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AbstractsAbstracts from ATTD 20136th International Conference on Advanced Technologies & Treatments for Diabetes Paris, France, February 27–March 2, 2013

2013; Mary Ann Liebert, Inc.; Volume: 15; Issue: S1 Linguagem: Inglês

10.1089/dia.2012.1221

1557-8593

Isabelle Guilhem, Marie-Anne Lefebvre, Y. Assayag, E. Lam, Jean-Yves Poirier,

Diabetes and associated disorders

Diabetes Technology & TherapeuticsVol. 15, No. S1 AbstractsAbstracts from ATTD 20136th International Conference on Advanced Technologies & Treatments for DiabetesParis, France, February 27–March 2, 2013Free AccessPublished Online:26 Feb 2013https://doi.org/10.1089/dia.2012.1221AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail ATTD 2013 Oral PresentationsS.A. Amiel Diabetes and Nutritional Sciences, King's College London, London, UKO-1 HYPOGLYCEMIA AWARENESS AND UNAWARENESSHypoglycemia and fear of hypoglycemia remain major barriers to good diabetes control and quality of life. Loss of awareness of hypoglycemia, induced by recurrent exposure to hypoglycemia and associated with measurable defects in counterregulatory responses to hypoglycemia, carries a six-fold increase in risk for severe episodes. Awareness can be restored by structured education in insulin management but only in about 50% of victims. For some of the remaining 50%, technologies such as insulin pumps and perhaps glucose sensors can provide benefit but for some patients, the problems are less tractable. There is evidence of abnormal cortical responses to hypoglycemia in these patients, and also evidence to suggest that they have greater difficulty in complying with regimen change in their diabetes self-management than patients who retain awareness of their hypoglycemia. Patients with persistent hypoglycemia unawareness commonly express unhelpful cognitions around their diabetes and their hypoglycemia experience. Cell replacement therapy in the form of pancreas or islet transplantation offers new protection from further hypoglycemia, but is not widely available or suitable for all. There is preliminary evidence to suggest that use of hypoglycemia-specific psychologically-based therapies may be able to help.S.A. Amiel 1, K.F. Hunt 2, J. Dunn 3, P. Marsden 31Diabetes and Nutritional Sciences, King's College London, London, UK2Diabetes Research Group, King's College London, London, UK3PET Imaging Centre, King's College London, London, UKO-2 METABOLIC NEUROIMAGING–POSTITRON EMISSION TOMOGRAPHY STUDIES IN THE CENTRAL CONTROL OF METABOLISMThe brain plays a major role in the control of energy balance and metabolism. Positron emission tomography allows visualisation of brain regions active in task performance, either through imaging the accumulation of glucose analogues (using changes in glucose metabolism as a surrogate marker of neuronal activation) or changes in the disctibution of labelled water, using changes in regional perfusion as the marker. Other applications allow visualisation of neurotransmitter receptor occupancy. We have used glucose and water positron emission tomography to visualise the human brain's response to hypoglycaemia and also to insulin, in health and in insulin resistance. Latterly, we have explored the human brain's response to food ingestion in obesity and the treatment of obesity. There is evidence for regional brain insulin resistance in people with systemic insulin resistance which are compatible with a difference in the brain's response to food ingestion that might drive overeating and obesity. Treatments for obesity such as bariatric surgery influence the brain's response to food ingestion and PET is being used to explore the mechanisms of action for such treatments.A. Bansal , R. Shah , S. Aasmul , J. Kristensen , B. Liang , T. Dang , J. Rodriguez , K. Knarreborg , R. Russell , D. Choy , A. Kantak Sensor R&D, Medtronic Diabetes, Northridge, CA, USAO-3 DEVELOPMENT OF AN ORTHOGONALLY REDUNDANT GLUCOSE SENSOR SYSTEMMedtronic Diabetes is partnering with the Juvenile Diabetes Research Foundation and Helmsley Charitable Trust to develop a first-of-its-kind orthogonally redundant glucose sensor system to improve CGM accuracy and reliability for closed loop application.Our approach integrates two distinct glucose sensing technologies: optical and electrochemical. The sensors' unique failure modes and responses to local physiological changes provide independency that offers greater reliability than simple redundancy (multiple sensors of the same type). We will present preclinical results from a prototype system that simultaneously measures electrochemical and optical signals from an integrated