Prevention of nocturnal hypoglycemia using predictive alarm algorithms and insulin pump suspension.
Prevention of nocturnal hypoglycemia using predictive alarm algorithms and insulin pump suspension.
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DOI：
10.2337/dc09-2303
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发表时间：
2010-05
期刊：
影响因子：
16.2
通讯作者：
Doyle FJ 3rd
中科院分区：
文献类型：
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作者：
Buckingham B;Chase HP;Dassau E;Cobry E;Clinton P;Gage V;Caswell K;Wilkinson J;Cameron F;Lee H;Bequette BW;Doyle FJ 3rd
这项研究的目的是开发一种部分闭环系统，在1型糖尿病患者预测低血糖时，通过暂停胰岛素供应来安全地预防夜间低血糖。40名1型糖尿病患者(年龄范围12-39岁)在医院过夜进行研究。对于前14名受试者，低血糖(60 mg/dl)是通过逐渐增加基础胰岛素输注速率(不使用停泵算法)诱导的。在随后的26个患者研究中，当五个算法中的三个(n=10)或五个中的两个(n=16)算法根据Freestyle Navigator(雅培糖尿病护理)测量的血糖水平预测低血糖时，就会发生泵关闭。标准化方案在14个晚上中有13个(93%)导致低血糖。使用一种需要三种算法来触发胰岛素泵暂停的投票方案，在10个晚上中的6个晚上(60%)可以预防夜间低血糖。当投票方案改变为只需要两个算法来预测低血糖以触发泵暂停时，低血糖在16个晚上中的12个晚上(75%)被预防。在后一项研究中，有25例低血糖的预测，因为一些受试者在一个晚上发生了多次低血糖事件，其中84%的低血糖事件得到了预防。当预测到低血糖时，使用算法关闭胰岛素泵，可以在75%的夜晚(84%的事件)预防低血糖，否则低血糖就会发生。
The aim of this study was to develop a partial closed-loop system to safely prevent nocturnal hypoglycemia by suspending insulin delivery when hypoglycemia is predicted in type 1 diabetes. Forty subjects with type 1 diabetes (age range 12–39 years) were studied overnight in the hospital. For the first 14 subjects, hypoglycemia (<60 mg/dl) was induced by gradually increasing the basal insulin infusion rate (without the use of pump shutoff algorithms). During the subsequent 26 patient studies, pump shutoff occurred when either three of five (n = 10) or two of five (n = 16) algorithms predicted hypoglycemia based on the glucose levels measured with the FreeStyle Navigator (Abbott Diabetes Care). The standardized protocol induced hypoglycemia on 13 (93%) of the 14 nights. With use of a voting scheme that required three algorithms to trigger insulin pump suspension, nocturnal hypoglycemia was prevented during 6 (60%) of 10 nights. When the voting scheme was changed to require only two algorithms to predict hypoglycemia to trigger pump suspension, hypoglycemia was prevented during 12 (75%) of 16 nights. In the latter study, there were 25 predictions of hypoglycemia because some subjects had multiple hypoglycemic events during a night, and hypoglycemia was prevented for 84% of these events. Using algorithms to shut off the insulin pump when hypoglycemia is predicted, it is possible to prevent hypoglycemia on 75% of nights (84% of events) when it would otherwise be predicted to occur.