Coming of age: the artificial pancreas for type 1 diabetes.
Coming of age: the artificial pancreas for type 1 diabetes.
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DOI：
10.1007/s00125-016-4022-4
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发表时间：
2016-09
期刊：
影响因子：
8.2
通讯作者：
Hovorka R
中科院分区：
文献类型：
--
作者：
Thabit H;Hovorka R
人工胰腺（闭环系统）解决了改善血糖控制的未满足的临床需求，同时减轻了1型糖尿病患者的糖尿病自我护理负担。高于和低于由探头葡萄糖读数通知的预设胰岛素量的葡萄糖响应胰岛素输送将闭环系统与传统的阈值暂停和预测暂停胰岛素泵治疗区分开来。1型糖尿病患者的胰岛素需求可以在每天的三分之一至三倍之间变化。闭环系统可适应这些变化，并降低与严格血糖控制相关的低血糖风险。在这篇综述中，我们专注于正在取得的进展，在门诊设置的闭环系统的开发和评估。随机过渡性研究表明，在监督或远程监测下的闭环系统的可行性和有效性。与传感器增强胰岛素泵相比，儿童、青少年和成人在自由生活、无人监督条件下的闭环应用显示出血糖结局改善、低血糖减少和用户接受度提高。创新的方法，以提高闭环性能进行了讨论，我们还提出了前景和策略，用于缓解临床采用闭环系统。
The artificial pancreas (closed-loop system) addresses the unmet clinical need for improved glucose control whilst reducing the burden of diabetes self-care in type 1 diabetes. Glucose-responsive insulin delivery above and below a preset insulin amount informed by sensor glucose readings differentiates closed-loop systems from conventional, threshold-suspend and predictive-suspend insulin pump therapy. Insulin requirements in type 1 diabetes can vary between one-third–threefold on a daily basis. Closed-loop systems accommodate these variations and mitigate the risk of hypoglycaemia associated with tight glucose control. In this review we focus on the progress being made in the development and evaluation of closed-loop systems in outpatient settings. Randomised transitional studies have shown feasibility and efficacy of closed-loop systems under supervision or remote monitoring. Closed-loop application during free-living, unsupervised conditions by children, adolescents and adults compared with sensor-augmented pumps have shown improved glucose outcomes, reduced hypoglycaemia and positive user acceptance. Innovative approaches to enhance closed-loop performance are discussed and we also present the outlook and strategies used to ease clinical adoption of closed-loop systems.