sensor (Figures 1 and 2). A housing that co-locates both miniaturized sensors in one insertion needle and a wireless interrogation device that connects to both sensors were developed to enable real time data collection from sensors implanted in rats for 6 days.O-3 FIG. 1. System diagram showing integrated housing and interrogation device.O-3 FIG. 2. First three days of most recent six-day preclinical rat study.Ongoing efforts include further miniaturization, improved sensor design and development of smart algorithms to fully realize this concept's unique benefits.N. Baysal 1, F. Cameron 1, M. Stenerson 2, B.A. Buckingham 2, D.M. Wilson 2, E.J. Mayer-Davis 3, D.M. Maahs 4, B.W. Bequette 11Rensselaer Polytechnic Institute, Troy, NY2Stanford University, Stanford, CA3The University of North Carolina, Chapel Hill, NC4University of Colorado-Denver, Denver, CO, USAO-4 USING ACTIVITY MONITORS TO IMPROVE CGM SENSOR ANOMALY DETECTIONObjective: Continuous glucose monitors (CGM) are an essential component of a closed-loop artificial pancreas. CGM signals can suffer from artifacts, such as nocturnal sensor attenuation (NSA), which occur when patients roll over on their sensor. An algorithm that we have developed to detect NSAs assumes that an individual is sleeping during nighttime periods, but this is not satisfactory during shift-work or international travel, for example. In this project we have incorporated activity monitor signals to avoid false detection caused by a glucose drop associated with physical activity.Method: The detection of an NSA is based on exceeding a non-physiologic (for overnight) rate-of-change in CGM readings. It is known, however, that physical activity can cause rapid decreases in CGM signals so a NSA detection algorithm could have a high false positive rate if an individual is active during overnight hours. To observe the effect of physical activity on NSA detection, we analyzed over 3200 hours of data from 29 subjects wearing activity monitors.Result: If the standard NSA algorithm was applied to all of the data, then 271 sensor anomalies would be detected; 203 of these, however, were during daytime. By using activity data to infer wake periods, 108 of the 203 false detections were removed.Conclusion: This approach is especially vital for patients who do not sleep on a normal schedule due to night-time travel or shift-work. It is important that a sensor anomaly detection algorithm include activity monitoring to understand if rapid CGM changes are physiologic.J. Jager-Amsellem 1, C. Hasselmann 1, E. Perrodeau 1, N. Faure 1, I. Mercat 1, F. Labarthe 1, E. Bonnemaison 21CHU Tours, Tours, France2Unité de Spécialités Pédiatriques, CHU Tours, Tours, FranceO-5 CONTINUOUS SUBCUTANEOUS INSULIN INFUSION VERSUS MULTIPLE DAILY INJECTIONS IN CHILDREN AT ONSET OF TYPE-1 DIABETESObjective: Continuous subcutaneous insulin infusion (CSII) has been used in children with diabetes for many years, but its use at onset of diabetes has been little studied. Our aim was to compare CSII started at onset of type-1 diabetes with multiple daily injections (MDI) to assess metabolic control and safety.Research design and methods: 41 children treated by CSII at onset of diabetes (January 2005–July 2009) were paired with 41 newly diagnosed children treated by MDI. They were paired by age and gender. Data such as HbA1c, BMI, insulin requirement, severe hypoglycemia, diabetic ketoacidosis and hospitalization related to the diabetic condition, were recorded retrospectively over a period of 18 months.Results: The proportion of children with an HbA1c remaining below 7.5% during the entire study was significantly greater in the CSII group (43.3% vs. 8.7%). Insulin doses (IU/kg/d) were lower in the CSII group after 1 year of treatment (0.6 vs. 0.71 IU/kg/d). No difference was found regarding BMI, severe hypoglycemia or hospitalization. The length of the initial hospitalization was longer in the CSII group.Conclusions: Our study suggests that the use of CSII, when started at onset of type-1 diabetes, allows better metabolic control than MDI and requires lower insulin doses. CSII appears as safe as MDI regarding severe hypoglycemia and diabetic ketoacidosis.S. Borot 1, S. Franc 2,3, P.Y. Benhamou 4, B. Guerci 5, H. Hanaire 6, A. Farret 7, Y. Reznik 8, C. Simon 9, A. Penfornis 10, G. Charpentier 2,3, on behalf the Diabeloop Study Group1Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, EA 3920, University of Franche-Comté, Besançon2Diabetology Endocrinology, Centre Hospitalier Sud Francilien, Corbeil3Centre d'Etudes et de Recherche pour l'Intensification du Traitement du Diabète - CERITD, Evry4Department of Endocrinology, University