Impact of Hybrid Closed Loop Therapy on Hypoglycemia Awareness in Individuals with Type 1 Diabetes and Impaired Hypoglycemia Awareness
Impact of Hybrid Closed Loop Therapy on Hypoglycemia Awareness in Individuals with Type 1 Diabetes and Impaired Hypoglycemia Awareness
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DOI：
10.1089/dia.2020.0593
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发表时间：
2021-07-01
影响因子：
5.4
通讯作者：
Jones, Timothy W.
中科院分区：
文献类型：
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作者：
Burckhardt, Marie-Anne;Abraham, Mary B.;Jones, Timothy W.
目的：本研究评估了使用混合闭环（HCL）系统在恢复低血糖意识受损（IAH）个体的低血糖意识方面的功效。研究设计和方法：IAH 参与者（金分 >= 4）被招募参加随机交叉试点研究。他们参加了两个为期 8 周的周期，使用 HCL 系统 (Medtronic 670G (TM))（干预）和标准胰岛素泵治疗（对照）。在基线和每个研究期结束时进行高胰岛素低血糖钳夹研究，以评估对低血糖的反调节激素和症状反应。结果：该研究纳入了 17 名参与者（平均年龄 [标准差] 35.8 岁 [11.2 岁]）。低血糖反应的肾上腺素峰值水平（中位四分位数范围 [IQR]）在干预后和控制期相似； 234.7 pmol/L（109.2；938.9）与 188.3 pmol/L（133.7；402.9），P = 0.233。然而，干预后肾上腺素能峰值和神经低糖症状评分均较高；分别为 5.0 (4.5; 9.0) 与 4.0 (4.0; 5.5)，P = 0.009，以及 8.5 (6.0; 15.0) 与 6.5 (6.0; 7.0) P = 0.014。自我报告的低血糖意识得到改善：中位 (IQR) 金级评分为 4.0 (3.0; 5.5) 对比 5.5 (4.5; 6.0)；干预与对照，P = 0.033。花费时间
Objective: This study evaluated the efficacy of using a hybrid closed loop (HCL) system in restoring hypoglycemia awareness in individuals with impaired awareness of hypoglycemia (IAH). Research Design and Methods: Participants with IAH (Gold score >= 4) were recruited into a randomized crossover pilot study. They participated in two 8-week periods using a HCL system (Medtronic 670G (TM)) (intervention) and standard insulin pump therapy (control). Hyperinsulinemic hypoglycemic clamp studies were undertaken at baseline and at the end of each study period for the evaluation of the counter-regulatory hormonal and symptomatic responses to hypoglycemia. Results: Seventeen participants (mean age [standard deviation] 35.8 years [11.2 years]) were included in the study. Peak epinephrine levels (median, interquartile range [IQR]) in response to hypoglycemia were similar postintervention and control periods; 234.7 pmol/L (109.2; 938.9) versus 188.3 pmol/L (133.7; 402.9), P = 0.233. However, both peak adrenergic and neuroglycopenic symptom scores were higher after intervention; 5.0 (4.5; 9.0) versus 4.0 (4.0; 5.5), P = 0.009, and 8.5 (6.0; 15.0) versus 6.5 (6.0; 7.0) P = 0.014, respectively. Self-reported hypoglycemia awareness improved: median (IQR) Gold score was 4.0 (3.0; 5.5) versus 5.5 (4.5; 6.0); intervention versus control, P = 0.033. Time spent