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Sensors 2017, 17(1), 161; doi:10.3390/s17010161

Continuous Glucose Monitoring Enables the Detection of Losses in Infusion Set Actuation (LISAs)

1
Department of Chemical & Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
2
Stanford University School of Medicine, Stanford, CA 94305, USA
3
Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO 80045, USA
4
Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
Current address: Insulet Corporation, Billerica, MA 01821, USA
Current address: Stanford University School of Medicine, Stanford, CA 94305, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Giovanni Sparacino, Andrea Facchinetti and J. Hans DeVries
Received: 3 November 2016 / Revised: 5 January 2017 / Accepted: 8 January 2017 / Published: 15 January 2017
(This article belongs to the Special Issue Glucose Sensors: Revolution in Diabetes Management 2016)
View Full-Text   |   Download PDF [455 KB, uploaded 17 January 2017]   |  

Abstract

Reliable continuous glucose monitoring (CGM) enables a variety of advanced technology for the treatment of type 1 diabetes. In addition to artificial pancreas algorithms that use CGM to automate continuous subcutaneous insulin infusion (CSII), CGM can also inform fault detection algorithms that alert patients to problems in CGM or CSII. Losses in infusion set actuation (LISAs) can adversely affect clinical outcomes, resulting in hyperglycemia due to impaired insulin delivery. Prolonged hyperglycemia may lead to diabetic ketoacidosis—a serious metabolic complication in type 1 diabetes. Therefore, an algorithm for the detection of LISAs based on CGM and CSII signals was developed to improve patient safety. The LISA detection algorithm is trained retrospectively on data from 62 infusion set insertions from 20 patients. The algorithm collects glucose and insulin data, and computes relevant fault metrics over two different sliding windows; an alarm sounds when these fault metrics are exceeded. With the chosen algorithm parameters, the LISA detection strategy achieved a sensitivity of 71.8% and issued 0.28 false positives per day on the training data. Validation on two independent data sets confirmed that similar performance is seen on data that was not used for training. The developed algorithm is able to effectively alert patients to possible infusion set failures in open-loop scenarios, with limited evidence of its extension to closed-loop scenarios. View Full-Text
Keywords: type 1 diabetes; fault detection; continuous subcutaneous insulin infusion; sensor-augmented pump type 1 diabetes; fault detection; continuous subcutaneous insulin infusion; sensor-augmented pump
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MDPI and ACS Style

Howsmon, D.P.; Cameron, F.; Baysal, N.; Ly, T.T.; Forlenza, G.P.; Maahs, D.M.; Buckingham, B.A.; Hahn, J.; Bequette, B.W. Continuous Glucose Monitoring Enables the Detection of Losses in Infusion Set Actuation (LISAs). Sensors 2017, 17, 161.

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