Use of an artificial pancreas among adolescents for a missed snack bolus and an underestimated meal bolus

Objective: The objective of this study was to evaluate the safety and performance of the artificial pancreas ( AP) in adolescents with type 1 diabetes ( T1D) following insulin omission for food. Research design and methods: In a randomized, cross- over trial, adolescents with T1D aged 13- 18 yr were enrolled in a randomized, cross- over trial. On separate days, received either usual care ( UC) through their home insulin pump or used an AP system ( Diabetes Assistant platform, continuous glucose monitor, and insulin pump). Approximately 1 h after admission, participants in both groups received an unannounced snack of 30 g carbohydrate, and 4 h later they received an 80 g lunch, for which both groups only received 75% of the calculated insulin dose to cover carbohydrates. On the UC day ( but not the AP day), they received their full high blood glucose ( BG) correction factor at lunch. Each admission lasted approximately 8 h. Results: A total of 16 participants completed the trial. On the AP day ( compared to UC), mean BG was lower ( 197 +/- 10 vs. 235 +/- 14 mg/ dL) and time in range 70- 180 mg/ dL was higher ( 43%+/- 7 vs. 19%+/- 7) ( both p< 0.05) overall; these results held in the time following the snack and meal ( also p< 0.05). During the trial, there were no differences between groups in the rate of hypoglycemia < 70 mg/ dL. Conclusions: The AP provided improvements in short- term glycemic control without increases in hypoglycemia following missed insulin for food in adolescents. Thus, the AP partly compensates for missed insulin boluses for food, a common occurrence in adolescent diabetes care. Further testing is needed in longer- term settings.