What Is A Closed-loop Insulin Delivery System For Treating Diabetes? | Insulin Pumps - Sharecare
What is a closed-loop insulin delivery system for treating diabetes? Dr. Jack Merendino, MD on behalf of The Best Life A closed-loop insulin delivery system is essentially an artificial pancreas. The loop refers to the continuous cycle of feedback information: the blood glucose level changes; the change is detected by the continuous glucose monitor (CGM); the CGM sends information to the insulin pump, which adjusts its insulin output; and the blood glucose level changes again in response to the insulin. The loop is closed when this happens automatically. At present CGM-insulin pump systems are not closed-loop because the person has to make the decision of how much insulin to give rather than this happening automatically. It's hard to predict when such a system will actually become available, but prototype systems are already being used in experimental settings. One problem with these systems is that the glucose level in the tissue fluid doesn't change as quickly as the blood glucose level, and it takes some time for insulin injected into subcutaneous fat to take effect. As a result, the insulin effect always lags somewhat compared to insulin that's made by a normally functioning pancreas, where changes in blood glucose are sensed instantaneously and the insulin is released directly into the blood. Given the serious problems -- glucose levels that are dangerously high or dangerously low -- that can result if the wrong dose of insulin is given, such systems will have to be studied extensively before they are made available for widespread use. But we're optimistic that the technical hurdles will be overcome. Along with islet cell transplantation, closed-loop insulin delivery systems offer the promise of revolutionizing the management of type 1 diabetes. Continue reading >>
Closed Loop Vs Open Loop Hydraulic Systems
Closed Loop VS Open Loop Hydraulic Systems Closed Loop VS Open Loop Hydraulic Systems If someone talks about an open loop or closed loop hydraulic system, what exactly do they mean? Fundamentally, the difference can be described in just two sentences, and is most easily defined by the pump: An open loop pump draws all of its flow directly from a reservoir and sends the majority of it directly back to the reservoir after performing its function. A closed loop pump draws most of its flow directly from the return flow of its actuator(s). Unfortunately, the pros, cons, and implications of each are not quite as easy to summarize and understand. In order to avoid the pain and consequences of choosing the wrong type of circuit for your application, it is wise to think about the big picture design intentions and analyze the merits of each approach. Here are some questions that you should answer before attempting to make this decision: What Type and How Many Actuators Do I Need? If you are providing flow to cylinders, you most likely dont want a closed loop. This is because the volume entering one side of a single rod cylinder does not equal the volume going out of the other side. One side or the other would experience a pressure spike or cavitation due to these unequal volumes working against each other. A double rod cylinder could theoretically work until the cylinder reached end-of-stroke. It would be a very uncommon situation in which you could benefit from a closed loop providing flow to cylinders. Hydraulic motors are the typical actuators in a closed loop. They generally operate bi-directionally and must have some special features to be appropriate. A loop flushing valve and/or relief valves can be built into a closed loop motor. This can eliminate the need for other suc Continue reading >>
Medtronic’s Minimed 670g Hybrid Closed Loop: 1,500-person Study!
Comparing Medtronic’s MiniMed 670G to injections and pumps in people with type 1 diabetes, with and without CGM; enrollment to open in May at some trial locations Clinical Trials Identifier: NCT02748018 Trial name: Multi-center Trial in Adult and Pediatric Patients With Type 1 Diabetes Using Hybrid Closed Loop System at Home Diabetes type: Type 1 diabetes What it’s testing: This research study will test the safety and effectiveness of the MiniMed 670G hybrid closed loop system compared to multiple daily injections, an insulin pump without continuous glucose monitoring (CGM), and an insulin pump with CGM. What the trial is measuring: Researchers will mainly look at A1c levels, the number of severe hypoglycemia episodes, and the number of DKA episodes over a six-month period. They will also look at time spent with a blood sugar below 70 mg/dl and time spent in-range (70-180 mg/dl). Why this is new/important: Medtronic’s MiniMed 670G is a hybrid closed loop system, consisting of an insulin pump (with tubing), a continuous glucose monitoring (CGM) sensor inserted under the skin, and a transmitter worn on the body. When the 670G is operating in “Auto Mode,” it receives a glucose value from the CGM every five minutes and uses it to automatically adjust basal insulin delivery, targeting a blood glucose level of 120 mg/dl. The 670G is the first and only approved “hybrid closed loop” system in the US, having received FDA approval in September 2016. This approval was based on a short three-month study without a control group, which showed that the 670G is safe. However, as a condition of the approval, Medtronic has to conduct a larger study to provide additional outcomes data. The 670G has already begun a controlled launch (Customer Training Phase), with a broader l Continue reading >>
Closed Loop Systems: Future Treatment For Diabetes?
