Run-to-run control of meal-related insulin dosing

Abstract

Background: This study was designed to determine if it was feasible to use a run-to-run algorithm to improve postprandial glucose concentrations in individuals with type 1 diabetes mellitus (T1DM).

Methods: Fourteen subjects were recruited for this 10-week study. During the initial phases of the study, the following information was derived for each subject: basal insulin infusion rates, insulin-to-carbohydrate ratios, insulin correction factors for hyperglycemia, and insulin sensitivities. During the final phases, the algorithm was used to suggest preprandial insulin doses, with a goal of bringing the postprandial glucose into a predetermined target range within 3-7 days.

Results: In the single-meal phase (phase 5), 33% of the subject-meal responses were convergent in 3-4 days to a clinically acceptable range, 33% always stayed in range, and 33% had divergent responses, incorrect sensitivities, and/or other mitigating circumstances. In the three-meal phase (phase 6), 41% of the subject-meal responses were convergent in 3-4 days to a clinically acceptable range, 26% were always in range, and 33% had divergent responses, incorrect sensitivities, and/or other mitigating circumstances.

Conclusions: Overall, we were able to safely demonstrate that run-to-run control can be used to manage meal-related insulin in subjects with T1DM.