ORIGINAL ARTICLE A Remote Monitoring System for Artificial Pancreas Support Is Safe, Reliable, and User Friendly Tal Oron, MD, 1 Alon Farfel, MD, 1 Ido Muller, BSc, 1 Shahar Miller, BSc, 1 Eran Atlas, MSc, 1 Revital Nimri, MD, 1 and Moshe Phillip, MD 1,2 Abstract Introduction: We developed a unique remote monitoring and control diabetes management system (MDRS) supporting the use of an artificial pancreas (AP) at home. In this study, we aimed at assessing the efficacy and safety of the MDRS and its ability to prevent or shorten nocturnal hypoglycemia episodes without the use of an AP, as well as evaluating parental attitudes toward the use of such a system in the future. Materials and Methods: This was a prospective, case control, randomized study. Eighteen patients treated nightly over a 2-week period by the MDRS were compared with 19 patients treated with sensor-augmented pump (SAP) therapy. We analyzed the performance of the MDRS, the number and duration of hypo- or hyperglycemia episodes, and the efficacy of the MDRS in detecting them. Parents of the study participants completed the hypoglycemia fear survey, attitude, and satisfaction questionnaires. Results: The MDRS allows continuous monitoring of the patients using it. Without the use of an AP, the MDRS did not significantly prevent nocturnal hypoglycemia episodes. The patients and their parents found the system reliable and user-friendly. The overall impression of the MDRS users was favorable, with a keen interest of the patients and their caregivers to use such a system in the future. Conclusions: The MDRS is reliable and safe remote monitoring system for AP at-home systems. Remote monitoring of type 1 diabetes patients treated with SAP therapy is a promising and feasible task that is highly anticipated by patients and their caregivers. Introduction T elemedicine systems supporting diabetes management have been tested and used in the last few decades. Most of these systems are designed for decision support or serve as electronic patient records. 1 The widespread use of the Inter- net, smartphones, and short message service has further augmented the development of telemedicine systems aimed at improving glycemic control and patient care. 2 However, systemic reviews and meta-analyses examining the benefit of such devices and systems demonstrate conflicting data re- garding improvement in glucose control or other aspects of diabetes management. 3–5 The increasing use of continuous glucose monitoring (CGM) devices, as well as the progress in the development of artificial pancreas (AP) systems, suggests a new role for telemedicine in the management of diabetes. Telemedicine can be now used to monitor patients in real time, alert them when indicated, and provide medical assis- tance if needed. In addition, it is widely accepted that the realization of AP technology for everyday use will require an additional safety layer that will be provided by remote monitoring and remote decision support. 2,6,7 Our group developed the MD-Logic AP (MDLAP) sys- tem. The MDLAP algorithm applies fuzzy logic theory mimicking lines of reasoning of diabetes caregivers, in addition to real-time learning abilities and safety modules designed to prevent hypoglycemia episodes and prolonged hyperglycemia episodes. 8,9 In recently published studies, we demonstrated the ability of the MDLAP to control overnight glucose levels within the near-normal range as well as to prevent hypoglycemia episodes in children and young adults with type 1 diabetes mellitus. 10,11 Nevertheless, these studies were conducted in the protected setting of a clinical research center or a tightly supervised diabetes camp. 1 Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah-Tikva, Israel. 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. This study is registered at ClinicalTrials.gov with clinical trial registration number NCT01509157. DIABETES TECHNOLOGY & THERAPEUTICS Volume 16, Number 11, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/dia.2014.0090 699