Having Type 1 Diabetes sometimes seems like a chore, testing, needles, making sure you’re eating correctly, and more. There are some days it’s just all too overwhelming. With technology moving faster than ever, you’d think there would be an easier way than sticking your finger every few hours and then figuring out how much insulin to inject. There is good news for those with Type 1 diabetes, science and technology have finally come together to create the artificial pancreas. We’re just a few small steps away from not having to wake our children up in the middle of the night to test their blood glucose levels. Or what if you didn’t have to worry about being late to a meeting because you were injecting insulin? Companies like Medtronic have paved the way into bionic management of Type 1 Diabetes and their device could be coming to you sooner than you think. What’s an Artificial Pancreas? Unlike the name implies, an artificial pancreas does not work exactly like a person’s biological pancreas. It is a device, not an organ, that requires a system of pumps, monitors, and algorithms to deliver insulin and glucagon directly to the patient. It’s not surgically implanted into a patient, rather it’s attached to the patient’s abdomen, on the outside of their body. Artificial pancreas’ are only for patients with Type 1 Diabetes. The system automatically monitors blood glucose levels, every 5 minutes, and provides the right dose of insulin or glucagon if needed. Algorithms are set in place which link the monitor to the pump. Some other names for the artificial pancreas include closed loop device and bionic pancreas. Patients who have an artificial pancreas will have more freedom and less stress about having to test, monitor, and administer medications for their Continue reading >>
Pilot Study Completed For Closed Loop Insulin Pump
Pilot Study Completed for Closed Loop Insulin Pump Tandem Diabetes Care, Inc. reported that a successful pilot study was completed on the companys t:slim X2 Insulin Pump, utilizing a hybrid closed-loop system that utilizes algorithms from TypeZero Technologies and Dexcom's G6 continuous glucose monitoring. The study is the first of 3 in the International Diabetes Closed Loop (IDCL) trial, funded by the National Institute of Health (NIH). It was a 36- to 48-hour study with 5 participants at the University of Virginia. The second of the 3 studies, which will be last 2 weeks, is currently enrolling patients at 7 clinical sites and is expected to begin in early 2018. We have enjoyed introducing patients to this latest advancement in technology, featuring an easy-to-use system and an algorithm with a successful track record in past clinical trials of improving blood glucose control while simultaneously decreasing hypoglycemia, Sue Brown, MD, an associate professor at the Center for Diabetes Technology at the University of Virginia and the endocrinologist in charge of the IDCL trials that utilize the embedded technology, said in a statement . This study was an exciting step forward in closed-loop technology for people with diabetes. The IDCL trial began near the end of 2016, and will include close to 360 adults with type 1 diabetes in total. A premarket approval submission is expected to be given to the US Food and Drug Administration (FDA) upon the completion of the trio of trials. The first successful use of the commercial version of our hybrid closed-loop system is a huge step forward, and the speed of the development cycle for this product has been impressive for our industry, Kim Blickenstaff, MBA, president and CEO of Tandem Diabetes Care, said in a statement. We look Continue reading >>
Automated Insulin Delivery
The development of automated insulin delivery has many names artificial pancreas, hybrid closed loop, Bionic Pancreas, predictive low glucose suspendbut all share the same goal: using continuous glucose monitors (CGMs) and smart algorithms that decide how much insulin to deliver via pump. The goal of these products is to reduce/eliminate hypoglycemia, improve time-in-range, and reduce hyperglycemia especially overnight. See below for an overview of the automated insulin delivery field, focused on companies working to get products approved. Do-it-yourself automated insulin delivery systems like OpenAPS and Loop are not included here, though they are currently available and used by a growing number of motivated, curious users. Weve also included helpful links to articles on specific product and research updates, as well as some key questions . Whois Closing the Loop and How Fast Are They Moving? Below we include a list of organizations working to bring automated insulin delivery products to market this includes their most recently announced public plans for pivotal studies, FDA submissions, and commercial launch. The organizations are ordered from shortest to longest time to a pivotal study, though these are subject to change. This list excludes those without a commercial path to market (e.g., academic groups). The first table focuses on the US, with European-only systems listed in the second table . MiniMed 670G/Guardian Sensor 3 hybrid closed loop that automates basal insulin delivery (still requires meal boluses) FDA-approved and currently launching this fall to ~35,000 Priority Access Program participants in the US. Pump shipments to non-Priority Access customers will start in October, with sensors and transmitters to ship by the end of 2017 or early 2018. Medtronic Continue reading >>
