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OBJECTIVE--To compare three continuous glucose monitoring (CGM) devices in subjects with type 1 diabetes under closed-loop blood glucose (BG) control. RESEARCH DESIGN AND METHODS--Six subjects with type 1 diabetes (age [...]

OBJECTIVE--To test whether safe and effective glycemic control could be achieved in type 1 diabetes using a bihormonal bionic endocrine pancreas driven by a continuous glucose monitor in experiments lasting [...]

The safety and effectiveness of a continuous, day-and-night automated glycaemic control system using insulin and glucagon has not been shown in a free-living, home-use setting. We aimed to assess whether bihormonal bionic pancreas initialised only with body mass can safely reduce mean glycaemia and hypoglycaemia in adults with type 1 diabetes who were living at home and participating in their normal daily routines without restrictions on diet or physical activity.

The safety and efficacy of continuous, multiday, automated glycaemic management has not been tested in outpatient studies of preadolescent children with type 1 diabetes. We aimed to compare the safety and efficacy of a bihormonal bionic pancreas versus conventional insulin pump therapy in this population of patients in an outpatient setting.

The existence of a hydrodynamically relevant endothelial glycocalyx of ∼0.5μm in thickness is well established in capillaries and venules in vivo. Since the glycocalyx is likely to have implications for broad areas of vascular physiology and pathophysiology, including endothelial-cell mechanotransduction, vascular permeability, and atherosclerosis, it is necessary to determine the extent to which the glycocalyx is present on arteriolar endothelium. We applied microviscometric analysis to data obtained using microparticle image velocimetry in cremaster-muscle arterioles of wild-type mice. Due to the pulsatile nature of the flow regimes in arterioles, data acquisition was triggered with the electrocardiogram at specific time points in the cardiac cycle. Results show the existence of a hydrodynamically relevant glycocalyx having a mean thickness of 0.38μm in arterioles ∼20–70μm in diameter (n=20), which is ∼0.13μm thinner (p=0.03) than that found previously in venules having a similar diameter range and under similar hemodynamic conditions. Results from data obtained at multiple time points in the cardiac cycle show that the glycocalyx remains hydrodynamically relevant in arterioles with statistically insignificant changes in mean thickness throughout the cardiac cycle, despite the inherent unsteadiness of the flow regimes in these microvessels. These results provide direct in vivo confirmation of the existence of a hydrodynamically relevant surface glycocalyx that essentially eliminates fluid shear stress on arteriolar endothelium throughout the entire cardiac cycle.

High-resolution near-wall fluorescent microparticle image velocimetry (μ-PIV) was used in mouse cremaster muscle venules in vivo to measure velocity profiles in the red cell-depleted plasma layer near the endothelial lining. μ-PIV data of the instantaneous translational speeds and radial positions of fluorescently labeled microspheres (0.47μm) in an optical section through the midsagittal plane of each vessel were used to determine fluid particle translational speeds. Regression of a linear velocity distribution based on near-wall fluid-particle speeds consistently revealed a negative intercept when extrapolated to the vessel wall. Based on a detailed three-dimensional analysis of the local fluid dynamics, we estimate a mean effective thickness of ∼0.33μm for an impermeable endothelial surface layer or ∼0.44μm assuming the lowest hydraulic resistivity of the layer that is consistent with the observed particle motions. The extent of plasma flow retardation through the layer required to be consistent with our μ-PIV data results in near complete attenuation of fluid shear stress on the endothelial-cell surface. These findings confirm the presence of a hydrodynamically effective endothelial surface layer, and emphasize the need to revise previous concepts of leukocyte adhesion, stress transmission to vascular endothelium, permeability, and mechanotransduction mechanisms.

A mechano-electrochemical theory of the surface glycocalyx on capillary endothelial cells is presented that models the structure as a mixture of electrostatically charged macromolecules hydrated in an electrolytic fluid. Disturbances arising from mechanical deformation are introduced as perturbations away from a nearly electroneutral equilibrium environment. Under mechanical compression of the layer, such as might occur on the passing of stiff leukocytes through capillaries, the model predicts that gradients in the electrochemical potential of the compressed layer cause a redistribution of mobile ions within the glycocalyx and a rehydration and restoration of the layer to its equilibrium dimensions. Because of the large deformations of the glycocalyx arising from passing leukocytes, nonlinear kinematics associated with finite deformations of the layer are accounted for in the theory. A pseudo-equilibrium approximation is invoked for the transport of the mobile ions that reduces the system of coupled nonlinear integro-differential equations to a single nonlinear partial differential equation that is solved numerically for the compression and recovery of the glycocalyx using a finite difference method on a fixed grid. A linearized model for small strains is also obtained as verification of the finite difference solution. Results of the asymptotic analysis agree well with the nonlinear solution in the limit of small deformations of the layer. Using existing experimental and theoretical estimates of glycocalyx properties, the glycocalyx fixed-charge density is estimated from the analysis to be ∼1 mEq/l, i.e., we estimate that there exists approximately one fixed charge on the glycocalyx for every 100 ions in blood. Such a charge density would result in a voltage differential between the undeformed glycocalyx and the capillary lumen of ∼0.1mV. In addition to providing insight into the mechano-electrochemical dynamics of the layer under deformation, the model suggests several methods for obtaining improved estimates of the glycocalyx fixed-charge density and permeability in vivo.

An algorithm continuously delivers appropriate insulin and glucagon doses to diabetic patients, maintaining their blood glucose at near-normal values, even after high-carbohydrate meals.