Advances in Care for Insulin-Requiring Patients Without Closed Loop.
Advances in Care for Insulin-Requiring Patients Without Closed Loop.
复制标题
无闭环治疗需要胰岛素的患者的进展。
DOI：
10.1089/dia.2018.0084
复制
发表时间：
2018
影响因子：
5.4
通讯作者：
Maahs,DavidM
中科院分区：
文献类型：
--
作者：
Lal,RayhanA;Buckingham,Bruce;Maahs,DavidM
For people with diabetes, there is growing evidence for the improved safety and glycemic control with artificial pancreas systems. 1–2 Despite this, the use of hybrid closedloop diabetes technology remains limited. Sherr et al. reported on rates of insulin pump use among children and adolescents with type 1 diabetes enrolled in the German/Austrian Prospective Diabetes Follow-up Registry (DPV), the US T1D Exchange (T1DX), and the English/Welsh National Paediatric Diabetes Audit (NPDA). The NPDA group had only 14% pump utilization, while DPV and T1DX had greater use of 41% and 47%, respectively, in 2011–2012. 3 Another study analyzing an international pediatric diabetes registry of 16,570 found 44% of participants using insulin pumps. 4 Tanenbaum analyzed 1503 adult patients from the T1DX and found 32% used an insulin pump and continuous glucose monitor (CGM), 38% used an insulin pump with glucometer, 5% used multiple daily injections (MDI) with CGM, and 25% used MDI with glucometer. 5 They also assessed barriers to device use among 249 subjects who discontinued CGM and 72 who stopped using an insulin pump. The most commonly reported obstacles to CGM use were cost, number of alarms, inaccuracy, body image concerns related to wearing devices, and discomfort. The most frequent reasons for stopping insulin pump use were body image with wearing the device, discomfort, cost, and trust. 5In addition to the ADA-reported 1.25 million people in the United States with type 1 diabetes, about 29% of the 29 million individuals with type 2 diabetes use insulin. 6 Indeed, this 8.4 million represents the vast majority of insulin users in the United States. The 2014 OpT2mise international controlled trial of 331 patients with type 2 diabetes on insulin demonstrated significant reduction in hemoglobin A1c (HbA1c) of 0.7%(P< 0.0001) at 6 months for those using insulin pump rather than MDI. 7 However, the most recent closed-loop technology from Medtronic received FDA
