Closed-loop basal insulin delivery over 36 hours in adolescents with type 1 diabetes: randomized clinical trial.
Closed-loop basal insulin delivery over 36 hours in adolescents with type 1 diabetes: randomized clinical trial.
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DOI：
10.2337/dc12-0816
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发表时间：
2013-04
期刊：
影响因子：
16.2
通讯作者：
Hovorka R
中科院分区：
文献类型：
--
作者：
Elleri D;Allen JM;Kumareswaran K;Leelarathna L;Nodale M;Caldwell K;Cheng P;Kollman C;Haidar A;Murphy HR;Wilinska ME;Acerini CL;Dunger DB;Hovorka R
我们评估了在睡眠期间、规律进餐后和突然运动后闭环基础胰岛素输注的安全性和有效性。在临床研究机构对12名1型糖尿病青少年（5名男性;平均年龄15.0 [SD 1.4]岁; HbA 1c 7.9 [0.7]%; BMI 21.4 [2.6] kg/m2）进行了两次研究，并以随机顺序接受闭环基础胰岛素输注或传统胰岛素泵治疗36 h。在闭环胰岛素输注期间，根据皮下探头葡萄糖水平通知的模型预测控制算法，每15分钟调整一次胰岛素泵基础率。在对照访视期间，采用受试者的标准输注速率。餐时胰岛素推注在主餐前（50-80 g碳水化合物）给药，但不在零食前（15-30 g碳水化合物）给药。受试者在上午（40分钟）和下午（20分钟）在固定自行车上以140 bpm的心率进行中等强度的运动，未通知算法。主要结局是血糖在目标范围（71-180 mg/dL）内的时间。闭环基础胰岛素输注延长了血糖在目标范围内的时间百分比（中位数84% [四分位距78-88%] vs. 49% [26-79%]，P = 0.02），并降低了平均血糖水平（128 [19] vs. 165 [55] mg/dL，P = 0.02）。在闭环胰岛素输注期间，24个晚上中有17个晚上的血糖水平100%处于目标范围内。在对照访视期间发生了10次低血糖，在闭环给药期间发生了9次低血糖（5次发作与运动相关，4次发生在餐时推注后2.5小时内）。昼夜闭环基础胰岛素输注可改善青少年血糖控制。然而，突然的中等强度运动和过量的餐时推注对无低血糖的闭环基础胰岛素输送提出了挑战。
We evaluated the safety and efficacy of closed-loop basal insulin delivery during sleep and after regular meals and unannounced periods of exercise. Twelve adolescents with type 1 diabetes (five males; mean age 15.0 [SD 1.4] years; HbA1c 7.9 [0.7]%; BMI 21.4 [2.6] kg/m2) were studied at a clinical research facility on two occasions and received, in random order, either closed-loop basal insulin delivery or conventional pump therapy for 36 h. During closed-loop insulin delivery, pump basal rates were adjusted every 15 min according to a model predictive control algorithm informed by subcutaneous sensor glucose levels. During control visits, subjects’ standard infusion rates were applied. Prandial insulin boluses were given before main meals (50–80 g carbohydrates) but not before snacks (15–30 g carbohydrates). Subjects undertook moderate-intensity exercise, not announced to the algorithm, on a stationary bicycle at a 140 bpm heart rate in the morning (40 min) and afternoon (20 min). Primary outcome was time when plasma glucose was in the target range (71–180 mg/dL). Closed-loop basal insulin delivery increased percentage time when glucose was in the target range (median 84% [interquartile range 78–88%] vs. 49% [26–79%], P = 0.02) and reduced mean plasma glucose levels (128 [19] vs. 165 [55] mg/dL, P = 0.02). Plasma glucose levels were in the target range 100% of the time on 17 of 24 nights during closed-loop insulin delivery. Hypoglycemia occurred on 10 occasions during control visits and 9 occasions during closed-loop delivery (5 episodes were exercise related, and 4 occurred within 2.5 h of prandial bolus). Day-and-night closed-loop basal insulin delivery can improve glucose control in adolescents. However, unannounced moderate-intensity exercise and excessive prandial boluses pose challenges to hypoglycemia-free closed-loop basal insulin delivery.
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影响因子：
16.2
作者：
Castle JR;Engle JM;El Youssef J;Massoud RG;Yuen KC;Kagan R;Ward WK
通讯作者：
Ward WK
DOI：
10.1111/j.1464-5491.2012.03605.x
发表时间：
2012-05
期刊：
Diabetic medicine : a journal of the British Diabetic Association
影响因子：
--
作者：
Peyrot M;Barnett AH;Meneghini LF;Schumm-Draeger PM
通讯作者：
Schumm-Draeger PM
影响因子：
4.7
作者：
Brage, S;Brage, N;Wareham, NJ
通讯作者：
Wareham, NJ
影响因子：
3.3
作者：
Brage, S;Brage, N;Wareham, NJ
通讯作者：
Wareham, NJ
影响因子：
5.4
作者：
Kowalski, Aaron J.
通讯作者：
Kowalski, Aaron J.