Efficacy of a Hybrid Closed-Loop Solution in Patients With Excessive Time in Hypoglycaemia: A Post Hoc Analysis of Trials With DBLG1 System.

BACKGROUND: Automated insulin delivery is an efficient treatment for patients with type 1 diabetes. Little is known on its impact on patients with excessive time in hypoglycaemia. METHODS: We performed a post hoc analysis of three randomized control trials that used the DBLG1 (Diabeloop Generation 1) hybrid closed-loop solution. Patients whose time below 70 mg/dL during baseline, open-loop phase exceeded 5% were selected. The outcomes were the differences between the closed-loop and the open-loop phases in time in various ranges and Glycemia Risk Index (GRI). RESULTS: We identified 45 patients exhibiting ≥5% of time below 70 mg/dL during the open-loop phase. Under closed-loop, the time in hypoglycaemia (54 to <70 mg/dL) dropped from 7.9% (SD 2.4) to 3.2% (SD 1.6) (difference -4.7% [-5.3; -4.1], P < 10-4). The time below 54 mg/dL decreased from 1.9% (SD 1.3) to 0.8% (SD 0.7) (difference -0.9% [-1.4; -0.8], P < 10-4). The time in range (TIR 70-180 mg/dL) improved from 63.3 (SD 9.5) to 68.2% (SD 8.2) (difference 5.1% [2.9; 7.0], P < 10-4). The GRI improved from 51.2 (SD 12.4) to 38.0 (SD 10.9) (difference 13.2 [10.4; 16.0], P < 10-4). CONCLUSION: DBLG1 decreased time in hypoglycaemia by more than 50% even in patients with excessive time in hypoglycaemia at baseline, while also improving both TIR and GRI, under real-life conditions. The improvement in GRI (13.2%) exceeded that of the improvement in TIR (5.1%) indicating that in this data set, GRI was more sensitive than TIR to the improvement in glycaemia achieved with closed-loop. These results support the safety and efficacy of this treatment.

Supervised Bayesian Source Separation of Nonlinear Mixtures for Quantitative Analysis of Gas Mixtures.

In medical applications, quantitative analysis of breath may open new prospects for diagnosis or for patient monitoring. To detect acetone, a breath biomarker for diabetes, we use a single metal-oxide (MOX) gas sensor working in a dual temperature mode. We propose a linear-quadratic model to describe the mixing model mapping gas concentrations to MOX sensor responses. In this purpose, it is necessary to inverse the nonlinear problem in order to quantify the component of the gas mixture. As a proof of concept, we study a mixture of two gases, acetone and ethanol diluted in air buffer. In order to estimate the concentration of each gas, we introduce a supervised Bayesian source separation method. Based on MCMC stochastic sampling methods to estimate the mean of the posterior distribution, this Bayesian approach is robust to noise for solving this ill-posed non-linear inversion problem. We analyze the performance on a set of samples associated with a set of gas concentration covering the range suitable for exhaled breath. We use a cross-validation approach, calibrating the mixing parameters with some samples and validating the source estimation with others. Our new supervised method applied on a linear-quadratic model allows to estimate acetone and ethanol concentration with a precision of around 2 ppm.

A Linear-Quadratic Model for the Quantification of a Mixture of Two Diluted Gases with a Single Metal Oxide Sensor.

The aim of our work is to quantify two gases (acetone and ethanol) diluted in an air buffer using only a single metal oxide (MOX) sensor. We took advantage of the low selectivity of the MOX sensor, exploiting a dual-temperature mode. Working at two temperatures of the MOX sensitive layer allowed us to obtain diversity in the measures. Two virtual sensors were created to characterize our gas mixture. We presented a linear-quadratic mixture sensing model which was closer to the experimental data. To validate this model and the experimental protocol, we inverted the system of quadratic equations to quantify a mixture of the two gases. The linear-quadratic model was compared to the bilinear model proposed in the literature. We presented an experimental evaluation on mixtures made of a few ppm of acetone and ethanol, and we obtained a precision close to the ppm. This is an important step towards medical applications, particularly in terms of diabetes, to deliver a non-invasive measure with a low-cost device.

Increased BOLD activation in the left parahippocampal cortex after 1 year of medical school: an association with cumulative verbal memory learning.

Although several studies have shown left-right hippocampus asymmetry during learning, it is unclear whether such asymmetry also exists for the parahippocampal cortex, a structure within the limbic system that is also involved in memory and learning. Using a common mental navigation task known to activate the bilateral parahippocampal cortex, this study aimed at determining how BOLD activation in these two areas changes after 1 year of medical school, a program characterized by intensive verbal learning. Fifteen first-year medical students participated in this study and underwent two sessions of functional MRI, at a 1-year interval. In the first session, we observed marginal differences between left and right parahippocampal cortex activity. However, 1 year later, left parahippocampal activation significantly increased (+4.7%), whereas the right remained stable. These results bring new information as to how intensive learning can modify regional metabolism in the human brain and how the left parahippocampal region is particularly important for cumulative verbal memory.