Introduction: There is need to improve glucose control and QoL for type 1 diabetes (T1D) using automated insulin delivery (AID) . We evaluated non-glucose signals in subjects with T1D on AID using the multi-functional Empatica E4 device (E4) .

Method: During a 2-week prospective AID study for 12 participants with T1D, pharmacological stress was induced with three doses of hydrocortisone delivered at 9 am (40 mg) , 1 pm (20 mg) , and 5 pm (20 mg) . Frequent salivary cortisol measurements confirmed pharmacologic stress. The correlation of normalized power spectral density (PSD) of Electrodermal activity (EDA) data from E4 with the salivary cortisol (SC) gold standard was evaluated. EDA PSD was computed at min windows before and after the hydrocortisone administration. Subsequently, the impact of SC and EDA PSD on CGM and insulin delivery data was analyzed. Pearson's moment (R value) was utilized to evaluate correlation between two variables.

Results: Significant change in SC was observed after each dosage: 159.6 ±88.6 ng/dL before to 18247.6 ±18834 ng/dL after (Dose 1/D1) , 1911.9 ±7ng/dL to 7716.1±4485 ng/dL (D2) , and 798.4 ±629 ng/dL to 7458.1±9995 ng/dL (D3) . A positive change was also noted in the EDA PSD with all three doses: -96.5±13.9 dB/Hz to -95.5 ±21.2 dB/Hz (D1) , -96.1±14.02 dB/Hz to -94.6 ±9.1db/Hz (D2) , and -85.9 ±23.6dB/Hz to -81.6 ±23.6dB/Hz (D3) . R value between EDA PSD and SC was 0.82 (p = 0.015) . The post lunch time in hyperglycemia was 78.7 %±9.7 (p = 0.0paired t-test) with an average insulin delivery of 10.36 U±2.24

Conclusions: There is significant effect of pharmacological stress on cortisol and EDA PSD. AID has poor postprandial glycemic outcomes with pharmacological stress indicating need for detecting stress and updating control strategy. E4 EDA can be utilized to monitor pharmacological stress and can be incorporated for testing in Next Gen AID.


A.Banerjee: None. R.Kaur: None. I.Zaniletti: None. M.Church: None. S.K.Mccrady-spitzer: None. D.Desjardins: None. S.Gupta: None. Y.C.Kudva: Advisory Panel; Novo Nordisk, Research Support; Dexcom, Inc., Hemsley Charitable Trust, JDRF, National Institutes of Health, Roche Diabetes Care, Tandem Diabetes Care, Inc.


JDRF grant (2-SRA-2017-503-M-B)

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