Fully integrated artificial pancreas in type 1 diabetes: modular closed-loop glucose control maintains near normoglycemia.
Fully integrated artificial pancreas in type 1 diabetes: modular closed-loop glucose control maintains near normoglycemia.
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DOI：
10.2337/db11-1445
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发表时间：
2012-09
期刊：
影响因子：
7.7
通讯作者：
International Artificial Pancreas Study Group
中科院分区：
文献类型：
--
作者：
Breton M;Farret A;Bruttomesso D;Anderson S;Magni L;Patek S;Dalla Man C;Place J;Demartini S;Del Favero S;Toffanin C;Hughes-Karvetski C;Dassau E;Zisser H;Doyle FJ 3rd;De Nicolao G;Avogaro A;Cobelli C;Renard E;Kovatchev B;International Artificial Pancreas Study Group
集成的闭环控制(CLC)将连续血糖监测(CGM)和胰岛素泵(连续皮下胰岛素输注[CSII])相结合，称为人工胰腺，可以帮助优化糖尿病患者的血糖控制。通过对弗吉尼亚大学、帕多瓦大学和蒙彼利埃大学的11名青少年和27名成年人的临床研究，我们提出了一个用于《中图法》设计的基本模块化概念。我们测试了两种模块化的CLC结构：标准范围控制(SCTR)，旨在通过防止极端的血糖漂移来增加泵和CGM；以及增强型范围控制(ECTR)，旨在真正优化控制在3.9mmolL-10mmoL/L的接近正常血糖范围内。所有研究都采用了随机交叉设计，比较了CSII和CLC在相同的22小时住院期间，包括进餐、夜间休息和30分钟锻炼。SCTR显著延长了接近正常血糖的时间，从61%增加到74%，同时将低血糖降低了2.7倍。ECTR在不增加低血糖的情况下，将平均血糖从7.73mmoL/L提高到6.68mmol.L，在接近正常血糖和严格控制血糖的情况下分别达到97%和77%，并在一夜之间减少了变异性。总之，SCTR和ECTR代表着迈向自动化CLC、防止极端(SCTR)和进一步优化控制(ECTR)的连续步骤。这种方法激发了引人注目的新概念：模块化组装、顺序部署、测试和临床接受定制的CLC系统，以满足个人患者的需求。
Integrated closed-loop control (CLC), combining continuous glucose monitoring (CGM) with insulin pump (continuous subcutaneous insulin infusion [CSII]), known as artificial pancreas, can help optimize glycemic control in diabetes. We present a fundamental modular concept for CLC design, illustrated by clinical studies involving 11 adolescents and 27 adults at the Universities of Virginia, Padova, and Montpellier. We tested two modular CLC constructs: standard control to range (sCTR), designed to augment pump plus CGM by preventing extreme glucose excursions; and enhanced control to range (eCTR), designed to truly optimize control within near normoglycemia of 3.9–10 mmol/L. The CLC system was fully integrated using automated data transfer CGM→algorithm→CSII. All studies used randomized crossover design comparing CSII versus CLC during identical 22-h hospitalizations including meals, overnight rest, and 30-min exercise. sCTR increased significantly the time in near normoglycemia from 61 to 74%, simultaneously reducing hypoglycemia 2.7-fold. eCTR improved mean blood glucose from 7.73 to 6.68 mmol/L without increasing hypoglycemia, achieved 97% in near normoglycemia and 77% in tight glycemic control, and reduced variability overnight. In conclusion, sCTR and eCTR represent sequential steps toward automated CLC, preventing extremes (sCTR) and further optimizing control (eCTR). This approach inspires compelling new concepts: modular assembly, sequential deployment, testing, and clinical acceptance of custom-built CLC systems tailored to individual patient needs.
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影响因子：
16.2
作者：
Atlas E;Nimri R;Miller S;Grunberg EA;Phillip M
通讯作者：
Phillip M
DOI：
10.1249/01.mss.0000227322.61964.d2
发表时间：
2006-07-01
影响因子：
4.1
作者：
Irving, Brian A.;Rutkowski, Jason;Weltman, Arthur
通讯作者：
Weltman, Arthur
影响因子：
4.2
作者：
Kovatchev, B;Cox, D;Clarke, W
通讯作者：
Clarke, W
影响因子：
5.4
作者：
Mastrototaro, J J
通讯作者：
Mastrototaro, J J
影响因子：
7.7
作者：
ALBISSER, AM;LEIBEL, BS;ZINGG, W
通讯作者：
ZINGG, W