Novel use of glucagon in a closed-loop system for prevention of hypoglycemia in type 1 diabetes.
Novel use of glucagon in a closed-loop system for prevention of hypoglycemia in type 1 diabetes.
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DOI：
10.2337/dc09-2254
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发表时间：
2010-06
期刊：
影响因子：
16.2
通讯作者：
Ward WK
中科院分区：
文献类型：
--
作者：
Castle JR;Engle JM;El Youssef J;Massoud RG;Yuen KC;Kagan R;Ward WK
通过闭环胰岛素输注系统中的自动胰高血糖素输注，最大限度地减少1型糖尿病受试者的低血糖。1型糖尿病成人受试者接受了一项胰岛素+安慰剂闭环研究和一项胰岛素+胰高血糖素研究，在即将发生低血糖时给药。7例受试者使用高增益参数接受胰高血糖素，6例受试者使用低增益参数以更长时间的方式接受胰高血糖素。每10分钟测量一次血糖水平，每5分钟调整一次胰岛素和胰高血糖素输注。所有受试者在餐后通知后接受一部分通常的餐前胰岛素。与安慰剂加胰岛素相比，自动胰高血糖素加胰岛素输注显著减少了低血糖范围内的时间（15 ± 6 vs 40 ± 10 min/天，P = 0.04）。与安慰剂相比，高增益胰高血糖素输送降低了低血糖事件的频率（1.0 ± 0.6 vs. 2.1 ± 0.6事件/天，P = 0.01）和对碳水化合物治疗的需求（1.4 ± 0.8 vs. 4.0 ± 1.4治疗/天，P = 0.01）。胰高血糖素与低增益参数并没有显着降低低血糖事件的频率（P = NS），但减少了碳水化合物治疗的频率（P = 0.05）。在1型糖尿病受试者的闭环治疗期间，胰高血糖素的高增益脉冲降低了低血糖的频率。需要更大规模和更长期的研究来评估持续胰高血糖素治疗对总体血糖控制的影响。
To minimize hypoglycemia in subjects with type 1 diabetes by automated glucagon delivery in a closed-loop insulin delivery system. Adult subjects with type 1 diabetes underwent one closed-loop study with insulin plus placebo and one study with insulin plus glucagon, given at times of impending hypoglycemia. Seven subjects received glucagon using high-gain parameters, and six subjects received glucagon in a more prolonged manner using low-gain parameters. Blood glucose levels were measured every 10 min and insulin and glucagon infusions were adjusted every 5 min. All subjects received a portion of their usual premeal insulin after meal announcement. Automated glucagon plus insulin delivery, compared with placebo plus insulin, significantly reduced time spent in the hypoglycemic range (15 ± 6 vs. 40 ± 10 min/day, P = 0.04). Compared with placebo, high-gain glucagon delivery reduced the frequency of hypoglycemic events (1.0 ± 0.6 vs. 2.1 ± 0.6 events/day, P = 0.01) and the need for carbohydrate treatment (1.4 ± 0.8 vs. 4.0 ± 1.4 treatments/day, P = 0.01). Glucagon given with low-gain parameters did not significantly reduce hypoglycemic event frequency (P = NS) but did reduce frequency of carbohydrate treatment (P = 0.05). During closed-loop treatment in subjects with type 1 diabetes, high-gain pulses of glucagon decreased the frequency of hypoglycemia. Larger and longer-term studies will be required to assess the effect of ongoing glucagon treatment on overall glycemic control.
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