Portal de Periódicos da CAPES

Preventing Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension

2009; Mary Ann Liebert, Inc.; Volume: 11; Issue: 2 Linguagem: Inglês

10.1089/dia.2008.0032

1557-8593

Bruce A. Buckingham, Erin Cobry, Paula Clinton, Victoria Gage, Kimberly Caswell, Elizabeth L. Kunselman, Fraser Cameron, H. Peter Chase,

Intravenous Infusion Technology and Safety

Nocturnal hypoglycemia is a significant problem. From 50% to 75% of hypoglycemia seizures occur at night. Despite the development of real-time glucose sensors (real-time continuous glucose monitor [CGM]) with hypoglycemic alarms, many patients sleep through these alarms. The goal of this pilot study was to assess the feasibility using a real-time CGM to discontinue insulin pump therapy when hypoglycemia was predicted.Twenty-two subjects with type 1 diabetes had two daytime admissions to a clinical research center. On the first admission their basal insulin was increased until their blood glucose level was <60 mg/dL. On the second admission hypoglycemic prediction algorithms were tested to determine if hypoglycemia was prevented by a 90-min pump shutoff and to determine if the pump shutoff resulted in rebound hyperglycemia.Using a statistical prediction algorithm with an 80 mg/dL threshold and a 30-min projection horizon, hypoglycemia was prevented 60% of the time. Using a linear prediction algorithm with an 80 mg/dL threshold and a 45-min prediction horizon, hypoglycemia was prevented 80% of the time. There was no rebound hyperglycemia following pump suspension.Further development of algorithms is needed to prevent all episodes of hypoglycemia from occurring.