Artificial β-cell: clinical experience toward an implantable closed-loop insulin delivery system
Artificial β-cell: clinical experience toward an implantable closed-loop insulin delivery system
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DOI：
10.1016/s1262-3636(06)72802-6
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发表时间：
2006-12-01
影响因子：
7.2
通讯作者：
Bringer, J.
中科院分区：
文献类型：
--
作者：
Renard, E.;Costalat, G.;Bringer, J.
目的：恢复糖尿病患者长期正常血糖控制支持人工β细胞的阐述。植入这一系统的三个关键组成部分的可能性（胰岛素输送装置、葡萄糖传感器和控制器）进行分析。长期传感器系统（R）项目旨在开发一种完全可植入的人工β细胞，通过联合植入一个用于腹膜胰岛素输送的泵和一个靠近右心房的中央静脉葡萄糖传感器来评估葡萄糖控制的可行性，通过皮下导线连接。从2000年开始，我们的诊所在10例1型糖尿病患者中开始使用它。在这方面的经验获得的数据进行审查，并面临使用其他approaches.Results报告的闭环试验：没有显着的并发症相关的静脉内传感器的长期植入发生和组合植入物的耐受性良好。静脉内探头的葡萄糖测量值与血糖仪值相关性良好（r=0.83-0.93，平均绝对偏差为16.5%），准确性平均持续9个月。通过设计用于闭环胰岛素输注的算法对泵电子设备进行扩展，允许进行旨在实现自动血糖控制的48小时住院试验。葡萄糖控制与将皮下传感器与可穿戴泵结合用于皮下胰岛素输注的研究报告相似。更多的生理胰岛素动力学的好处，由于腹膜内输送已阻碍了静脉内sensor.Conclusion的响应时间慢：虽然一个完全植入式人工β细胞的概念已被验证为可行的，有限的性能，在实现葡萄糖控制要求改进的传感器结构，以增加其寿命和减少传感器延迟。
Aim: Restoration of long-term normal blood glucose control in diabetic patients supports the elaboration of an artificial beta cell. The possibility of implantation of the three crucial components of such a system (insulin delivery device, glucose sensor and controller) is analyzed.Methods: The Long-Term Sensor System (R) project, aiming at a fully implantable artificial beta cell, assessed the feasibility of glucose control by the combined implantation of a pump for peritoneal insulin delivery and a central intravenous glucose sensor close to the right atrium, connected via a subcutaneous lead. It was initiated in 10 Type 1 diabetic patients in our clinic from 2000. Data obtained during this experience are reviewed and confronted to reported closed-loop trials using other approaches.Results: No significant complication related to prolonged implantation of intravenous sensors occurred and the combined implants were well tolerated. Glucose measurement by the intravenous sensors correlated well with meter values (r=0.83-0.93, with a mean absolute deviation of 16.5%) and accuracy has been sustained for an average duration of 9 months. Uploading of pump electronics by algorithms designed for closed-loop insulin delivery allowed in-patient 48 hour-trials aiming at automated glucose control. Glucose control was similar to that reported by investigations combining subcutaneous sensors to wearable pumps for subcutaneous insulin infusion. The benefits of more physiological insulin kinetics due to intra-peritoneal delivery have been hampered by the slow response time of intravenous sensors.Conclusion: Although the concept of a fully implantable artificial beta cell has been validated as feasible, the limited performance in achieving glucose control requests improvements in the sensor structure to increase its longevity and decrease sensor delay.