Effects of the Artificial Pancreas on Glucose Control, Cardiac Arrhythmia Risk and Sleep in Older People with Type 1 Diabetes

研究问题：这项建议将帮助我回答三个关键的研究问题：在患有1型糖尿病的老年人中，人工胰腺是否：a)改善血糖控制，b)降低心律失常风险，c)改善睡眠参数，与常规护理相比？背景：1型糖尿病(T1D)是一种终生疾病，患者需要每天接受胰岛素治疗才能存活并避免严重并发症。随着T1D患者预期寿命的增加，患有T1D的老年人数量也会增加。针对患有T1D的特定年龄组的推荐治疗目标已经公布，但由于低血糖水平(低血糖)的风险一直存在，实现这些目标仍然具有挑战性。此外，由于不平等地获得新的治疗方法和技术，老年糖尿病患者往往处于不利地位。患有1型糖尿病的老年人通常面临着独特的挑战，由于失去了通常的低血糖症状，如感到饥饿或焦虑，患严重低血糖(极低血糖导致意识丧失)的风险更高，在某些情况下，这可能是致命的。一些研究人员推测，频繁而严重的低血糖会使心跳过快或不规则，从而可能导致死亡。许多研究试图证明这两者之间存在联系。然而，直到最近，对血糖水平和心率的同时连续监测很少进行，特别是在患有T1D的老年人中。与年轻年龄组相比，患有严重低血糖的老年人数量不成比例，这可能是患有T1D的老年人突然或心脏相关死亡的一种机制。一些研究表明，与没有T1D的人相比，患有T1D的人睡眠障碍的发生率更高(睡眠质量较差，睡眠时间更短)，这可能会对血糖水平和心理社会健康产生负面影响。睡眠障碍对患有T1D的老年人的影响，特别是与自我管理和坚持行为有关的影响，目前尚不清楚。目前的连续血糖监测和胰岛素泵设备不会自动改变胰岛素输送或胰岛素剂量，仍然需要人对其胰岛素进行自我调节。这可能会导致潜在的高或低血糖水平，以及与之相关的风险。相比之下，人工胰腺自动控制胰岛素的输送，计算机软件根据连续血糖监测检测到的血糖水平每分钟的变化仔细地改变胰岛素的输送。然而，这项旨在减轻糖尿病负担的技术在老年人中仍然有限。需要评估新的治疗战略，以改善这一服务不足人群的健康结果。研究环境：我将与曼彻斯特心脏中心、曼彻斯特大学生物计时中心和剑桥人工胰腺小组合作，在患有T1D的老年人(&gt；60岁)中比较血糖控制和人工胰腺与常规胰岛素治疗，并研究这组人的低血糖和高血糖水平是否会影响心率、节律和睡眠模式的变化。多达40名参与者将被邀请参加这项研究。每个参与者都将在研究过程中佩戴人造胰腺设备和便携式心脏和睡眠监测器，分别记录和分析他们的血糖、睡眠和心率。预期影响和结论：该结果将提高我们对人工胰腺在这个年龄段的影响的理解，并明确血糖水平、心律失常和睡眠特征之间的联系。预计这一结果将为患有T1D的老年人、他们的照顾者、医疗保健提供者和政策制定者带来重大好处。这项提议将支持我的学术生涯，在我目前的专业领域之外发展新的研究技能和知识。

Research questions: This proposal will help me to answer three key research questions: In older people with type 1 diabetes, does the artificial pancreas: a) improve glucose control, b) reduce arrhythmia risk and c) improve sleep parameters when compared to usual care?Background: Type 1 diabetes (T1D) is a life-long condition, with affected individuals requiring daily insulin treatment to survive and avoid serious complications. As life expectancy of people with T1D increases, the number of older people living with the condition grows. Recommended treatment goals for specific age groups with T1D have been published, but achieving these remains challenging due to the ever-present risk of low blood glucose levels (hypoglycaemia). In addition, older people with diabetes are often disadvantaged due to unequal access to new treatments and technologies. Older people with type 1 diabetes often face unique challenges and have a higher risk of severe hypoglycaemia (extremely low blood glucose leading to loss of consciousness)due to loss of usual hypoglycaemia symptoms such as feeling hungry or anxious, which in some cases, can be fatal. Some researchers have speculated that frequent and severe hypoglycaemia can make the heart beat too fast or irregularly, which can lead to death. A number of studies have tried to prove a link between the two. However until recently, simultaneous continuous monitoring of glucose levels and heart rhythm have been rarely performed, especially in older people with T1D. Compared to younger age groups, a disproportionate number of older people suffer from severe hypoglycaemia, which is a possible mechanism of sudden or heart-related deaths in older people with T1D. Several studies have shown higher rates of sleep disturbance (poor sleep quality and shorter sleep duration) in people with T1D compared to those without T1D, which can have negative effects on glucose levels and psychosocial health. The impact of sleep disturbance in older people with T1D, specifically in relation to self-management and adherence behaviours, is unknown. Current continuous glucose monitoring and insulin pump devices do not automatically alter insulin delivery or insulin dose, and still require the person to make self-adjustments to their insulin. This may lead to potentially high or low sugar levels, and its associated risks. In contrast, the artificial pancreas automatically controls insulin delivery, which is carefully altered by computer software according to minute-to-minute changes in sugar levels detected by the continuous glucose monitoring. However, access to this technology designed to reduce the burden of diabetes remains limited in older people. Evaluation of new treatment strategies to improve health outcomes in this under-served population is needed. Research environment: In partnership with Manchester Heart Centre, University of Manchester's Centre for Biological Timing and Cambridge Artificial Pancreas Group,I will compare glucose control with the artificial pancreas against usual insulin therapy in older people (>60 years old) with T1D, and study whether low and high glucose levels in this group affect changes in heart rate, rhythm and sleep patterns. Up to 40 participants will be invited to the study. Each participant will wear an artificial pancreas device, and a portable heart and sleep monitor during the study to record and analyse their glucose, sleep and heart rhythm respectively. Expected impact and conclusions: The results will improve our understanding of the impact of the artificial pancreas in this age group, and define the links between glucose levels, cardiac arrhythmia and sleep traits. The results are expected to have major benefits for older people with T1D, their carers, healthcare providers and policy makers. This proposal will support my academic career in developing new research skills and knowledge beyond my current areas of expertise.