Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control-based fully-automated artificial pancreas in patients with type 1 diabetes: a pilot study.
Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control-based fully-automated artificial pancreas in patients with type 1 diabetes: a pilot study.
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DOI：
10.1111/dom.12999
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Zisser HC
中科院分区：
文献类型：
--
作者：
Dassau E;Renard E;Place J;Farret A;Pelletier MJ;Lee J;Huyett LM;Chakrabarty A;Doyle FJ 3rd;Zisser HC
比较腹膜内(IP)和皮下(SC)胰岛素在人工胰腺(AP)中的应用。10名成年1型糖尿病患者参加了一项非随机、非盲目的序贯AP研究，研究使用了相同的SC血糖感应和调整了胰岛素清除量的区域模型预测控制(ZMPC)算法。在第一次入院时，受试者接受了24小时的闭环控制，SC注射了一种快速作用的胰岛素类似物。在植入DiaPort IP胰岛素输送系统后，进行了与IP常规胰岛素输送相同的24小时试验。临床方案包括三餐未公布的碳水化合物，分别为70、40和70克。主要终点是血糖(BG)在80-140 mg/dL(4.4-7.7 mmol/L)范围内的时间。在80到140 mg/dL范围内，IP分娩的时间百分比显著高于SC分娩：39.8±7.6比25.6±13.1(P=0.03)。IP胰岛素组的平均血糖(mg/dL)和在70-180 mg/dL范围内停留的时间百分比也明显更好：分别为151.0±11.0vs190.0±31.0(P=0.004)和65.7vs43.9vs43.9±14.7(P=.001)。IP胰岛素控制血糖的优势来自于高血糖时间的减少(>；180 mg/dL：32.4±8.9 vs 53.5±17.4，P=.014；>；250 mg/dL：5.9±5.6 vs 23.0±11.3，P=.0004)。IP组每日胰岛素剂量(Iu)较高(43.7±0.1vs32.3±0.1，P<；.001)，所用时间百分比无增加(IP：2.5±2.9vsSC：4.1±5.3，P=.42)。全自动AP注射IP胰岛素的血糖调节效果优于SC胰岛素注射。这项初步研究为将ZMPC算法与IP胰岛素传递相结合的AP系统提供了概念验证。
To compare intraperitoneal (IP) to subcutaneous (SC) insulin delivery in an artificial pancreas (AP). Ten adults with type 1 diabetes participated in a non-randomized, non-blinded sequential AP study using the same SC glucose sensing and Zone Model Predictive Control (ZMPC) algorithm adjusted for insulin clearance. On first admission, subjects underwent closed-loop control with SC delivery of a fast-acting insulin analogue for 24 hours. Following implantation of a DiaPort IP insulin delivery system, the identical 24-hour trial was performed with IP regular insulin delivery. The clinical protocol included 3 unannounced meals with 70, 40 and 70 g carbohydrate, respectively. Primary endpoint was time spent with blood glucose (BG) in the range of 80 to 140 mg/dL (4.4–7.7 mmol/L). Percent of time spent within the 80 to 140 mg/dL range was significantly higher for IP delivery than for SC delivery: 39.8 ± 7.6 vs 25.6 ± 13.1 (P = .03). Mean BG (mg/dL) and percent of time spent within the broader 70 to 180 mg/dL range were also significantly better for IP insulin: 151.0 ± 11.0 vs 190.0 ± 31.0 (P = .004) and 65.7 ± 9.2 vs 43.9 ± 14.7 (P = .001), respectively. Superiority of glucose control with IP insulin came from the reduced time spent in hyperglycaemia (>180 mg/dL: 32.4 ± 8.9 vs 53.5 ± 17.4, P = .014; >250 mg/dL: 5.9 ± 5.6 vs 23.0 ± 11.3, P = .0004). Higher daily doses of insulin (IU) were delivered with the IP route (43.7 ± 0.1 vs 32.3 ± 0.1, P < .001) with no increased percent time spent <70 mg/dL (IP: 2.5 ± 2.9 vs SC: 4.1 ± 5.3, P = .42). Glycaemic regulation with fully-automated AP delivering IP insulin was superior to that with SC insulin delivery. This pilot study provides proof-of-concept for an AP system combining a ZMPC algorithm with IP insulin delivery.
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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
影响因子：
4.2
作者：
Huyett LM;Dassau E;Zisser HC;Doyle FJ 3rd
通讯作者：
Doyle FJ 3rd
影响因子：
7.7
作者：
Burnett DR;Huyett LM;Zisser HC;Doyle FJ 3rd;Mensh BD
通讯作者：
Mensh BD
影响因子：
5.1
作者：
Renard, Eric;Costalat, Guy;Bringer, Jacques
通讯作者：
Bringer, Jacques
影响因子：
16.2
作者：
Renard E;Place J;Cantwell M;Chevassus H;Palerm CC
通讯作者：
Palerm CC