New strategies for post-prandial glycaemic control using insulin pump therapy in type 1 diabetes
Administrative data: DPI2010-20764-C02-01
Title:New strategies for post-prandial glycaemic control using insulin pump therapy in type 1 diabetes – CLOSEDLOOP4MEAL
Participating centers: Coordinated project
Subproject 1: Universitat Politècnica de València (coordinator)
Subproject 2: Universitat de Girona
Principal investigator: Jorge Bondia (coordinador); Josep Vehí
Funded by: Ministerio de Ciencia e Innovación
Funding awarded: Subproject 1: €267,410.00; Subproject 2: €223,850.00
Diabetes is a chronic disease characterised by absolute or relative insulin deficiency (type 1 diabetes mellitus – T1DM and type 2 diabetes mellitus – T2DM, respectively). The total number of people with diabetes is projected to rise from 284.6 million in 2010 to 438.4 million in 2030. The cost burden of the diabetes pandemic in the EU is responsible in most countries for over 10% of health expenditure. Compared to multiple daily insulin injections, continuous subcutaneous insulin infusion (CSII) through an insulin pump has shown to be effective in the reduction of HbA1c (an index of mean glyaemic control) in adults with type 1 diabetes, however, hypoglycaemia episodes are not reduced. In the last two decades, technological progresses have fuelled research on closed-loop glucose control systems (the so-called artificial pancreas) combining an insulin pump and a subcutaneous continuous glucose monitor (CGM), for a more effective treatment of type 1 diabetic subjects. Although satisfactory enough clinical results have been reported on overnight glucose control, postprandial (post-meal) glucose control is indeed still an open issue due to controller overcorrection leading to hypoglycaemia. The lack of accuracy of current continuous glucose monitors, especially in the hypoglycaemic range, has also been identified as a limiting factor in the development of an artificial pancreas.
The general objective of this project is thus the development of new efficient and safe strategies for postprandial glucose control in type 1 diabetic patients, aiming at the relieve of the burden of hypoglycaemia. This project will focus on insulin-pump-based therapies, both in open loop (CSII), and closed loop in combination with a subcutaneous continuous glucose monitor (artificial pancreas). This will be achieved through the following specific objetives:
Objective 1. Gaining a better understanding of the glycamic effect of a mixed meal perturbation.
Objective 2. Development of new robust control strategies to counteract efficiently meal perturbations without hypoglycaemia risk.
Objective 3. Understanding of the dynamic relationship between plasma and intestitial glucose to develop new calibration algorithms for CGM with improved accuracy and hypoglycaemia detection.
Objective 4. Development of fault-detection algorithms for the supervision of insulin infusion. It is expected that the improvement in control algorithms, measurement accuracy and fault-detection systems will allow getting the performance and safety required for automated post-meal control in type 1 diabetes.
Universitat Politècnica de València:
Jorge Bondia (coordinador)
José Luis Díez
- Fátima Barceló
- Alejandro Laguna
- Diego de Pereda
Universitat de Girona
- Josep Vehí (co-IP)
- Remei Calm
Crisóstomo A. Barajas
Hospital Clínico de Valencia
- F. Javier Ampudia
Hospital Francesc de Borja de Gandía
- Paolo Rossetti
Hospital Clínic de Barcelona
- Ignacio Conget
- Marga Giménez
- Carmen Quirós