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Safety and Feasibility of the PEPPER Adaptive Bolus Advisor and Safety System: A Randomized Control Study
- Source :
- © Diabetes Technology & Therapeutics, 2021, vol. 23, núm. 3, Articles publicats (D-EEEiA), DUGiDocs – Universitat de Girona, instname
- Publication Year :
- 2021
- Publisher :
- Mary Ann Liebert, 2021.
-
Abstract
- Background: The Patient Empowerment through Predictive Personalized Decision Support (PEPPER) system provides personalized bolus advice for people with type 1 diabetes. The system incorporates an adaptive insulin recommender system (based on case-based reasoning, an artificial intelligence methodology), coupled with a safety system, which includes predictive glucose alerts and alarms, predictive low-glucose suspend, personalized carbohydrate recommendations, and dynamic bolus insulin constraint. We evaluated the safety and efficacy of the PEPPER system compared to a standard bolus calculator. Methods: This was an open-labeled multicenter randomized controlled crossover study. Following 4-week run-in, participants were randomized to PEPPER/Control or Control/PEPPER in a 1:1 ratio for 12 weeks. Participants then crossed over after a washout period. The primary end-point was percentage time in range (TIR, 3.9-10.0 mmol/L [70-180 mg/dL]). Secondary outcomes included glycemic variability, quality of life, and outcomes on the safety system and insulin recommender. Results: Fifty-four participants on multiple daily injections (MDI) or insulin pump completed the run-in period, making up the intention-to-treat analysis. Median (interquartile range) age was 41.5 (32.3-49.8) years, diabetes duration 21.0 (11.5-26.0) years, and HbA1c 61.0 (58.0-66.1) mmol/mol. No significant difference was observed for percentage TIR between the PEPPER and Control groups (62.5 [52.1-67.8] % vs. 58.4 [49.6-64.3] %, respectively, P = 0.27). For quality of life, participants reported higher perceived hypoglycemia with the PEPPER system despite no objective difference in time spent in hypoglycemia. Conclusions: The PEPPER system was safe, but did not change glycemic outcomes, compared to control. There is wide scope for integrating PEPPER into routine diabetes management for pump and MDI users. Further studies are required to confirm overall effectiveness. Clinical trial registration: ClinicalTrials.gov NCT03849755 The work outlined in this manuscript was developed with the support of the awarded distinction by the Generalitat de Catalunya 2017 SGR 1551, and the European Union’s Horizon 2020 research and innovation programme under grant agreement No 689810 (PEPPER)
- Subjects :
- Adult
Blood Glucose
medicine.medical_specialty
Decision support system
Artificial intelligence
Patient Empowerment
Endocrinology, Diabetes and Metabolism
Decision support systems
System a
Predictive low-glucose suspend
law.invention
Endocrinology & Metabolism
Endocrinology
Bolus (medicine)
Insulin Infusion Systems
Sistemes d'ajuda a la decisió
Randomized controlled trial
law
Pepper
medicine
Humans
Hypoglycemic Agents
Insulin
Medical physics
Glycated Hemoglobin
Cross-Over Studies
Diabetis
Adaptive bolus calculator
business.industry
Diabetes
PEPPER
food and beverages
1103 Clinical Sciences
Personalized carbohydrate recommendations
Middle Aged
Medical Laboratory Technology
Diabetes Mellitus, Type 1
Type 1 diabetes
Case-based reasoning
1116 Medical Physiology
Quality of Life
Predictive glucose alarms
Feasibility Studies
Raonament basat en casos
Intel·ligència artificial -- Aplicacions a la medicina
business
Artificial intelligence -- Medical applications
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- © Diabetes Technology & Therapeutics, 2021, vol. 23, núm. 3, Articles publicats (D-EEEiA), DUGiDocs – Universitat de Girona, instname
- Accession number :
- edsair.doi.dedup.....3ff81c8751150e3af34569bf404dbd89