Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes.
Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes.
复制标题
1 型糖尿病儿童和青少年的胰岛素输送和夜间血糖控制。
DOI：
10.1080/17425247.2017.1360866
复制
发表时间：
2017
影响因子：
6.6
通讯作者：
Hovorka,Roman
中科院分区：
文献类型：
--
作者：
Tauschmann,Martin;Hovorka,Roman
简介：1型糖尿病儿童和青少年的夜间血糖控制仍然具有挑战性，因为夜间胰岛素需求变化很大。这个问题可以解决葡萄糖响应胰岛素输送的基础上实时连续glucose measurements.Areas覆盖：本文综述了葡萄糖响应胰岛素输送系统从儿科的角度来看，最近的发展。我们涵盖了基于阈值的暂停应用，预测性低血糖暂停，以及更先进的单激素和双激素闭环系统。方法进行评估，特别是在门诊随机对照试验夜间血糖控制。专家意见：翻译研究从控制临床中心设置的自由生活的无监督的家庭研究取得了重大进展，在过去的十年中。使用闭环系统可以改善夜间血糖控制，同时降低低血糖风险。继美国监管机构批准首个混合闭环系统用于非儿科人群后，包括儿科人群在内的大型多国闭环临床试验和关键研究正在进行或准备中，以促进闭环系统在临床实践中的使用。
Introduction: Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements.Areas covered: This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials.Expert opinion: Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.