Assessment of Meal Anticipation for Improving Fully Automated Insulin Delivery in Adults With Type 1 Diabetes.
Assessment of Meal Anticipation for Improving Fully Automated Insulin Delivery in Adults With Type 1 Diabetes.
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评估1型糖尿病成人全自动胰岛素递送的饮食预期。
DOI：
10.2337/dc23-0119
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发表时间：
2023-09-01
期刊：
影响因子：
16.2
通讯作者：
Breton, Marc D.
中科院分区：
文献类型：
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作者：
Garcia-Tirado, Jose;Colmegna, Patricio;Villard, Orianne;Diaz, Jenny L.;Esquivel-Zuniga, Rebeca;Koravi, Chaitanya L. K.;Barnett, Charlotte L.;Oliveri, Mary C.;Fuller, Morgan;Brown, Sue A.;Deboer, Mark D.;Breton, Marc D.
对于1型糖尿病（T1D）患者来说，饮食一直是血糖控制的挑战。我们的目的是在全自动胰岛素输送（AID）系统中评估成人T1D患者进餐预期对血糖的影响。我们报告了一项随机交叉临床试验的结果，比较了AID系统的三种模式：混合闭环（HCL）、全闭环（FCL）和全闭环与进餐预期（FCL+）。在三个监督的24小时入院期间对模式进行了测试，其中早餐，午餐和晚餐分别在每个参与者的家庭计划中固定时间和延迟1.5小时食用。主要终点是FCL+与FCL的早餐-餐后时间在70-180 mg/dL范围内的百分比。随机选取35例T1D患者（年龄44.5±15.4岁，HbA1c 6.7±0.9%，女性23例，男性12例）。早餐后5 h， HCL、FCL和FCL+组的TIR分别为75±23%、58±21%和63±19%，FCL+组与FCL组之间无显著差异。晚餐前2小时，FCL和FCL+的低于范围时间（TBR）相似。晚餐后5小时内，FCL+和FCL的TIR相似（71±34%比72±29%，P = 1.0），而FCL+的TBR降低（中位数0%[0-0%]比0% [0-0.8%],P = 0.03）。总体而言，HCL、FCL和FCL+的24小时控制率分别为86±10%、77±11%和77±12%。虽然混合AID方案的餐后控制仍然是最佳的，但两种完全AID方案在低血糖暴露相似或更低的情况下，总TIR均达到70%。预期并没有显著改善AID系统的餐后控制，但也没有增加延迟用餐时的低血糖风险。
Meals are a consistent challenge to glycemic control in type 1 diabetes (T1D). Our objective was to assess the glycemic impact of meal anticipation within a fully automated insulin delivery (AID) system among adults with T1D. We report the results of a randomized crossover clinical trial comparing three modalities of AID systems: hybrid closed loop (HCL), full closed loop (FCL), and full closed loop with meal anticipation (FCL+). Modalities were tested during three supervised 24-h admissions, where breakfast, lunch, and dinner were consumed per participant’s home schedule, at a fixed time, and with a 1.5-h delay, respectively. Primary outcome was the percent time in range 70–180 mg/dL (TIR) during the breakfast postprandial period for FCL+ versus FCL. Thirty-five adults with T1D (age 44.5 ± 15.4 years; HbA1c 6.7 ± 0.9%; n = 23 women and n = 12 men) were randomly assigned. TIR for the 5-h period after breakfast was 75 ± 23%, 58 ± 21%, and 63 ± 19% for HCL, FCL, and FCL+, respectively, with no significant difference between FCL+ and FCL. For the 2 h before dinner, time below range (TBR) was similar for FCL and FCL+. For the 5-h period after dinner, TIR was similar for FCL+ and FCL (71 ± 34% vs. 72 ± 29%; P = 1.0), whereas TBR was reduced in FCL+ (median 0% [0–0%] vs. 0% [0–0.8%]; P = 0.03). Overall, 24-h control for HCL, FCL, and FCL+ was 86 ± 10%, 77 ± 11%, and 77 ± 12%, respectively. Although postprandial control remained optimal with hybrid AID, both fully AID solutions offered overall TIR >70% with similar or lower exposure to hypoglycemia. Anticipation did not significantly improve postprandial control in AID systems but also did not increase hypoglycemic risk when meals were delayed.
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影响因子：
16.2
作者：
Maahs DM;Buckingham BA;Castle JR;Cinar A;Damiano ER;Dassau E;DeVries JH;Doyle FJ 3rd;Griffen SC;Haidar A;Heinemann L;Hovorka R;Jones TW;Kollman C;Kovatchev B;Levy BL;Nimri R;O'Neal DN;Philip M;Renard E;Russell SJ;Weinzimer SA;Zisser H;Lum JW
通讯作者：
Lum JW
DOI：
10.1016/j.ecl.2019.10.011
发表时间：
2020-03-01
影响因子：
4.5
作者：
Riddell, Michael C.;Pooni, Rubin;Scott, Sam N.
通讯作者：
Scott, Sam N.
影响因子：
3.4
作者：
Chernavvsky, Daniel R.;DeBoer, Mark D.;Breton, Marc D.
通讯作者：
Breton, Marc D.
影响因子：
5.4
作者：
Cameron, Faye M.;Ly, Trang T.;Bequette, B. Wayne
通讯作者：
Bequette, B. Wayne
影响因子：
5.4
作者：
Forlenza, Gregory P.;Cameron, Faye M.;Buckingham, Bruce A.
通讯作者：
Buckingham, Bruce A.