Hydraulic Circuits, Open Vs. Closed
There are different types of hydraulic circuits used in fluid power applications. The two types are described as Open Loop (or Open Circuit) and Closed Loop (or Closed Circuit). These are circuits where both the inlet to the hydraulic pump and the motor (or valve) return are connected to a hydraulic reservoir. The hydraulic flow from the pressure port on the pump is directed to the device that it is powering and then returned back to the reservoir. A relief valve or directional valve in the circuit may divert any unused fluid back to the reservoir. Suction strainers and return filters keep the fluid clean. Better for lower pressure applications (below 3000 PSI). Simple to maintain and easier to diagnose problems if they occur. Could create heat in the system if working pressure exceeds the relief valve setting when using fixed displacement pumps. Reservoir size has to be larger for adequate cooling of the fluid. These are circuits where the motor return is connected directly to the hydraulic pump inlet. To maintain pressure in the loop, the circuits have a charge pump (a small gear pump) that supplies cooled and filtered oil to the low-pressure side. Closed-loop circuits are generally used for hydrostatic transmissions in mobile applications. The reservoir only has to have enough capacity to feed the small charge pump. These circuits are mainly used with higher-pressure piston hydraulic pumps and motors. Systems can run at higher pressures with less fluid flow so smaller hydraulic lines can be used. Direction can be reversed without the use of valves. Continue reading >>
Diabetes And The Artificial Pancreas: Closed-loop Systems
An article I read recently declared that the artificial pancreas, or a closed-loop artificial pancreas system for diabetes management, is likely to hit the market by 2018. This is potentially life-altering news for anyone with Type 1 diabetes — this is the next step in diabetes care that we have been waiting for. But what is a closed-loop artificial pancreas system, and what are the details researchers need to iron out for such a system to truly be a viable day-to-day option for diabetes management? A closed-loop artificial pancreas system is a device, or series of devices, that can work in concert with one another to automatically give the correct amount of insulin in response to food intake and rising blood glucose. There is also research into dual-hormone systems — these would provide insulin in response to rising blood sugars, and provide glucagon in response to falling blood sugars. However, the current formulations of glucagon are not as stable as would be ideal, and the reservoir would have to be replaced every 24 hours. The most likely candidate for release in the near future is a closed-loop artificial pancreas system that only supplies insulin. Such a system would be much less likely to CAUSE hypoglycemia, but on the occasions when hypoglycemia does occur, it would simply alert the user of low blood sugar and still require us to eat some of our good old glucose tablets. So now that we know what a closed-loop artificial pancreas system is, we need to know the components researchers will address in the next couple of years to make the bold prediction of 2018 a reality. Let’s take a look. 1. Glucose monitoring Obviously, accurate and continuous glucose monitoring (CGM) is absolutely vital in implementing a closed-loop artificial pancreas system. CGM systems Continue reading >>
Beta Cells Vs. Closed-loop Pumps Which Is Better?
Read more: How to Grow Beta Cells in 40 Days However, this seemingly large supply of beta cells still doesnt solve all problems with the transplant process. People with Type 1 diabetes who undergo islet therapy must take drugs to suppress their immune systems or their bodies will destroy the transplanted beta cells. There also is still room for improvement in quality of the grown cells. Currently, the best beta cells grown in the lab match the poorest quality of beta cells made naturally in the body. Millman believes the quality of cells grown in the lab will only improve in the coming years. Making beta cells is pretty much figured out, he said. These cells will be quite good just a few years from now. But while Millman can point to successful transplants involving individual patients, the number of patients who have successfully worn closed-loop insulin pumps number in the thousands, and that made Kowalskis case much easier to argue. Kowalskis argument was simple closed loop pumps work and they make the lives of people with Type 1 easier right now. To buoy his case, he came armed with statistics that JDRF advocates often cite, including that studies have shown that most people with Type 1 diabetes arent meeting the A1C goals necessary to avoid long-term complications. Kowalski and others at JDRF say that this isnt because people arent trying; its just that the task of being ones own pancreas is extremely difficult. Hybrid closed loop pumps make that task easier, he said. In trials, the pumps, which still require individuals to bolus for meals, have been shown to significantly reduce glucose variation and improve A1C scores. These trials have also shown that closed loop pump technology had the greatest impact when people with Type 1 were asleep and cant manage their g Continue reading >>
Closed-loop Control | Ksb
