007 2008 P aediatric efficacy study D ietstudy E xercise study 2009 A dult efficacy study Autom ated C L study CL in pregnancy A utom ated C L Hom e Prototype: P aediatric & A dultstudies A lcohol study 2007 2007 2008 2008 P aediatric efficacy study D ietstudy E xercise study 2009 2009 A dult efficacy study Autom ated C L study CL in pregnancy A utom ated C L Hom e Prototype: P aediatric & A dultstudies A lcohol study • The second study will compare overnight CL insulin delivery with CSII following an evening of drinking alcohol, in particular assessing glucose control and frequency of hypoglycaemia. 18:00 20:00 22:00 00:00 02:00 04:00 06:00 08:00 G lucose (m m ol/L) 0 2 4 6 8 10 12 14 16 C SII C losed Loop dinner& prandial bolus Sample of overnight algorithm CL control in adults
description
R. Hovorka, J.M. Allen, L.J.Chassin, A. De Palma, D. Elleri, J. Harris, J.F. Hayes, T. Hovorka, K. Kumareswaran, A.F. Larsen, J. Mangat, M. Nodale, M.E. Wilinska, C.L. Acerini, D.B.Dunger, M.L. Evans, H.R. Murphy - PowerPoint PPT Presentation
Transcript of Artificial Pancreas Project at Cambridge
Artificial Pancreas Project at Cambridge Artificial Pancreas Project at Cambridge
UNIVERSITY OFCAMBRIDGEUNIVERSITY OFCAMBRIDGE
R. Hovorka, J.M. Allen, L.J.Chassin, A. De Palma, D. Elleri, J. Harris, J.F. Hayes, T. Hovorka, K. Kumareswaran,
A.F. Larsen, J. Mangat, M. Nodale, M.E. Wilinska, C.L. Acerini, D.B.Dunger, M.L. Evans, H.R. Murphy
Institute of Metabolic Science, Department of Paediatrics and Department of Medicine, University of Cambridge, United Kingdom
Glossary
AP - Artificial pancreas CL - Closed-loop systemAPCam - AP project at Cambridge T1D - Type 1 diabetesCSII - Continuous Subcutaneous Insulin InfusionMPC - Model-Predictive Control
Acknowledgements
Grateful thanks are due to the many children, young people and adults who have participated in the studies and to the staff of the Wellcome Trust Clinical Research Facility without whose assistance the studies could not have taken place.
Thanks also for the support given by JDRF, Diabetes UK, MRC CORD, EFSD and NIHR Cambridge Biomedical Research Centre.
References:
[1]Hovorka R et al, ADA June 2008
[2]Hovorka R et al, EASD Sept 2008
[3]Hovorka R et al, ATTD Feb 2009
CLOSED LOOP IN CHILDREN CLOSED LOOP IN CHILDREN
AUTOMATED CLOSED LOOP IN CHILDRENAUTOMATED CLOSED LOOP IN CHILDREN
CLOSED LOOP IN ADULTSCLOSED LOOP IN ADULTS
CLOSED LOOP IN PREGNANCY CLOSED LOOP IN PREGNANCY
FUTURE : HOME STUDIESFUTURE : HOME STUDIES
• The Artificial Pancreas Project started in 2007 and the first three studies evaluated the manual closed loop (CL) in children and adolescents with T1D.
Exercise Study
Diet Study
Paediatric Efficacy Study The first clinical study compared
the continuous subcutaneous insulin infusion (CSII) against CL in 12 children and adolescents with T1D.
The results showed improved glucose control with CL whilst reducing the risk of hypoglycaemia [1 ] (see figure below).
The second study evaluated the performance of the CL system following a rapidly and slowly absorbed large meal. A subset of 6 subjects from the first study participated.
The results demonstrated that CL is safe and efficacious in controlling overnight glucose following the ingestion of a large meal irrespective of its composition [2].
The third study tested the CL in post- exercise conditions in 9 subjects.
Overnight CL with MPC following afternoon exercise avoids hypoglycaemia and increases time spent in target glucose range twofold [3].
The progression from manual to fully automated CL system is under evaluation in the Wellcome Trust Clinical Research Facility (WTCRF).
The aim is to evaluate the safety and efficacy of automated overnight CL when initiated before an evening meal or before bed.
• The first CL study in adults is underway. Preliminary analyses demonstrate improved efficacy under CL control, as compared to conventional pump therapy.
Having completed almost 100 overnight studies, the research team are focusing on progression to home studies.
The first adult and paediatric studies using overnight automated CL in the home setting (prototype pictured) will commence Autumn 2009.
• Type 1 Diabetes (T1D) is one of the most common chronic conditions in developed nations. To improve glucose control, quality of life and prevent long term complications, new tools are being developed.
• The Artificial Pancreas Project at the University of Cambridge focuses on closed-loop (CL) overnight insulin delivery in people with T1D.
• It combines a purpose-made model-predictive control (MPC) algorithm with an off-the-shelf continuous glucose monitor and an insulin pump.
OVERVIEWOVERVIEW
• Optimising glucose control is particularly challenging in pregnancy.
• To inform CL algorithms specific for pregnancy, physiological studies of glucose gut absorption are currently underway.
2007 2008
Paediatric efficacy study
Diet study
Exercise study
2009
Adult efficacy study
Automated CL study
CL in pregnancy
Automated CLHome Prototype:
Paediatric & Adult studies
Alcohol study
20072007 20082008
Paediatric efficacy study
Diet study
Exercise study
20092009
Adult efficacy study
Automated CL study
CL in pregnancy
Automated CLHome Prototype:
Paediatric & Adult studies
Alcohol study
• The second study will compare overnight CL insulin delivery with CSII following an evening of drinking alcohol, in particular assessing glucose control and frequency of hypoglycaemia.
Tim e (h)
18:00 20:00 22:00 00:00 02:00 04:00 06:00 08:00
Glu
co
se
(m
mo
l/L)
0
2
4
6
8
10
12
14
16 CSIIClosed Loop
dinner &prandial
bolus
Sample of overnight algorithm CL control in adults
