- Author
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J. Kropff
- Title
- The artificial pancreas
- Subtitle
- From logic to life
- Supervisors
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J.H. de Vries
- Co-supervisors
- Award date
- 31 March 2017
- Number of pages
- 231
- ISBN
- 978-94-6332-144-0
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
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In this thesis we investigated the efficacy of real-life use of an artificial pancreas starting with use of these systems in a hotel setting and finally 24/7 long-term use at home. We investigated the accuracy of continuous glucose monitoring (CGM) systems that act as input for the artificial pancreas or for use in combination with an insulin pump or pen. Since CGM data are used for insulin-dosing, their accuracy and reliability are essential. Our research on two commonly used CGM systems indicates that measurement accuracy differs to an extent that is clinically relevant. We show that a novel category of implantable CGM can perform safely and accurately over a lifetime of up to 180 days whereas current CGM have a lifetime of 7 days. Innovations as these provide opportunities for use in artificial pancreas systems. Our results indicate that an artificial pancreas can be used safely and effectively not only during night-time in a hotel environment but also during long term day and night use. The artificial pancreas improves glycaemic control including a reduction of time spent in hypoglycaemia, hyperglycaemia and HbA1c compared to open-loop use of a sensor and pump. Use of an adaptive, self-learning, artificial pancreas further improves glycaemic control during night-time. Participants appreciate the positive effects on glucose regulation but technical errors limit their appreciation for the current system. We conclude that the artificial pancreas facilitates good glucose control and holds the promise to alleviate the disease burden improving the life of a person with diabetes substantially.
- Permalink
- http://hdl.handle.net/11245.1/1e5ad6a3-db28-42be-b249-6e623f1f86fd
- Downloads
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Thesis (complete)
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Front matter
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Chapter 0: General introduction to automation of insulin infusion
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Chapter 1: Assessing the accuracy of continuous glucose monitoring (CGM) calibrated with capillary values using capillary or venous glucose levels as a reference
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Chapter 2: Accuracy of two continuous glucose monitoring systems: a head-to-head comparison under clinical research centre and daily life conditions
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Chapter 3: Accuracy and longevity of an implantable continuous glucose sensor in the PRECISE study: A 180 day, prospective multi-centre pivotal trial
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Chapter 4: Continuous glucose monitoring, future products, and update on worldwide artificial pancreas projects
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Chapter 5: Multicenter outpatient dinner/overnight reduction of hypoglycaemia and increased time of glucose in target with a wearable artificial pancreas using modular model predictive control in adults with type 1 diabetes
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Chapter 6: 2 month evening and night closed-loop glucose control in patients with type 1 diabetes under free-living conditions: a randomised crossover trial
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Chapter 7: Psychological outcomes of evening and night closed-loop insulin delivery under free living conditions in patients with type 1 diabetes: a 2 month randomized cross-over trial
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Chapter 8: Day and night closed-loop glucose control in patients with type 1 diabetes under free-living conditions: Results of a single-arm 1-month experience compared with a previously reported feasibility study of evening and night at home
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Chapter 9: Individually adaptive artificial pancreas in subjects with type 1 diabetes. A one-month proof-of-concept trial in free-living conditions
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Chapter 10: Summary, discussion and future perspectives
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Chapter 11: Samenvatting, discussie en toekomstperspectief (Summary, discussion and future perspectives in Dutch)
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Appendix: List of abbreviations | List of publications | Contributing authors | PhD Portfolio | Curriculum Vitae (in Dutch) | Acknowledgment (in Dutch)
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Back cover
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Stellingen
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