Bio-Behavioral Feedback and Control of Type 1 Diabetes

1 型糖尿病的生物行为反馈和控制

• 批准号: 7996764
• 负责人: BORIS P KOVATCHEV
• 金额: $ 0.4万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-01-01 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7996764
• 关键词: Adverse event; Affect; Automobile Driving; Awareness; Behavior Control; Behavior Therapy; Behavioral; Blood Circulation; Blood Glucose Self-Monitoring; Blood Vessels; Blood capillaries; Characteristics; Chronic; Clinical; Computer Simulation; Data; Data Collection; Development; Endocrine; Endocrine system; Endothelium; Environment; Epinephrine; Exercise; Failure; Feedback; Frequencies; Fright; Glucagon; Glucose; Glycosylated hemoglobin A; Grant; Health; Hormonal; Hormones; Hyperglycemia; Hypoglycemia; Impairment; Incidence; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Investigation; Laboratories; Maintenance; Measures; Methods; Modeling; Monitor; Muscle; Outcome; Outcome Study; Patients; Pattern; Perfusion; Permeability; Phase; Physiological; Principal Investigator; Process; Protocols documentation; Recording of previous events; Recruitment Activity; Recurrence; Regulation; Relative (related person); Research; Risk; Stochastic Processes; Symptoms; System; Systems Biology; Testing; Time; Translating; Ultrasonography; Work; base; biobehavior; capillary; counterregulation; design; experience; field study; glycemic control; high risk; hospital laboratories; improved; indexing; insight; insulin sensitivity; interstitial; model development; network models; programs; prospective; research study; response

DESCRIPTION (provided by applicant): This proposal continues ten years of research on biobehavioral monitoring methods with proven utility to the assessment of Type 1 diabetes (T1DM), by taking the next logical step - from monitoring to feedback. We plan to test and validate the following general hypothesis: The optimization of glycemic control in T1DM, i.e. the maintenance of near-normal HbA1c without increasing the risk of hypoglycemia, is almost entirely dependent on the quality of two levels of feedback: (1) External behavioral level defined as the availability and utilization by patients of information about symptoms, awareness, risk of hypoglycemia, and HbA1c, and (2) Internal endocrine system level defined as the feedback networks of microvascular recruitment, hormonal counter regulation, and insulin-glucose interaction. Consequently, the proposed research plan includes field investigation of the utility of behavioral feedback (Phase 1) and hospital laboratory investigations of the internal feedback loops of insulin transfer (Phase 2) and counter regulation (Phase 3). Specifically: Phase 1 will create an Integrated Biobehavioral Monitoring and Feedback (IBMF) system and will investigate its clinical utility to improve glycemic control in a field outcomes study of T1 DM patients in their natural environment, assuming that the everyday behavioral control of T1DM depends on the quality of 4 sequential steps: monitoring -> assessment -> feedback to the patient -> behavioral optimization. Phase 2 will investigate, in T1DM subjects at low vs. high risk for hypoglycemia as determined in Phase 1, the time course of insulin transfer from circulation to iterstitium using a stochastic process model of insulin-induced microvascular recruitment and subsequent insulin transport through the capillary endothelium. Phase 3 will use a dynamical network model to investigate the time course of development, and the dynamical characteristics of hypoglycemia-associated autonomic failure (HAAF) in T1DM subjects at low vs. high risk for hypoglycemia as determined in Phase 1. Transferring the results from Phases 2 and 3 into Phase 1 we will clarify: (1) the relative contribution of insulin sensitivity and HAAF to risk for recurrent hypoglycemia in the field, and (2) the ability of IBMF to reverse HAAF and reduce risk of hypoglycemia, thereby contributing to improved glycemic control.

描述(由申请人提供)：这项建议通过采取下一个合乎逻辑的步骤-从监测到反馈，继续了十年来对生物行为监测方法的研究，并证明了对1型糖尿病(T1 DM)的评估是有效的。我们计划测试和验证以下一般假设：T1 DM患者血糖控制的优化，即在不增加低血糖风险的情况下维持接近正常的HbA1c，几乎完全取决于两个水平的反馈的质量：(1)外部行为水平，定义为患者对有关症状、意识、低血糖风险和HbA1c的信息的可用性和利用，以及(2)内部内分泌系统水平，定义为微血管招募、激素反调节和胰岛素-葡萄糖相互作用的反馈网络。因此，拟议的研究计划包括现场调查行为反馈的效用(第一阶段)和医院实验室调查胰岛素转移的内部反馈回路(第二阶段)和反调节(第三阶段)。具体地说，就是： 第一阶段将创建一个集成的生物行为监测和反馈(IBMF)系统，并将在T1 DM患者的自然环境中的现场结果研究中调查其改善血糖控制的临床效用，假设T1 DM的日常行为控制取决于4个连续步骤的质量：监测->评估->反馈给患者->>行为优化。 第二阶段将使用胰岛素诱导的微血管募集和随后的胰岛素通过毛细血管内皮细胞运输的随机过程模型，在第一阶段确定的低血糖风险与高风险的T1糖尿病患者中，研究胰岛素从循环转移到间质的时间进程。 第三阶段将使用动态网络模型来研究发展的时间进程，以及在第一阶段确定的低血糖风险与高风险低血糖的T1 DM受试者中低血糖相关自主神经衰竭(HAF)的动态特征。 将第二阶段和第三阶段的结果转移到第一阶段，我们将阐明：(1)胰岛素敏感性和HAAF对现场复发低血糖风险的相对贡献，以及(2)IBMF逆转HAAF和降低低血糖风险的能力，从而有助于改善血糖控制。