Closed-loop insulin delivery using a subcutaneous glucose sensor and intraperitoneal insulin delivery: feasibility study testing a new model for the artificial pancreas.
Closed-loop insulin delivery using a subcutaneous glucose sensor and intraperitoneal insulin delivery: feasibility study testing a new model for the artificial pancreas.
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DOI：
10.2337/dc09-1080
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发表时间：
2010-01
期刊：
影响因子：
16.2
通讯作者：
Palerm CC
中科院分区：
文献类型：
--
作者：
Renard E;Place J;Cantwell M;Chevassus H;Palerm CC
通过使用由皮下葡萄糖传感器引导的来自便携式泵的皮下胰岛素输送来构建人工胰腺的尝试遇到了胰岛素吸收的延迟和可变性。我们通过比例积分微分（PID）算法测试了由皮下葡萄糖传感器驱动的植入泵的闭环腹膜内胰岛素输注。在医院环境中，根据随机顺序，对8例接受植入式胰岛素泵治疗的1型糖尿病患者进行了为期2天的闭环治疗（餐前15分钟手动推注除外）与为期1天的腹腔内开环胰岛素输注对照期的比较。血糖在4.4-6.6 mmol/l范围内的时间百分比是主要终点。在闭环阶段，血糖在4.4-6.6 mmol/l范围内的平均± SEM时间百分比显著较高（39.1 ± 4.5 vs. 27.7 ± 6.2%，P = 0.05），患者间血糖值的总体离散度降低。更好的闭环血糖控制来自于不包括餐后两个小时的时间段，其中4.4-6.6 mmol/l范围内的时间百分比较高（46.3 ± 5.3 vs. 28.6 ± 7.4，P = 0.025），平均血糖水平较低（6.9 ± 0.3 vs. 7.9 ± 0.6 mmol/l，P = 0.036）。两个研究阶段血糖<3.3 mmol/l的时间较短且相似。我们的研究结果证明了人工β细胞腹膜内胰岛素输送的可行性，并支持进一步研究的必要性。此外，根据半自动模式，餐前推注在时间和量方面的特征值得进一步研究。
Attempts to build an artificial pancreas by using subcutaneous insulin delivery from a portable pump guided by an subcutaneous glucose sensor have encountered delays and variability of insulin absorption. We tested closed-loop intraperitoneal insulin infusion from an implanted pump driven by an subcutaneous glucose sensor via a proportional-integral-derivative (PID) algorithm. Two-day closed-loop therapy (except for a 15-min premeal manual bolus) was compared with a 1-day control phase with intraperitoneal open-loop insulin delivery, according to randomized order, in a hospital setting in eight type 1 diabetic patients treated by implanted pumps. The percentage of time spent with blood glucose in the 4.4–6.6 mmol/l range was the primary end point. During the closed-loop phases, the mean ± SEM percentage of time spent with blood glucose in the 4.4–6.6 mmol/l range was significantly higher (39.1 ± 4.5 vs. 27.7 ± 6.2%, P = 0.05), and overall dispersion of blood glucose values was reduced among patients. Better closed-loop glucose control came from the time periods excluding the two early postprandial hours with a higher percentage of time in the 4.4–6.6 mmol/l range (46.3 ± 5.3 vs. 28.6 ± 7.4, P = 0.025) and lower mean blood glucose levels (6.9 ± 0.3 vs. 7.9 ± 0.6 mmol/l, P = 0.036). Time spent with blood glucose <3.3 mmol/l was low and similar for both investigational phases. Our results demonstrate the feasibility of intraperitoneal insulin delivery for an artificial β-cell and support the need for further study. Moreover, according to a semiautomated mode, the features of the premeal bolus in terms of timing and amount warrant further research.
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