Hospital, Grenoble5Department of Endocrinology, University Hospital of Nancy-Brabois, Vandoeuvre-lès-Nancy6Cardiovascular and Metabolic Department, University Hospital Center of Toulouse, Toulouse7Endocrinology Department, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier8Department of Endocrinology, University Hospital, Caen9Department of Endocrinology, University Hospital, Lyon10Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, EA 3920, University of Franche-Comté, Grenoble, FranceO-6 THE MINIATURIZED JEWEL® INSULIN PATCH PUMP (DEBIOTECH) IS MORE PRECISE, MORE SENSITIVE TO OCCLUSION AND BETTER ACCEPTED THAN CONVENTIONAL CATHETER PUMPSIntroduction: The miniaturized Jewel® insulin patch pump (JW), 20.8 g, delivers subcutaneously insulin through a tubeless canula thanks to a miniaturized piezoelectric motor, driven by an Android smartphone. Its performance has been compared to that of available pumps.Methods: On bench trials, we measured insulin delivery by continuous micro-weighing over 24h at 1IU/h using 3JW, 3 Minimed-Paradigm (MM), 1 Omnipod (OP), Animas (AS), and Accuchek (AK). The delay before the occurrence of the occlusion alarm was also measured.In patients with type 1 diabetes (T1D), we measured the volumes administered over 24h, both by the JW filled with normal saline, and by their own pump, both pumps were concomitantly working with identical delivery rates. Patients' comfort level was measured using a visual analog scale (VAS).Results: On bench trials, the relative differences (%) of mean (max;min) insulin amounts delivered over 24h were similar: 1.2% (−0.3;+2.2) for JW, −1.5% (−2.2;−0.9) for MM, −0.7% (−1.5;+0.08) for OP. The dispersion of relative errors, measured over 60 minutes, was significantly better (p<0.0001) with JW, i.e., 1.5%, −2.8% and 5.3% for JW, MM and OP. After occlusion, the amount of non-injected insulin before the alarm sounded was significantly lower with JW: 0.1±0.04 IU vs MM (1.2±0.1IU), AS (1.6±0.1 IU), AK 1D have worn their own pump and the JW over 28 periods of 24h. The amounts of insulin delivered were not significantly different: 0.26 IU/24h (−1.00;0.49) vs 1.06IU/24h (−1.98;−0.13) respectively.The comfort level measured by VAS was 8.1±1.7 (JW) and 5.5±2.1 (usual pumps), p 18 yrs) and baseline HbA1c level (9.0–9.5%, 8.0 to 8.9%, and 7.0–7.9%). Analysis of this data will help in better understanding how to improve HbA1c levels in subjects with type 1 diabetes of different ages and with different levels HbA1c of elevation.A. Cinar 1, K. Turksoy 2, E.S. Bayrak 1, L. Quinn 3, E. Littlejohn 41Chemical and Biological Engineering, University of Chicago, Chicago, IL, USA2Biomedical Engineering, Illinois Institute of Technology, University of Chicago, Chicago, IL, USA3College of Nursing, University of Ilinois Chicago, Chicago, IL, USA4Biological Sciences Division, University of Chicago, Chicago, IL, USAO-11 MULTIVARIABLE ADAPTIVE CONTROL OF AN ARTIFICIAL PANCREAS WITHOUT MEAL ANNOUNCEMENTSIntroduction: Accurate closed-loop control is essential for artificial pancreas (AP) systems. Glucose concentration information from CGM systems is the most important information for the control system. Additional physiological measurements provide valuable information that enhances controller performance. Proportional-integral-derivative control and model predictive control have been popular in AP development. Their implementations to date rely on meal announcements by users. Adaptive control offers a powerful alternative that does not necessitate meal or activity announcement.Methods: Adaptive control systems based on generalized predictive control are developed by extending recursive modeling techniques. Physiological signals are used along with glucose measurements to generate a multiple-input-single-output model for predicting future glucose concentrations used by the controller. Insulin on-board (IOB) is also estimated and used in control decisions. The controllers are tested with clinical studies that include seven cases with three different patients for 32 or 60 hours without any meal or activity announcements.Results: The adaptive control system kept glucose concentration in the normoglycemic range without any meal or activity announcements during most of the test period (Figure 1 Closed loop operation: green region). After IOB estimation is added to the control system, mild hypoglycemic episodes were observed only in one of the three experiments.O-11 FIG. 1. Glucose concentration and insulin infusion.M. Clarke Information Systems and Computing, Brunel University, Uxbridge, UKO-12 APPLYING THE IEEE 11073 DEVICE STANDARDS TO RESEARCH PROJECTSThe IEEE 