Development of a "Cognitive Awareness Artificial Pancreas Enhancement" (CAPE) to Help Adolescents with Type 1 Diabetes Optimize their use of Artificial Pancreas Systems

Adolescents with type 1 diabetes (T1D) demonstrate suboptimal glycemic control and self management behaviors, even when using sophisticated artificial pancreas (AP) systems. The purpose of this proposal is to develop a “cognitive awareness” AP enhancement (CAPE) to “nudge” adolescents, via adaptive prompts based on current cognitive resources and behavioral tendencies, to improve their diabetes self-care with AP system, ultimately improving glycemic control. This will be done by first collecting real-time physiological, psychological, and behavioral inputs from adolescents who use AP systems. Next, these data will be used to create mental models based on the user’s awareness of their blood glucose levels, their ability to plan near-term actions around insulin boluses and meals and their overall cognitive load. Finally, we will use these mental models to create and pilot the CAPE algorithm, which will provide the AP user with carefully designed “nudges” to enhance self-management behavior. Nudges are environmental design factors or that affect people’s behavior outside their awareness, which can be used to encourage healthy choices by children and adolescents. A cognitively aware AP system is needed because effective “nudging” depends on optimal timing and situational awareness of the user, and current systems lack this level of modeling.