A randomized clinical trial for meal bolus decision using learning-based control in adults with type 2 diabetes.

BACKGROUND: We proposed an artificial-pancreas-like algorithm (AP-A) which could automatically determine the pre-prandial insulin dose based on intermittently scanned continuous glucose monitoring (isCGM) data trajectories in multiple dose injection (MDI) therapy. We aim to determine whether pre-prandial insulin dose adjustments guided by the AP-A is as effective and safe as physician decisions. METHODS: We performed a randomized, single-blind, clinical trial at a tertiary, referral hospital in Beijing, China. Type 2 diabetes participants were eligible if they were aged  18 years, with a glycated hemoglobin of 8.0% or higher. Eligible participants were randomly assigned (1:1) to the AP-A arm supervised by physician and the conventional physician treatment arm. The primary objective was to compare percentage time spent with sensor glucose level in 3.9-10.0 mmol/L (TIR) between the two study arms. Safety was assessed by the percentage time spent with sensor glucose level below 3.0 mmol/L (TBR). RESULTS: 140 participants were screened, of whom 119 were randomly assigned to AP-A arm (n = 59) or physician arm (n = 60). The TIR achieved by the AP-A arm was statistically non-inferior compared with the control arm (72.4% (63.3-82.1) vs. 71.2% (54.9-81.4)), with a median difference of 1.33% (95% CI, -6.00 to 10.94, non-inferiority margin -7.5%). TBR was also statistically non-inferior between the AP-A and control arms (0.0% (0.0-0.0) vs. 0.0% (0.0-0.0), respectively; median difference (95% CI, 0.00% (0.00 to 0.00), non-inferiority margin 2.0%). CONCLUSIONS: The AP-A supported physician titration of pre-prandial insulin dosage offers non-inferior glycemic control compared with optimal physician care in type 2 diabetes.

Preserved C-peptide is common and associated with higher time in range in Chinese type 1 diabetes.

Objective: The aim of this study is to determine the residual C-peptide level and to explore the clinical significance of preserved C-peptide secretion in glycemic control in Chinese individuals with type 1 diabetes (T1D). Research design and methods: A total of 534 participants with T1D were enrolled and divided into two groups, low-C-peptide group (fasting C-peptide ≤10 pmol/L) and preserved-C-peptide group (fasting C-peptide >10 pmol/L), and clinical factors were compared between the two groups. In 174 participants who were followed, factors associated with C-peptide loss were also identified by Cox regression. In addition, glucose metrics derived from intermittently scanned continuous glucose monitoring were compared between individuals with low C-peptide and those with preserved C-peptide in 178 participants. Results: The lack of preserved C-peptide was associated with longer diabetes duration, glutamic acid decarboxylase autoantibody, and higher daily insulin doses, after adjustment {OR, 1.10 [interquartile range (IQR), 1.06-1.14]; OR, 0.46 (IQR, 0.27-0.77); OR, 1.04 (IQR, 1.02-1.06)}. In the longitudinal analysis, the percentages of individuals with preserved C-peptide were 71.4%, 56.8%, 71.7%, 62.5%, and 22.2% over 5 years of follow-up. Preserved C-peptide was also associated with higher time in range after adjustment of diabetes duration [62.4 (IQR, 47.3-76.6) vs. 50.3 (IQR, 36.2-63.0) %, adjusted P = 0.003]. Conclusions: Our results indicate that a high proportion of Chinese patients with T1D had preserved C-peptide secretion. Meanwhile, residual C-peptide was associated with favorable glycemic control, suggesting the importance of research on adjunctive therapy to maintain ß-cell function in T1D.

[Effect of multiple paralleled acupuncture needles stimulation of scalp points on hemodynamics and blood flow energy of the common carotid artery in stroke patients].

OBJECTIVE: To observe the changes of carotid hemodynamic and hydraulic power indices after paralleled scalp-point acupuncture therapy in post-stroke patients. METHODS: Twenty post-stroke volunteer patients were enlisted in the present study. Aseptic filiform needles were inserted into Baihui (GV 20), bilateral Motor Area (MS 8), etc. with the needles retained for 5 min. The treatment was given one time. Hemodynamic indices: mean velocity of blood flow (Vmean), maximum velocity (Vmax), minimum velocity (Vmin), mean blood flow (Qmean), maximum blood flow (Qmax), minimum blood flow (Qmin), natural impedance (Zc), peripheral resistance (Rc), dynamic resistance (Dr), and critical pressure (Pc) before and after the treatment were detected with KF-3000 Brain Circulation Analyzer. The hydraulic power indices:stable potential energy (Ws), oscillation potential energy (Wo), total potential energy (Wc), stable kinetic energy (Ks), success kinetic energy (Ko), total kinetic energy (Kc), stable total energy (Ts), oscillation total energy (To), total energy (Tc), To/Tc, Kc/Tc, Wo/Wc and Ks/Kc were obtained through calculation. RESULTS: After the therapy, Vmin, Vmean, Qmin and Qmean increased significantly (P<0.001), while Rc decreased evidently (P<0.001). Ws, Ks, Ts, Wc, Kc, Tc and Kc/Tc increased obviously (P<0.001, P<0.05), and Ks/Kc declined significantly (P<0.01). The rest indices had no significant changes after the treatment. CONCLUSION: Multiple paralleled scalp acupuncture needles stimulation can effectively raise the blood flow volume of the common caroitid artery, leading to an increase of the energy supply of the cerebral blood circulation, but has no apparent influence on the total oscillatory energy/total energy in stroke patients.