***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background : Most patients with type 1 diabetes do not achieve their glycemic targets . We aim ed to assess the efficacy of glucose-responsive insulin and glucagon closed-loop delivery for controlling glucose levels in adults with type 1 diabetes . Methods : We conducted a r and omized crossover trial involving 15 adults with type 1 diabetes , comparing st and ard insulin-pump therapy with dual-hormone , closed-loop delivery .  Patients were admitted twice to a clinical research facility and received , in r and om order , both treatments . Each 15-hour visit ( from 1600 to 0700 ) included an evening exercise session , followed by a medium-sized meal , a bedtime snack and an overnight stay . During visits that involved closed-loop delivery , basal insulin and glucagon miniboluses were delivered according to recommendations based on glucose sensor readings and a predictive dosing algorithm at 10-minute intervals . During visits involving st and ard insulin-pump therapy ( control visits ) , patients used conventional treatment . Results : Dual-hormone closed-loop delivery increased the percentage of time for which patients ’ plasma glucose levels were in the target range ( median 70.7 % [ interquartile range ( IQR ) 46.1%–88.4 % ] for closed-loop delivery v. 57.3 % [ IQR 25.2%–71.8 % ] for control , p = 0.003 ) and decreased the percentage of time for which plasma glucose levels were in the low range ( bottom of target range [ < 4.0 mmol/L ] , 0.0 % [ IQR 0.0%–3.0 % ] for closed-loop delivery v. 10.2 % [ IQR 0.0%–13.0 % ] for control , p = 0.01 ; hypoglycemia threshold [ < 3.3 mmol/L ] , 0.0 % [ IQR 0.0%–0.0 % ] for closed-loop delivery v. 2.8 % [ IQR 0.0%–5.9 % ] for control , p = 0.006 ) . Eight participants ( 53 % ) had at least 1 hypoglycemic event ( plasma glucose < 3.0 mmol/L ) during st and ard treatment , compared with just 1 participant ( 7 % ) during closed-loop treatment ( p = 0.02 ) . Interpretation : Dual-hormone , closed-loop delivery guided by advanced algorithms improved short-term glucose control and reduced the risk of hypoglycemia in a group of 15 adults with  type 1 diabetes . Trial registration : Clinical Trials.gov , no. NCT01297946 OBJECTIVE We estimate the effect size of hypoglycemia risk reduction on closed-loop control ( CLC ) versus open-loop ( OL ) sensor-augmented insulin pump therapy in supervised outpatient setting . RESEARCH DESIGN AND METHODS Twenty patients with type 1 diabetes initiated the study at the Universities of Virginia , Padova , and Montpellier and Sansum Diabetes Research Institute ; 18 completed the entire protocol . Each patient participated in two 40-h outpatient sessions , CLC versus OL , in r and omized order . Sensor ( Dexcom G4 ) and insulin pump ( T and em t : slim ) were connected to Diabetes Assistant (DiAs)—a smartphone artificial pancreas platform . The patient operated the system through the DiAs user interface during both CLC and OL ; study personnel supervised on site and monitored DiAs remotely . There were no dietary restrictions ; 45-min walks in town and restaurant dinners were included in both CLC and OL ; alcohol was permitted . RESULTS The primary outcome —reduction in risk for hypoglycemia as measured by the low blood glucose ( BG ) index (LGBI)— result ed in an effect size of 0.64 , P = 0.003 , with a twofold reduction of hypoglycemia requiring carbohydrate treatment : 1.2 vs. 2.4 episodes/session on CLC versus OL ( P = 0.02 ) . This was accompanied by a slight decrease in percentage of time in the target range of 3.9–10 mmol/L ( 66.1 vs. 70.7 % ) and increase in mean BG ( 8.9 vs. 8.4 mmol/L ; P = 0.04 ) on CLC versus OL . CONCLUSIONS CLC running on a smartphone ( DiAs ) in outpatient conditions reduced hypoglycemia and hypoglycemia treatments when compared with sensor-augmented pump therapy . This was accompanied by marginal increase in average glycemia result ing from a possible overemphasis on hypoglycemia safety OBJECTIVE Inpatient studies suggest that model predictive control ( MPC ) is one of the most promising algorithms for