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R. Hovorka, J. M. Allen, L. J. Chassin, A. De Palma, D. Elleri, J. 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 Artificial Pancreas Project at Cambridge Institute of Metabolic Science, Department of Paediatrics and Department of Medicine, University of Cambridge, United Kingdom OVERVIEW CLOSED LOOP IN CHILDREN • The Artificial Pancreas Project started in 2007 and the first three • Type 1 Diabetes (T 1 D) is one of the most common studies evaluated the manual closed loop (CL) in children and adolescents with T 1 D. chronic conditions in developed nations. To improve glucose control, quality of life and prevent long term complications, new tools are being developed. Paediatric Efficacy Study § The first clinical study compared the continuous subcutaneous insulin infusion (CSII) against CL in 12 children and adolescents with T 1 D. • The Artificial Pancreas Project at the University of Cambridge focuses on closed-loop (CL) overnight insulin delivery in people with T 1 D. CLOSED LOOP IN ADULTS • The first CL study in adults is Sample of overnight algorithm CL control in adults underway. Preliminary analyses demonstrate improved efficacy under CL control, as compared to conventional pump therapy. • 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. • It combines a purpose-made model-predictive § The results showed improved glucose control with CL whilst reducing the risk of hypoglycaemia [1 ] (see figure below). control (MPC) algorithm with an off-the-shelf continuous glucose monitor and an insulin pump. CLOSED LOOP IN PREGNANCY • Optimising glucose control is particularly pregnancy. challenging in • To inform CL algorithms specific for pregnancy, physiological studies of glucose gut absorption are currently underway. Diet Study § 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. FUTURE : HOME STUDIES § 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]. Exercise Study § The third study tested the CL in postexercise conditions in 9 subjects. § Overnight CL with MPC following afternoon exercise avoids hypoglycaemia and increases time spent in target glucose range twofold [3]. AUTOMATED CLOSED LOOP IN CHILDREN § 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. § 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. Glossary References: Acknowledgements AP - Artificial pancreas CL - Closed-loop system APCam - AP project at Cambridge T 1 D - Type 1 diabetes CSII - Continuous Subcutaneous Insulin Infusion MPC - Model-Predictive Control [1]Hovorka R et al, ADA June 2008 [2]Hovorka R et al, EASD Sept 2008 [3]Hovorka R et al, ATTD Feb 2009 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.