Closed-loop control is a procedure during which a quantity to be controlled (controlled quantity) is continually measured, compared to another quantity (reference quantity), and adjusted accordingly in a closed loop. Closed-loop control is therefore a process whereby the output variable also influences the control variable via feedback. The actual value of the output is fed back to the controller, and disruptive influences are taken into account and corrected at this time so that the setpoint can be reached despite imprecise models. Open-loop control systems do not have a feedback loop. See Fig. 1 Closed-loop control Fig. 1 Closed-loop control: Closed-loop and open-loop control principles Closed-loop control for centrifugal pumps and pump systems In conjunction with operating pumps, flow rate closed-loop control refers to methods and the accompanying equipment for varying this rate and adjusting it in accordance with a desired value (setpoint). The centrifugal pump and pump system are two systems that are connected in series. The performance of a centrifugal pump can be shown graphically on its H/Q curve (characteristic curve) by plotting the head (H) over the flow rate (Q) for a specific type of pump . Flow through the system causes a head loss that varies as a square of the flow rate and is defined by the system characteristic curve (with Hsys as the system head). If head H is the same as the head Hsys, this will result in the flow rate at operating point B. Fig. 2 Closed-loop control: Characteristic curve of centrifugal pump and of system If the system characteristic curve becomes steeper as a result of throttling (Hsys > Hsys), the flow is decelerated in the valve and the flow velocity and flow rate decrease. This occurs until a new balanced state (Hsys = Hsys) is Continue reading >>
Pump Head In A Closed Loop
In a Chilled water system, how do you calculate your head? ( what are the different types of head) - The building is 150 meters high. Does that go in for the head caluclation? Another question, if the pump is switched off, system full of water, what would be the reading on the gauge before and after the pump. If the pump was switched off, the pressure readings on either side of the pump would be the static head of 150 meters. Refer to the discussion on water systems in the link. High rise buildings are generally zoned off to minimize large pressure differentials. In a closed loop system the static pressure at the lowest point in the system must be at least equal to the static head of the fluid (water) at the highest point, in your case 150m. However to avoid cavitation and air bubbles forming, the system is usually pressured to a bit more so that the highest point the pressure is always > 0 barg, often 1-2 barg. This increase the static head at the lowest point. The differential head of the pump though, regardless of where it is located, is the head required to pump the water around the system at the flow rate required through the elements required (AHU, chiller etc). Often the pump on large building is located at the top to reduce the pressure rating of the pump and its seals. The height of building is irrelevant to this calcualtion as the height issue cancels each other out. Also: If you get a response it's polite to respond to it. Correction to my post. If the pump was switched off, the pressure reading on the discharge side of the pump would be the static pressure head created by the difference between the elevations of the uppermost pipe (assume that it is on the roof) and the pump plus any residual pressure that was put into the closed loop by the pump. The press Continue reading >>
Hybrid Closed Loop System.
NEW! The Suspend before low§ option avoids lows and rebound highs proactively by automatically stopping insulin 30 minutes before you reach your pre-selected low limits, then automatically restarts insulin when your levels recover, all without bothersome alerts. NEW! The Auto Mode‡ option automatically adjusts your basal insulin delivery every 5 minutes based on your sugar levels to keep you in target range, all day and night. Watch Video View Brochure Get Started NEW! Guardian® Sensor 3 continuous glucose monitoring sensor. Introducing the most accurate sensor from Medtronic, now with up to 7 day wear and easy insertion. It is the FIRST and ONLY continuous glucose monitoring sensor FDA approved and trusted to control insulin dosing. Exclusive CONTOUR®NEXT LINK 2.4 meter1 Get easy and accurate CGM calibration, insulin dosing and remote bolusing with our exclusive meter. “This device will mean peace of mind, in knowing a person will be in normal blood sugar range a great majority of the time,” “It’s a medical device with the potential to change the lives of more than 1 million Americans who suffer from Type 1 diabetes.” KEEP YOUR GLUCOSE IN RANGE SMARTGUARD® HCL TECHNOLOGY. Quick and easy access to your glucose and insulin information, all from the home screen. Bright color screen for easy readability - day or night. Waterproof - so you can enjoy underwater activities. Quick and easy bolus from your meter. Fewer shots than multiple daily injections. The only sensor FDA approved and trusted to control insulin dosing. Easy to insert. Know at all times where your glucose levels are trending. Click here for assistance if your insurance does not currently cover the MiniMed 670G system. * Mean Absolute Relative Difference. ** 3-4 calibrations per day required. Continue reading >>
First Impressions Of Medtronic's 670g Hybrid Closed Loop
