A controlled study of the effectiveness of an adaptive closed-loop algorithm to minimize corticosteroid-induced stress hyperglycemia in type 1 diabetes

Joseph El Youssef, Jessica Castle, Deborah L. Branigan, Ryan G. Massoud, Matthew E. Breen, Peter Jacobs, B. Wayne Bequette, W. Kenneth Ward

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

To be effective in type 1 diabetes, algorithms must be able to limit hyperglycemic excursions resulting from medical and emotional stress. We tested an algorithm that estimates insulin sensitivity at regular intervals and continually adjusts gain factors of a fading memory proportional-derivative (FMPD) algorithm. In order to assess whether the algorithm could appropriately adapt and limit the degree of hyperglycemia, we administered oral hydrocortisone repeatedly to create insulin resistance. We compared this indirect adaptive proportional-derivative (APD) algorithm to the FMPD algorithm, which used fixed gain parameters. Each subject with type 1 diabetes (n = 14) was studied on two occasions, each for 33 h. The APD algorithm consistently identified a fall in insulin sensitivity after hydrocortisone. The gain factors and insulin infusion rates were appropriately increased, leading to satisfactory glycemic control after adaptation (premeal glucose on day 2, 148 ± 6 mg/dl). After sufficient time was allowed for adaptation, the late postprandial glucose increment was significantly lower than when measured shortly after the onset of the steroid effect. In addition, during the controlled comparison, glycemia was significantly lower with the APD algorithm than with the FMPD algorithm. No increase in hypoglycemic frequency was found in the APD-only arm. An afferent system of duplicate amperometric sensors demonstrated a high degree of accuracy; the mean absolute relative difference of the sensor used to control the algorithm was 9.6 ± 0.5%. We conclude that an adaptive algorithm that frequently estimates insulin sensitivity and adjusts gain factors is capable of minimizing corticosteroid-induced stress hyperglycemia.

Original languageEnglish (US)
Pages (from-to)1312-1326
Number of pages15
JournalJournal of diabetes science and technology
Volume5
Issue number6
DOIs
StatePublished - 2011

Fingerprint

Medical problems
Type 1 Diabetes Mellitus
Hyperglycemia
Adrenal Cortex Hormones
Insulin
Derivatives
Insulin Resistance
Cortisol
Data storage equipment
Glucose
Hydrocortisone
Amperometric sensors
Adaptive algorithms
Hypoglycemic Agents
Psychological Stress
Steroids
Sensors

Keywords

  • Algorithms
  • Artificial pancreas
  • Corticosteroids
  • Glucose sensor
  • Insulin resistance
  • Type 1 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Bioengineering
  • Biomedical Engineering

Cite this

A controlled study of the effectiveness of an adaptive closed-loop algorithm to minimize corticosteroid-induced stress hyperglycemia in type 1 diabetes. / El Youssef, Joseph; Castle, Jessica; Branigan, Deborah L.; Massoud, Ryan G.; Breen, Matthew E.; Jacobs, Peter; Bequette, B. Wayne; Ward, W. Kenneth.

In: Journal of diabetes science and technology, Vol. 5, No. 6, 2011, p. 1312-1326.

Research output: Contribution to journalArticle

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