11073 medical device standards have been developed to bring semantic interoperability across multiple domains. The Continua Alliance extends the architecture to cover the health enterprise through the use of HL7 standards. We describe how we have applied and exploited the standards within the Reaction project to develop an interoperable and flexible platform to support management of diabetes patients through remote monitoring. We further describe the work of the IEEE 11073 group to develop standards for glucose monitors, continuous glucose monitoring and insulin pump that can support diabetes research.Our experience of applying the IEEE 11073 standards has shown that they: accelerate development of the platform as nomenclature, device models, and communication protocols are already defined; support technology (e.g., wireless modules, software, test tools) are available; the object model approach supports rapid development of new devices; expertise is available (IEEE 11073 PHD WG, Continua Alliance); devices may be re-used; interoperability between separate implementations is assured; commercial devices may be exploited; project outcomes may be exploited; the standards are inherently flexible and extensible.However, the flexibility and extensibility make the IEEE 11073 protocol more complex to implement than a simple bespoke solution and the advantages of the single solution are not immediately apparent. The goal is to encourage all manufacturers to adopt a standards approach, which will ultimately make interfacing devices for clinical investigation easier.A.H. Combs 1, H.I. Harjunmaa 1, S. Kun 1, R.A. Burrell 1, J. Keating 1, K. Flaton 1, J.P. Lock 2, R.A. Peura 11Grove Instruments Inc.2Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, MA, USAO-13 OPTICAL NONINVASIVE GLUCOMETER ACHIEVES ISO REQUIRED CLINICAL ACCURACY IN PILOT STUDYNoninvasive glucose measurement technology developed by Grove Instruments, Inc. (Worcester, MA, USA) was evaluated in a trial of 63 diabetic adult volunteers.Methods: Diabetic adult volunteers spent 4 hour sessions in an outpatient clinic during which 9–13 invasive blood glucose values (Hemocue™) and 17–25 blinded paired noninvasive readings were taken on each of 2 prototype Grove glucometers. These data were used to develop a calibration model for the noninvasive instrument and calculate blood glucose values using a leave one out cross-validation method. Because noninvasive readings were blinded, the results were reviewed post hoc and data pairs subsequently plotted on the Clarke Error Grid.Results: In the aggregate, 177 full patient sessions and 3,910 data pairs met criteria for analysis. Overall mean average relative difference (MARD) from control values was 7.0% (ISO requirement <20%), and Clarke A space was 96.3% (ISO requirement ≥95%).To evaluate calibration durability, all subjects having ≥2 qualified sessions were reviewed. A subset of 17 subject/device datasets with apparent calibration model durability were identified and analyzed. Calibration and prediction values were obtained on separate days yielding 512 calibration points and 374 prediction points for analysis. Intervals ranged from 1 day (24 hours) to three weeks between calibration and prediction. Prediction MARD was 8.6% and Clarke A Space was 96.4%.Conclusions: Noninvasive blood glucose determination in vivo using Grove's noninvasive optical method is capable of achieving the required accuracy for SMBG and could represent a painless and bloodless alternative to currently available glucometers.E. Leclair 1, J. Beaudry 1, R. Liggins 2, D. Coy 3, M. Vranic 4, M. Riddell 11Department of Kinesiology and Health Science, York University, Toronto, ON2The Center for Drug Research and Development, Vancouver, BC, Canada3Department of Medicine, Peptide Research Labs, Tulane University Medical Center, New Orleans, LA, USA4Departments of Physiology and Medicine, University of Toronto, Toronto, ON, CanadaO-14 SOMATOSTATIN RECEPTOR ANTAGONIST EFFICACY FOR GLUCAGON COUNTERREGULATORY RESPONSE TO HYPOGLYCEMIA IMPROVEMENTDiminished responsiveness to insulin-induced hypoglycemia is the main limitation of insulin treatment in diabetes. Pancreatic and/or circulating somatostatin levels are elevated in diabetes which may inhibit counterregulatory hormone release during hypoglycemia. Somatostatin is a peptide hormone that binds to several different subtype receptors (SSTR1-5), acting specifically on SSTR2 to inhibit glucagon secretion from pancreatic α-cells. Recently, a selective SSTR2 antagonist (PRL-2903) improved the glucagon response to hypoglycemic clamp in diabetic rats, suggesting that glucose counterregulation to