American Diabetes Association
DC23-0119 Supplementary_Materials.docx (3.04 MB)

An Assessment of Meal Anticipation for Improving Fully Automated Insulin Delivery in Adults with Type 1 Diabetes

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posted on 2023-07-21, 18:36 authored by Jose Garcia-Tirado, Patricio Colmegna, Orianne Villard, Jenny L. Diaz, Rebeca Esquivel-Zuniga, Chaitanya L. K. Koravi, Charlotte L. Barnett, Mary C. Oliveri, Morgan Fuller, Sue A. Brown, Mark D. DeBoe


Objective: Meals are a consistent challenge to glycemic control in type 1 diabetes (T1D). Our objective was to assess the glycemic impact of meal anticipation within a fully automated insulin delivery (AID) system among adults with T1D.

Research Design and Methods: We report the results of a randomized-crossover clinical trial comparing three modalities of AID systems: hybrid closed-loop (HCL), full closed-loop (FCL), and full closed-loop with meal anticipation (FCL+). Modalities were tested during three supervised 24h admissions, where breakfast, lunch, and dinner were consumed per participant’s home schedule, at a fixed time, and 1.5h delayed, respectively. Primary outcome was the percent time-in-range 70-180mg/dL (TIR) during the breakfast post-prandial period for FCL+ vs. FCL. 

Results: Thirty-five adults with T1D (age 44.5±15.4y; HbA1c 6.7±0.9%; 23F/12M) were randomized. TIR for the 5h-period following breakfast was 75±23%, 58±21%, and 63±19%, for HCL, FCL, and FCL+ respectively, with no significant difference between FCL+ and FCL. For the 2h before dinner TBR was similar for FCL and FCL+. For the 5h-period following dinner TIR was similar for FCL+ and FCL (71±34% vs. 72±29%; p=1.0) while TBR was reduced in FCL+ (median: 0 [0-0]% vs. 0 [0-0.8]%;p=0.03). Overall, 24-h control for HCL, FCL and FCL+ was 86±10%, 77±11%, and 77±12%, respectively.

Conclusions: While postprandial control remained optimal with hybrid AID, both fully AID solutions offered overall TIR above 70% with similar or lower exposure to hypoglycemia. Anticipation did not significantly improve postprandial control in AID systems but also did not increase hypoglycemic risk when meals were delayed.


National Institutes of Health (NIH) R01DK129553