Will the First Approved Automated Insulin Delivery System Be a Game-Changer in Type 1 Diabetes Management?
Will the First Approved Automated Insulin Delivery System Be a Game-Changer in Type 1 Diabetes Management?
复制标题
第一个获得批准的自动胰岛素输送系统会改变 1 型糖尿病管理的游戏规则吗？
DOI：
10.1089/dia.2017.0052
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发表时间：
2017
影响因子：
5.4
通讯作者：
Castle,JessicaR
中科院分区：
文献类型：
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作者：
Castle,JessicaR
在没有糖尿病的人中，血糖维持在非常窄的范围内。为了做到这一点，β细胞有一种聪明的机制，通过这种机制，它们可以通过增加胰岛素分泌来应对血糖水平的上升。随着血糖水平的升高，更多的葡萄糖被β细胞代谢，进而刺激胰岛素的分泌。相比之下，1型糖尿病(T1D)患者必须依赖胰岛素注射或胰岛素泵给药。作为独立的设备，胰岛素泵缺乏一个自动反馈机制来调整胰岛素的输送速度。他们已经设定了基本的速率曲线，并依赖于用户输入克碳水化合物和葡萄糖值来确定胰岛素推进量。2000年开始的连续血糖监测(CGM)的商业化应用极大地改变了可用于管理糖尿病的选择。1这些设备允许实时查看检测到的血糖值。但直到最近，一直缺乏的是自动胰岛素输送系统的可用性，该系统根据检测到的血糖值调节胰岛素输送。这些系统通常被称为人工胰腺系统，尽管这个术语有些误导，因为这些系统通常只提供胰岛素，不模仿胰腺的其他功能，并且缺乏许多控制正常胰腺激素分泌的输入。2第一个提供某种形式的胰岛素自动化的系统是带有Enlite的美敦力530G。该系统包括阈值暂停功能，当检测到的血糖值降至某个阈值(可在60至90 mg/dL之间设置)时，系统会发出警报。如果用户对警报没有反应，例如在睡觉时，胰岛素输送将暂停2小时，或直到手动恢复。在一项对247名记录在案的夜间低血糖患者的研究中，阈值悬浮功能显著降低了低血糖；传感器读数为50 mg/dL的百分比时间减少了57%。然而，美敦力530G系统的设计并不是为了预防低血糖，而是为了在低血糖发生后降低其严重程度和持续时间。美敦力640G系统旨在使用预测性低糖悬浮液预防低血糖
In a person without diabetes, glucose is maintained in a very narrow range. To accomplish this, beta cells have a clever mechanism by which they respond to rising glucose levels with increased insulin secretion. As glucose levels rise, more glucose is metabolized by the beta cell, which in turn stimulates insulin secretion. In contrast, people with type 1 diabetes (T1D) must rely on insulin delivery via injections or via an insulin pump. As stand-alone devices, insulin pumps lack an automated feedback mechanism by which to adjust insulin delivery rates. They have set basal rate profiles and rely on users to input grams of carbohydrate and glucose values to determine insulin bolus amounts. The commercial availability of continuous glucose monitoring (CGM) starting in 2000 dramatically changed the options available to manage diabetes. 1 These devices allow for viewing of sensed glucose values in real time. But what has been lacking up until recently is the availability of automated insulin delivery systems, which modulate insulin delivery in response to sensed glucose values. Often these systems are termed artificial pancreas systems, although this term is somewhat misleading as these systems typically only deliver insulin, do not mimic the other functions of the pancreas, and lack many inputs that control hormone secretion of the normal human pancreas. 2The first system to provide some form of insulin automation was the Medtronic 530G with Enlite. This system includes a threshold suspend feature, such that when the sensed glucose value drops to a certain threshold (settable between 60 and 90 mg/dL), the system alarms. If the user does not respond to the alarm, such as while asleep, insulin delivery is suspended for 2 h, or until manually resumed. In a study of 247 patients with documented nocturnal hypoglycemia, the threshold suspend feature significantly reduced hypoglycemia; the percent time of the sensor reading< 50mg/dL was decreased by 57%. 3 However, the Medtronic 530G system was not designed to prevent hypoglycemia, only to reduce the severity and duration of hypoglycemia once it occurs. The Medtronic 640G system was designed to prevent hypoglycemia using a predictive low-glucose suspend