artificial pancreas ( AP ) . So far , outpatient trials have used hypo/hyperglycemia-mitigation or medical-expert systems . In this study , we report the first wearable AP outpatient study based on MPC and investigate specifically its ability to control postpr and ial glucose , one of the major challenges in glucose control . RESEARCH DESIGN AND METHODS A new modular MPC algorithm has been design ed focusing on meal control . Six type 1 diabetes mellitus patients underwent 42-h experiments : sensor-augmented pump therapy in the first 14 h ( open-loop ) and closed-loop in the remaining 28 h. RESULTS MPC showed satisfactory dinner control versus open-loop : time-in-target ( 70–180 mg/dL ) 94.83 vs. 68.2 % and time-in-hypo 1.25 vs. 11.9 % . Overnight control was also satisfactory : time-in-target 89.4 vs. 85.0 % and time-in-hypo : 0.00 vs. 8.19 % . CONCLUSIONS This outpatient study confirms inpatient evidence of suitability of MPC-based strategies for AP . These encouraging results pave the way to r and omized crossover outpatient studies OBJECTIVE To evaluate the feasibility and efficacy of a fully integrated hybrid closed-loop ( HCL ) system ( Medtronic MiniMed Inc. , Northridge , CA ) , in day and night closed-loop control in subjects with type 1 diabetes , both in an inpatient setting and during 6 days at diabetes camp . RESEARCH DESIGN AND METHODS The Medtronic MiniMed HCL system consists of a fourth generation ( 4S ) glucose sensor , a sensor transmitter , and an insulin pump using a modified proportional-integral-derivative ( PID ) insulin feedback algorithm with safety constraints . Eight subjects were studied over 48 h in an inpatient setting . This was followed by a study of 21 subjects for 6 days at diabetes camp , r and omized to either the closed-loop control group using the HCL system or to the group using the Medtronic MiniMed 530 G with threshold suspend ( control group ) . RESULTS The overall mean sensor glucose percent time in range 70–180 mg/dL was similar between the groups ( 73.1 % vs. 69.9 % , control vs. HCL , respectively ) ( P = 0.580 ) . Meter glucose values between 70 and 180 mg/dL were also similar between the groups ( 73.6 % vs. 63.2 % , control vs. HCL , respectively ) ( P = 0.086 ) . The mean absolute relative difference of the 4S sensor was 10.8 ± 10.2 % , when compared with plasma glucose values in the inpatient setting , and 12.6 ± 11.0 % compared with capillary Bayer CONTOUR NEXT LINK glucose meter values during 6 days at camp . CONCLUSIONS In the first clinical study of this fully integrated system using an investigational PID algorithm , the system did not demonstrate improved glucose control compared with sensor-augmented pump therapy alone . The system demonstrated good connectivity and improved sensor performance BACKGROUND Artificial pancreas ( AP ) systems have shown an improvement in glucose control and a reduced risk of nocturnal hypoglycemia under controlled conditions but remain to be evaluated under daily-life conditions . OBJECTIVE To assess the feasibility , safety , and efficacy of the MD-Logic AP in controlling nocturnal glucose levels in the patient 's home . METHODS Two-arm study , each covering four consecutive nights comparing the MD-Logic AP ( ' closed-loop ' arm ) with sensor-augmented pump therapy ( ' control ' arm ) . Fifteen patients ( mean age 19 ± 10.4 yr , A1c 7.5 ± 0.5 % or 58 ± 5.9 mmol/mol , diabetes duration 9.9 ± 8.2 yr ) were r and omly assigned either to ' Group A ' ( first ' closed-loop ' , then ' control ' arm ) or to ' Group B ' ( vice versa ) . Investigators were masked to treatment intervention . Primary endpoints were the time spent with glucose levels below 70 mg/dL and the percentage of nights in which the mean overnight glucose levels were within 90 - 140 mg/dL. Endpoint analyses were based on unmodified sensor glucose readings of the four study nights . RESULTS Time of glucose levels spent below 70 mg/dL was significantly shorter on the closed-loop nights than on control nights , median and interquartile range 3.8 ( 0 , 11.6 ) and 48.7 ( 0.6 , 67.9 ) min , respectively ; p = 0.0034 . The