78-OR: Automated Glycemic Control with a Bionic Pancreas Configured for Use in the Critical Care Setting

Abstract

Tight glycemic control of hospitalized patients is difficult and labor intensive to achieve. We evaluated the feasibility of fully automated glycemic control with a version of the bionic pancreas (BP) designed for use in the critical-care setting. The fully automated BP controlled the intravenous delivery of insulin and 20% dextrose based on glucose values from the Abbott FreeStyle Navigator CGM. The same algorithm, initialized only with body mass, was used in all subjects. Adult subjects with type 1 (n=6) or type 2 (n=6) diabetes with a total daily dose (TDD) of insulin under usual care of 0.5-2.9 u/kg/day were under automated glucose control for an 8-hour period. Subjects started the study period fasted, later consumed an unrestricted meal of their choice, and still later took liquid nutrition nearly continuously for 2 hours before abruptly stopping, in order to simulate continuous enteral feeding and its interruption. Food intake was not announced to the BP. The primary outcome, mean plasma glucose (measured every 15 minutes), was 116±20 mg/dL. The % time within 70-180 mg/dL was 95±8% and the median (IQR) % of time <70 mg/dL was 0 (0, 2.3) and <54 mg/dl was 0 (0, 0). We concluded that the BP can achieve excellent glycemic control in volunteers with a wide range of insulin needs and in the face of realistic glycemic challenges. These results support feasibility testing of the critical care BP in the critical-care setting. Disclosure J. Sherwood: None. M.A. Hillard: None. K.B. Grennan: None. F. El-Khatib: Employee; Self; Beta Bionics. Stock/Shareholder; Self; Beta Bionics. E. Damiano: Advisory Panel; Self; Novo Nordisk A/S. Board Member; Self; Beta Bionics. Employee; Self; Beta Bionics. Stock/Shareholder; Self; Beta Bionics. Stock/Shareholder; Spouse/Partner; Beta Bionics. Other Relationship; Self; Ascensia Diabetes Care, Senseonics. S.J. Russell: Advisory Panel; Self; Companion Medical, Unomedical a/s. Consultant; Self; Flexion Therapeutics. Research Support; Self; Beta Bionics, MITRE Corporation, Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Self; ADOCIA, Ascensia Diabetes Care, Ascensia Diabetes Care, Lilly Diabetes, Roche Diabetes Care, Senseonics. Funding Wallace H. Coulter Foundation