Efficacy of dual-hormone artificial pancreas to alleviate the carbohydrate-counting burden of type 1 diabetes: A randomized crossover trial
Efficacy of dual-hormone artificial pancreas to alleviate the carbohydrate-counting burden of type 1 diabetes: A randomized crossover trial
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DOI：
10.1016/j.diabet.2015.05.001
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发表时间：
2016-02-01
影响因子：
7.2
通讯作者：
Haidar, A.
中科院分区：
文献类型：
--
作者：
Gingras, V.;Rabasa-Lhoret, R.;Haidar, A.
瞄准！- 对于许多1型糖尿病患者来说，碳水化合物计数是一项复杂的任务。本研究检测了基于葡萄糖传感器读数递送胰岛素和胰高血糖素的人工胰腺是否可以减轻碳水化合物计数的负担而不降低葡萄糖控制。- 12名成年人被招募到一项随机、三向、交叉试验中（ClinicalTrials.gov标识号NCT 01930097）。参与者从早上7点到晚上9点三次入院，并食用低碳水化合物早餐（女性：30 g;男性：50 g），中等碳水化合物晚餐（女性：50 g;男性：70 g）和高碳水化合物午餐（女性：90 g;男性：120 g）。在每次就诊时，血糖水平随机调节：（1）常规泵治疗;（2）人工胰腺（AP）伴餐时推注，根据胰岛素与碳水化合物的比例匹配膳食的碳水化合物含量（3）AP伴餐时推注（根据定量分类（常规或大剂量））（AP不伴碳水化合物计数）。- 低碳水化合物（P = 0.54）和中等碳水化合物（P = 0.38）餐后，与碳水化合物计数相比，无碳水化合物计数的AP实现了相似的AUC增量值，但在高碳水化合物餐后产生了更高的餐后波动（P = 0.004）。有和没有碳水化合物计数的AP产生了相似的平均葡萄糖水平（8.2 +/- 2.1 mmol/L vs. 8.4 +/- 1.7 mmol/L; P = 0.52），与传统泵治疗相比，两种策略均导致较低的平均葡萄糖（9.6 +/- 2.0 mmol/L; P = 0.02和P = 0.03）。- 对膳食量进行定性分类的AP可以减轻碳水化合物计数的负担，而不会影响血糖控制，尽管可能需要更多类别的膳食量来有效控制高碳水化合物膳食。(C)2015年Elsevier Masson SAS。All rights reserved.
Aim. - Carbohydrate-counting is a complex task for many patients with type 1 diabetes. This study examined whether an artificial pancreas, delivering insulin and glucagon based on glucose sensor readings, could alleviate the burden of carbohydrate-counting without degrading glucose control.Methods. - Twelve adults were recruited into a randomized, three-way, crossover trial (ClinicalTrials.gov identifier No. NCT01930097). Participants were admitted on three occasions from 7AM to 9PM and consumed a low-carbohydrate breakfast (women: 30 g; men: 50 g), a medium-carbohydrate dinner (women: 50 g; men: 70 g) and a high-carbohydrate lunch (women: 90 g; men: 120 g). At each visit, glucose levels were randomly regulated by: (1) conventional pump therapy; (2) an artificial pancreas (AP) accompanied by prandial boluses, matching the meal's carbohydrate content based on insulin-to-carbohydrate ratios (AP with carbohydrate-counting); or (3) an AP accompanied by prandial boluses based on qualitative categorization (regular or large) of meal size (AP without carbohydrate-counting).Results. - The AP without carbohydrate-counting achieved similar incremental AUC values compared with carbohydrate-counting after the low- (P = 0.54) and medium- (P = 0.38) carbohydrate meals, but yielded higher post-meal excursions after the high-carbohydrate meal (P = 0.004). The AP with and without carbohydrate-counting yielded similar mean glucose levels (8.2 +/- 2.1 mmol/L vs. 8.4 +/- 1.7 mmol/L; P = 0.52), and both strategies resulted in lower mean glucose compared with conventional pump therapy (9.6 +/- 2.0 mmol/L; P = 0.02 and P = 0.03, respectively).Conclusion. - The AP with qualitative categorization of meal size could alleviate the burden of carbohydrate-counting without compromising glucose control, although more categories of meal sizes are probably needed to effectively control higher-carbohydrate meals. (C) 2015 Elsevier Masson SAS. All rights reserved.