Assessment of Mitigation Methods to Reduce the Risk of Hypoglycemia for Announced Exercise in a Uni-hormonal Artificial Pancreas

Bertachi, Arthur; Beneyto, Aleix; Ramkissoon, Charrise Mary; Vehı́, Josep

doi:10.1089/dia.2017.0392

Cited by 18 publications

(14 citation statements)

References 27 publications

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“…Mitigation method is effective for patients using artificial pancreas (AP) systems to automatically control blood glucose levels. Since exercise-induced hypoglycemia is a major challenge, Arthur et al combined a closeloop controlled algorithm with feedforward action (FF action) to address it [37]. The FF action was evaluated in two scenarios: (1) exercise sessions during the postprandial period and (2) exercise sessions during the fasting period.…”

Section: The Mitigation Methods Prediction Algorithm and Autonomic Fmentioning

confidence: 99%

The hypoglycemia associated autonomic failure triggered by exercise in the patients with “brittle” diabetes and the strategy for prevention

Mao

Zhou

et al. 2019

Endocr J

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Exercise is a fundamental component of diabetes management. However, choosing inappropriate type or timing of exercise is associated with mild or severe hypoglycemia either during exercise or several hours after exercise. Several studies have shown that impaired counterregulatory responses triggers hypoglycemia. Therefore, in this investigation, we explored the appropriate intensity and time of exercise in patients with diabetes. The mechanisms of counterregulatory responses and hypoglycemia associated autonomic failure (HAAF), as well as the strategies for preventing episodes of hypoglycemia after exercise were also investigated. In this study, we obtained the following results: 1) High intensity interval exercise is more suitable for diabetic patients. 2) Morning exercise reduces nocturnal hypoglycemia risks compared with midday, afternoon and evening exercise. 3) Hypoglycemia can be prevented by dietary approach, reduction or suspension of insulin dose, use of mini dose glucagon, caffeine, mitigation methods, prediction algorithm, autonomic feedback controlled close-loop insulin delivery, real time continuous glucose monitoring. Based on these results we concluded that exercise may cause severe hypoglycemia or induce blunted response in patients with diabetes. For Diabetes Mellitus (DM) patients, the intensity and time of exercise influence the occurrence of hypoglycemia. This review summarizes the clinical characteristics of different types of exercises and time of exercise that can be potentially used to educate and guide patients regarding the role of exercise in standard of care.

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Section: The Mitigation Methods Prediction Algorithm and Autonomic Fmentioning

confidence: 99%

The hypoglycemia associated autonomic failure triggered by exercise in the patients with “brittle” diabetes and the strategy for prevention

Mao

Zhou

et al. 2019

Endocr J

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show abstract

“…Furthermore, the DRB algorithm may not be applicable in fully automatic AP systems, in which patients do not need to announce meals. Finally, the adjustments of IOB is a major task for AP systems which considers the SAFE layer, and the proper adjustment of this constraint also plays an important role even during physical activity [39,40], by reducing the amount of injected insulin during and after exercise.…”

Section: Scenario Cmentioning

confidence: 99%

Dynamic Rule-Based Algorithm to Tune Insulin-on-Board Constraints for a Hybrid Artificial Pancreas System

Bertachi

Biagi

Beneyto

et al. 2020

Journal of Healthcare Engineering

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The artificial pancreas (AP) is a system intended to control blood glucose levels through automated insulin infusion, reducing the burden of subjects with type 1 diabetes to manage their condition. To increase patients’ safety, some systems limit the allowed amount of insulin active in the body, known as insulin-on-board (IOB). The safety auxiliary feedback element (SAFE) layer has been designed previously to avoid overreaction of the controller and thus avoiding hypoglycemia. In this work, a new method, so-called “dynamic rule-based algorithm,” is presented in order to adjust the limits of IOB in real time. The algorithm is an extension of a previously designed method which aimed to adjust the limits of IOB for a meal with 60 grams of carbohydrates (CHO). The proposed method is intended to be applied on hybrid AP systems during 24 h operation. It has been designed by combining two different strategies to set IOB limits for different situations: (1) fasting periods and (2) postprandial periods, regardless of the size of the meal. The UVa/Padova simulator is considered to assess the performance of the method, considering challenging scenarios. In silico results showed that the method is able to reduce the time spent in hypoglycemic range, improving patients’ safety, which reveals the feasibility of the approach to be included in different control algorithms.

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“…The ability of CLAP to reduce exercise related hypoglycemia was also tested in silico by Bertachi et al . They used the University of Virginia/Padova T1D Simulator to test the ability of several feed‐forward actions to prevent exercise‐induced hypoglycemia in a CLAP setting.…”

Section: Objective Parameters In Clap Studiesmentioning

confidence: 99%

How Important Is a Closed‐Loop Artificial Pancreas?

Foltynski

2018

Artificial Organs

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Assessment of Mitigation Methods to Reduce the Risk of Hypoglycemia for Announced Exercise in a Uni-hormonal Artificial Pancreas

Abstract: The combination of the FF actions presented in this article within an AP system showed to be an effective strategy to mitigate the risk of hypoglycemia in front of aerobic exercise.

Cited by 18 publications

References 27 publications

The hypoglycemia associated autonomic failure triggered by exercise in the patients with “brittle” diabetes and the strategy for prevention

The hypoglycemia associated autonomic failure triggered by exercise in the patients with “brittle” diabetes and the strategy for prevention

Dynamic Rule-Based Algorithm to Tune Insulin-on-Board Constraints for a Hybrid Artificial Pancreas System

How Important Is a Closed‐Loop Artificial Pancreas?

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