{"doi":"10.2337/dc23-0119","title":"Assessment of Meal Anticipation for Improving Fully Automated Insulin Delivery in Adults With Type 1 Diabetes","abstract":"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 24-h admissions, where breakfast, lunch, and dinner were consumed per participant's home schedule, at a fixed time, and with a 1.5-h delay, respectively. Primary outcome was the percent time in range 70-180 mg/dL (TIR) during the breakfast postprandial period for FCL+ versus FCL. RESULTS: Thirty-five adults with T1D (age 44.5 ± 15.4 years; HbA1c 6.7 ± 0.9%; n = 23 women and n = 12 men) were randomly assigned. TIR for the 5-h period after 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 2 h before dinner, time below range (TBR) was similar for FCL and FCL+. For the 5-h period after dinner, TIR was similar for FCL+ and FCL (71 ± 34% vs. 72 ± 29%; P = 1.0), whereas 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: Although postprandial control remained optimal with hybrid AID, both fully AID solutions offered overall TIR >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.","journal":"Diabetes Care","year":2023,"id":322788,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":39,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9629,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":426482,"name":"Patricio Colmegna","orcid":"0000-0001-9074-8634","position":1,"is_corresponding":false},{"id":910108,"name":"Orianne Villard","orcid":"0000-0002-7420-1425","position":2,"is_corresponding":false},{"id":992076,"name":"Jenny L. Diaz","orcid":null,"position":3,"is_corresponding":false},{"id":1037468,"name":"Rebeca Esquivel-Zuniga","orcid":null,"position":4,"is_corresponding":false},{"id":1037469,"name":"Chaitanya L.K. Koravi","orcid":null,"position":5,"is_corresponding":false},{"id":357489,"name":"Charlotte L. Barnett","orcid":null,"position":6,"is_corresponding":false},{"id":356161,"name":"Mary Oliveri","orcid":"0009-0002-0112-290X","position":7,"is_corresponding":false},{"id":1037470,"name":"Morgan Fuller","orcid":null,"position":8,"is_corresponding":false},{"id":356162,"name":"Sue A. Brown","orcid":"0000-0002-8658-6270","position":9,"is_corresponding":false},{"id":426461,"name":"Mark D. DeBoer","orcid":"0000-0003-1462-591X","position":10,"is_corresponding":false},{"id":356160,"name":"Marc D. Breton","orcid":"0000-0001-7645-2693","position":11,"is_corresponding":false},{"id":426484,"name":"José Garcia‐Tirado","orcid":"0000-0002-9970-2162","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T01:07:47.432636Z","pmid":"37478323","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}