Anyone touched by type 1 diabetes has to be excited about the FDA's recent approval of the first pre-Artificial Pancreas system, the Medtronic Minimed 670G. It's a milestone towards ever-more-sophisticated automated insulin delivery! Today, we're thrilled to have our correspondent Wil Dubois walk us through a hands-on initial review of this exciting new system. Test-Driving the Medronic 670G, 'Future of Diabetes Technology' Everything about Medtronic’s new Minimed 670G hybrid closed loop insulin pump is so different that it requires a substantial shift in mindset. Like one of those team-building exercises where you cross your hands and fall backwards, counting on your peers to catch you, the 670G requires us to let go of elements of diabetes control that for years have bordered on sacred. Why? Because this pump isn’t like anything we’ve ever seen before. In fact, it isn’t like any diabetes therapy we’ve ever seen before. What the 670G Does and Doesn't Do How many times have you started your day high, even though you went to bed on-target and haven’t eaten for 8, 10, or more hours? How would you like a pump that could see you were drifting up while you slept, and just automatically gave you more insulin to fix the problem? Or a pump that could see that you are drifting down during a hard day’s work and shut off the flow of insulin to prevent a low? That’s the promise of the 670G. It’s designed to track changes in your blood sugar via a CGM, and keep you in target by automatically delivering “micro boluses” or withholding insulin—replacing a traditional fixed basal rate. All 670G users need to do is count carbs and enter them into the pump when they are going to eat. So, how well does it live up to its promise? Well… OK, first things first. The p Continue reading >>
Hybrid Closed-loop System Demonstrates Effectiveness In Controlling Glucose Levels In Children And Adults With Type 1 Diabetes
Hybrid Closed-Loop System Demonstrates Effectiveness in Controlling Glucose Levels in Children and Adults with Type 1 Diabetes Closed-loop systems safe for daytime and overnight use, and to reduce exercise-induced hypoglycemia For people with type 1 diabetes, continuous glucose monitoring (CGM) devices provide around-the-clock information on blood glucose levels. Insulin pumps allow insulin to be administered subcutaneously throughout the day. Over the recent past, researchers combined the technology of CGM and insulin pumps to form closed-loop systems, which allow people with diabetes to receive insulin through a pump continuously throughout the day and night based on the glucose measurements provided every five minutes by the CGM. The performance of closed-loop systems and their ability to prevent hypoglycemia is highlighted in two studies presented at the American Diabetes Associations 77th Scientific Sessions at the San Diego Convention Center. Safety and Feasibility of Omnipod Hybrid Closed-Loop in Children Aged 6-12 Years with Type 1 Diabetes Using a Personalized Model Predictive Control Algorithm Children with type 1 diabetes have increased insulin sensitivity compared to adolescents and adults, and are at increased risk of severe hypoglycemia (low blood glucose levels) overnight. This inpatient, research center study investigated the safety and feasibility of a new hybrid closed-loop system. Researchers combined an Omnipod patch pump, Dexcom, G4 CGM sensor with Bluetooth technology built into the receiver, and a personalized model, predictive control algorithm. Hybrid closed-loop, indicates that the system is continuously adjusting insulin delivery. However, at mealtime, the patient enters the amount of carbohydrates they are eating in order for the insulin pum Continue reading >>
Insulin Pump System
References * Mean Absolute Relative Difference. ** 3-4 calibrations per day required. 1. Bailey T, et al. Accuracy, Precision, and User Performance Evaluation of the CONTOUR®NEXT LINK 2.4 Blood Glucose Monitoring System. Poster presented at the 7th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD); 2014 February 5–8, Vienna, Austria. Important Safety Information: MiniMed® 670G System The Medtronic MiniMed 670G system is intended for continuous delivery of basal insulin (at user selectable rates) and administration of insulin boluses (in user selectable amounts) for the management of type 1 diabetes mellitus in persons, fourteen years of age and older, requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin. The MiniMed 670G system includes SmartGuard technology, which can be programmed to automatically adjust delivery of basal insulin based on continuous glucose monitor sensor glucose values, and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values. The system requires a prescription. The Guardian Sensor (3) glucose values are not intended to be used directly for making therapy adjustments, but rather to provide an indication of when a fingerstick may be required. A confirmatory finger stick test via the CONTOUR®NEXT LINK 2.4 blood glucose meter is required prior to making adjustments to diabetes therapy. All therapy adjustments should be based on measurements obtained using the CONTOUR®NEXT LINK 2.4 blood glucose meter and not on values provided by the Guardian Sensor (3). Always check the pump display to ensure the glucose result shown agrees with the glucose results shown on the CONTOUR®NE Continue reading >>
- FDA Approves MiniMed 670G System – World’s First Hybrid Closed Loop System
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- FDA Approves The First Automated Insulin System For Type 1 Diabetes