percentage of individual nights in which mean overnight glucose level was within 90 - 140 mg/dL was 67 ( 33 , 88 ) , and 50 ( 25 , 75 ) , under closed-loop and control nights , respectively , with no statistical difference . Secondary endpoint analyses demonstrated significant improvements in hypoglycemia parameters . No serious adverse events were reported . CONCLUSION This interim analysis demonstrates the feasibility , safety , and efficiency  of the MD-Logic AP system in home use , and demonstrates an improvement over sensor-augmented pump therapy . ( Clinical Trials.gov identifier NCT01726829 ) A total of 1,441 patients with IDDM were r and omly assigned to receive either intensive ( n = 711 ) or conventional ( n = 730 ) diabetes therapy in the Diabetes Control and Complications Trial ( DCCT ) . The patients were followed for an average of 6.5 years . Subjects were instructed to report all episodes of suspected severe hypoglycemia to their health care team . In addition , at quarterly follow-up visits , each subject was asked about the occurrence of severe hypoglycemia . There were 3,788 episodes of severe hypoglycemia ( requiring assistance ) ; 1,027 of these episodes were associated with coma and /or seizure . A total of 65 % percent of patients in the intensive group vs. 35 % of patients in the conventional group had at least one episode of severe hypoglycemia by the study end ; the overall rates of severe hypoglycemia were 61.2 per 100 patient-years vs. 18.7 per 100 patient-years in the intensive and conventional treatment groups , respectively , with a relative risk ( RR ) of 3.28 . The relative risk for coma and /or seizure was 3.02 for intensive therapy . The increased risk with intensive treatment persisted over each of the 9 years of follow-up in the DCCT and over the calendar years 1984 - 1993 during which the study was conducted . When baseline patient characteristics were examined for effects on the risk of severe hypoglycemia , the relative risk of hypoglycemia for intensive versus conventional treatment was > or = 2 for all subgroups . Several subgroups defined by baseline characteristics , including males , adolescents , and subjects with no residual C-peptide or with a prior history of hypoglycemia , had a particularly high risk of severe hypoglycemia in both treatment groups . Analyses of the cumulative incidence of successive episodes indicated that intensive treatment was also associated with an increased risk of multiple episodes within the same patient ( e.g. , 22 % experienced five or more episodes of severe hypoglycemia within the first 5 years of follow-up vs. 4 % in the conventional group ) . Within both treatment groups , patients who experienced severe hypoglycemia were at increased risk of subsequent episodes . Approximately 30 % of patients in each group experienced a second episode within the 4 months following the first episode of severe hypoglycemia . Within each treatment group , the number of prior episodes of hypoglycemia was the strongest predictor of the risk of future episodes , followed closely by the current HbA1c value . After adjustment for the current quarterly HbA1c level , intensive treatment was still associated with a significantly increased risk of hypoglycemia , indicating that the increased risk with intensive treatment is not completely explained by differences in HbA1c values BACKGROUND The safety and efficacy of continuous , multiday , automated glycaemic management has not been tested in outpatient studies of preadolescent children with type 1 diabetes . We aim ed to compare the safety and efficacy of a bihormonal bionic pancreas versus conventional insulin pump therapy in this population of patients in an outpatient setting . METHODS In this r and omised , open-label , crossover study , we enrolled preadolescent children ( aged 6 - 11 years ) with type 1 diabetes ( diagnosed for ≥1 year ) who were on insulin pump therapy , 
    Output:
    
INTERPRETATION Artificial pancreas systems uniformly improved glucose control in outpatient setting s , despite heterogeneous clinical and technical factors .