hypoglycemia may be improved with this form of therapy. The purpose of this study was to test the efficacy of a more selective SSTR2 antagonist (PRL-3285, 5 times higher affinity to SSTR2 than PRL-2903) on glucagon counterregulation.Methods: STZ-diabetic (D) rats underwent 4h of PRL-2903 or PRL-3285 infusion (3000 nmol/kg/h) or saline treatment with insulin-induced (10 U/kg) hypoglycemia, clamped at 2.5±0.5 mmol/L.Results: During hypoglycemia, the AUC for glucagon response with PRL-3285 (30742 pg/mL/min) and with PRL-2903 (26388 pg/mL/min) improved compared to D rats infused with saline (16218 pg/mL/min) (both P<0.05). No significant difference in glucagon response was observed between the two peptides, although PRL-3285 tended to have a higher AUC (P=0.24), approaching that observed in non-diabetic rats. PRL-3285 accumulated in pancreas relative to plasma and had 3 times higher concentration in pancreas relative to PRL-2903.Conclusions: Both PRL-3285 and PRL-2903 enhance glucagon release during hypoglycemia in diabetic rats. However, because of improved selectivity and affinity for the human SSTR2 receptor, and biodistribution, PRL-3285 may be preferable as a therapeutic agent.T. Danne Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, GermanyO-15 APPROACHES TO IMPROVING TYPE 1 DIABETES WITH BENCHMARKING: SWEET (EUROPE) VS. TYPE 1 DIABETES EXCHANGE (US)Two nonprofit organizations with the mission to improve outcomes of young people with T1D by means of a clinical registry have been recently created in Europe and the US. Data from both large registries show that too many youth with T1D fail to achieve target A1c levels (ISPAD recommends pediatric A1c targets <7.5%). The T1D Exchange Clinic Registry is funded by a grant from The Leona M. and Harry B. Helmsley Charitable Trust. Currently, 69 US based clinics are participating in the T1D Exchange Clinic Registry. “SWEET” is an acronym derived from “Better control in Pediatric and Adolescent diabeteS: Working to CrEate cEnTres of Reference” (COR's) and is based on a partnership of established national and European diabetes organizations (www.sweet-project.eu) led by ISPAD with valuable contributions of IDF Europe, FEND, and PCDE. Co-funding initiating SWEET was granted by the European Public Health Executive Agency with additional funds from corporate partners and foundations. Recently the first 12 SWEET COR's were approved jointly by the ISPAD Executive Committee and IDF Europe in the Czech Republic, France, Germany, Greece, Hungary, Italy, Luxembourg, the Netherlands, Poland, Portugal, Romania, Sweden, and the UK. While the T1D exchange is looking into combining clinical research with the expanding fields of social networking, SWEET aims at using electronic health records and benchmarking as a means of quality improvement among treatment centres. By exchanging examples of best practices the SWEET project is now reaching out to additional centres within countries and throughout Europe and beyond.E. Dassau 1,2, J.J.-S. Lee 1,2, E. Renard 3, H. Zisser 1,2, F.J. Doyle III1,21Chemical Engineering, University of California Santa Barbara2Sansum Diabetes Research Institute, Santa Barbara, CA, USA3Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital and University of Montpellier, Montpellier, FranceO-16 CLINICAL AND ENGINEERING ASPECTS OF IP INSULIN DELIVERY IN CLOSED LOOP STUDY: THE DIAPORT EXPERIENCEOne of the rate-limiting steps in controlling glucose excursions is the slow response to glucose changes using traditional subcutaneous (SC) insulin delivery. New insulin formulations and delivery devices are under development with the promise to provide faster kinetics and minimize transport delay. The DiaPort® 2 system from Roche Diagnostics, which facilitates Intraperitoneal (IP) insulin delivery using a traditional insulin pump and U100 insulin, has been used in clinical research to explore the benefits of IP insulin delivery.Ten type 1 diabetes subjects from Prof. Renard's clinic in Montpellier, France were recruited to the first-ever closed-loop study using the DiaPort® 2 system. The Artificial Pancreas System (APS™) was used as the research platform that facilitated the communication between: (a) the Roche Accu-Chek® Spirit Combo insulin pump and the DiaPort® 2 system; (b) Dexcom Seven® Plus continuous glucose monitor and (c) Model Predictive Control (Zone-MPC) and the Health Monitoring System (HMS) from the University of California Santa Barbara and the Sansum Diabetes Research Institute.The engineering development and interim clinical results of this innovative artificial pancreas design will be presented in this talk.P. Di Bartolo 1, M.C. Rossi 2, V