Benefits and Challenges of Current Closed-Loop Technologies in Children and Young People With Type 1 Diabetes.
Benefits and Challenges of Current Closed-Loop Technologies in Children and Young People With Type 1 Diabetes.
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DOI：
10.3389/fped.2021.679484
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发表时间：
2021
影响因子：
2.6
通讯作者：
Hovorka R
中科院分区：
文献类型：
--
作者：
Fuchs J;Hovorka R
糖尿病技术的最新进展促进了用于治疗 1 型糖尿病的闭环胰岛素输送系统的开发。现在有几种这样的系统可供儿童和青少年使用。虽然所有可用的系统都已被证明可以改善该人群的血糖控制和生活质量，但定性数据也凸显了使用闭环系统的挑战，这些系统在不同儿科年龄组之间有所不同。由于胰岛素敏感性高以及不可预测的饮食和运动模式，幼儿需要能够应对低胰岛素剂量和显着血糖变异性的系统。青少年的依从性通常与设备的尺寸和数量、系统的可用性、校准需求以及他们与系统交互的能力有关。鉴于创新的速度，了解当前系统的功能以及主要异同对于医疗保健专业人员、护理人员和患有 1 型糖尿病的年轻人来说可能具有挑战性。本次综述的目的是总结当前适用于 1 型糖尿病儿童和青少年的闭环系统的关键证据，并对可获得真实世界数据的用户体验进行评论。我们提出了系统基础上的研究结果，并确定了不同儿科年龄组的具体挑战，并评论了当前系统如何解决这些问题。最后，我们确定了未来研究的领域，涉及针对儿科使用定制的闭环技术，以及这些技术如何为报销提供信息并减轻疾病负担。
Recent advances in diabetes technology have led to the development of closed-loop insulin delivery systems for the management of type 1 diabetes. Several such systems are now commercially available for children and young people. While all available systems have been shown to improve glycaemic control and quality of life in this population, qualitative data also highlights the challenges in using closed-loop systems, which vary among different pediatric age-groups. Very young children require systems that are able to cope with low insulin doses and significant glycaemic variability due to their high insulin sensitivity and unpredictable eating and exercise patterns. Adolescents' compliance is often related to size and number of devices, usability of the systems, need for calibrations, and their ability to interact with the system. Given the speed of innovations, understanding the capabilities and key similarities and differences of current systems can be challenging for healthcare professionals, caregivers and young people with type 1 diabetes alike. The aim of this review is to summarize the key evidence on currently available closed-loop systems for children and young people with type 1 diabetes, as well as commenting on user experience, where real-world data are available. We present findings on a system-basis, as well as identifying specific challenges in different pediatric age-groups and commenting on how current systems might address these. Finally, we identify areas for future research with regards to closed-loop technology tailored for pediatric use and how these might inform reimbursement and alleviate disease burden.
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