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Multi-Timescale Rhythmicity of Blood Glucose and Insulin Delivery Reveals Key Advantages of Hybrid Closed Loop Therapy.

Authors
  • Grant, Azure D1
  • Lewis, Dana M2
  • Kriegsfeld, Lance J1, 3, 4, 5
  • 1 The Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA.
  • 2 OpenAPS, Seattle, WA, USA.
  • 3 Department of Psychology, University of California, Berkeley, CA, USA.
  • 4 Department of Integrative Biology, University of California, Berkeley, CA, USA.
  • 5 Graduate Group in Endocrinology, University of California, Berkeley, CA, USA.
Type
Published Article
Journal
Journal of Diabetes Science and Technology
Publisher
SAGE Publications
Publication Date
Jul 01, 2022
Volume
16
Issue
4
Pages
912–920
Identifiers
DOI: 10.1177/1932296821994825
PMID: 33719596
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Blood glucose and insulin exhibit coordinated daily and hourly rhythms in people without diabetes (nonT1D). Although the presence and stability of these rhythms are associated with euglycemia, it is unknown if they (1) are preserved in individuals with type 1 diabetes (T1D) and (2) vary by therapy type. In particular, Hybrid Closed Loop (HCL) systems improve glycemia in T1D compared to Sensor Augmented Pump (SAP) therapies, but the extent to which either recapitulates coupled glucose and insulin rhythmicity is not well described. In HCL systems, more rapid modulation of glucose via automated insulin delivery may result in greater rhythmic coordination and euglycemia. Such precision may not be possible in SAP systems. We hypothesized that HCL users would exhibit fewer hyperglycemic event, superior rhythmicity, and coordination relative to SAP users. Wavelet and coherence analyses were used to compare glucose and insulin delivery rate (IDR) within-day and daily rhythms, and their coordination, in 3 datasets: HCL (n = 150), SAP (n = 89), and nonT1D glucose (n = 16). Glycemia, correlation between normalized glucose and IDR, daily coherence of glucose and IDR, and amplitude of glucose oscillations differed significantly between SAP and HCL users. Daily glucose rhythms differed significantly between SAP, but not HCL, users and nonT1D individuals. SAP use is associated with greater hyperglycemia, higher amplitude glucose fluctuations, and a less stably coordinated rhythmic phenotype compared to HCL use. Improvements in glucose and IDR rhythmicity may contribute to the overall effectiveness of HCL systems.

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