Two of the major problems in attaining euglycemia in subjects with type 1 diabetes (T1D) arehypoglycemia (including fear of severe hypoglycemia) and post-meal hyperglycemia. The lattercommonly occurs in adolescents secondary to missed meal and snack insulin boluses. Both ofthese issues will be addressed over the five years of this grant. As over half of severehypoglycemic events occur during sleep, we will continue our development of algorithms topredict and prevent nocturnal hypoglycemia using a closed loop system (CLS) in which theinformation from a continuous glucose monitor (CGM) is used to suspend delivery of insulin byan insulin pump. Initial studies will be done in the Clinical Translational Research Centers(CTRCs) to document safety of the 'Florence' CLS (Abbott Diabetes Care) and we will thenconduct a randomized clinical trial in the home environment in years 2 and 3 of the grant.Similarly, a fully portable CLS will be used to detect and correct hyperglycemia resulting frommissed food boluses. The safety and efficacy of algorithms which utilize the signal form a CGMand provide output to an insulin pump will initially be studied in the CTRC's in year 3 of thegrant. In years 4 and 5 of this grant we plan to assess the combined algorithms for preventionof hypoglycemia and hyperglycemia in a fully ambulatory system developed by Abbott DiabetesCare. We believe that prevention of hypoglycemia, particularly at night, and reduction of postprandial hyperglycemia will result in improvement in glycemic control and reduction in HbA1clevels.
Hypoglycemia is one of the main deterrents for attaining optimal glycemic control for people with type 1 diabetes. This research is focused on reducing hypoglycemia as well as hyperglycemia after meals in people with type 1 diabetes. Hopefully this will lead to improved glycemic control for participants.
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