Evaluation of a novel artificial pancreas: closed loop glycemic control system with continuous blood glucose monitoring.

A closed-loop glycemic control system using an artificial pancreas has been applied with many clinical benefits in Japan since 1987. To update this system incorporating user-friendly features, we developed a novel artificial pancreas (STG-55). The purpose of this study was to evaluate STG-55 for device usability, performance of blood glucose measurement, glycemic control characteristics in vivo in animal experiments, and evaluate its clinical feasibility. There are several features for usability improvement based on the design concepts, such as compactness, display monitor, batteries, guidance function, and reduction of the preparation time. All animal study data were compared with a clinically available artificial pancreas system in Japan (control device: STG-22). We examined correlations of both blood glucose levels between two groups (STG-55 vs. control) using Clarke's error grid analysis, and also compared mean glucose infusion rate (GIR) during glucose clamp. The results showed strong correlation in blood glucose concentrations (Pearson's product-moment correlation coefficient: 0.97; n = 1636). Clarke's error grid analysis showed that 98.4% of the data fell in Zones A and B, which represent clinically accurate or benign errors, respectively. The difference in mean GIRs was less than 0.2 mg/kg/min, which was considered not significant. Clinical feasibility study demonstrated sufficient glycemic control maintaining target glucose range between 80 and 110 (mg/dL), and between 140 and 160 without any hypoglycemia. In conclusion, STG-55 was a clinically acceptable artificial pancreas with improved interface and usability. A closed-loop glycemic control system with STG-55 would be a useful tool for surgical and critical patients in intensive care units, as well as diabetic patients.

Simulation study of in vitro glucose measurement by NIR spectroscopy and a method of error reduction.

The effects of some important factors on the blood glucose measurements by NIR spectroscopy are investigated by numerical simulation, and a method is proposed to significantly reduce the prediction errors induced by these effects. The changes in the absorbance spectra with the changes in the glucose concentration, temperature and scattering characteristics of background tissue are obtained by a Monte Carlo simulation of light propagation for the wavelength range from 1200 nm to 1800 nm. The glucose concentration is predicted by applying a multivariate analysis to the numerically simulated spectra. This process estimates the errors in the prediction of the glucose concentration induced by the temperature and scattering changes. It has been found that only 1 C change in the temperature or only 1% change in the scattering coefficient induces about 500 mg dl(-1) or 300 mg dl(-1) errors, respectively, in the prediction of the glucose concentration. These errors can be significantly reduced to less than 20 mg dl(-1) of the glucose concentration by incorporating the effects of the temperature and scattering characteristics on the spectra to the multivariate analysis.