Fully automated closed-loop insulin delivery versus sermautomated hybrid control in pediatric patients with type 1 diabetes using an artificial pancreas
Fully automated closed-loop insulin delivery versus sermautomated hybrid control in pediatric patients with type 1 diabetes using an artificial pancreas
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DOI：
10.2337/dc07-1967
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发表时间：
2008-05-01
期刊：
影响因子：
16.2
通讯作者：
Tamborlane, Williani V.
中科院分区：
文献类型：
--
作者：
Weinzimer, Stuart A.;Steil, Garry M.;Tamborlane, Williani V.
目的：儿童1型糖尿病最有前途的p细胞替代疗法是一个包含连续血糖传感器和胰岛素泵的闭环人工胰腺。美敦力最小化外部生理胰岛素输送（ePID）系统将外部泵和传感器与可变胰岛素输注速率算法相结合，旨在模拟β细胞的生理特性。然而，胰岛素吸收的延迟与皮下给药途径有关，不可避免地导致餐后大量葡萄糖漂移。研究设计和方法：我们研究了美敦力ePID系统在青少年1型糖尿病患者中的可行性，并假设在闭环控制过程中，少量的手动餐前“启动”剂量可以减少餐后运动。17名青少年（15.9 +/- 1.6岁，AlC为7.1 +/- 0.8%）进行34 h的闭环控制，8名为全闭环（FCL）控制，9名为混合闭环（HCL）控制（餐前启动剂）。结果：HCL组的平均血糖水平为135 +/- 45 mg/dl， FCL组为141 +/- 55 mg/dl (P = 0.09)；HCL组白天平均血糖水平为149 +/- 47 mg/dl，而FCL组为159 +/- 59 mg/dl （P = 0.03）。HCL组餐后血糖峰值平均为194 +/- 47 mg/dl，而FCL组为226 +/- 51 mg/dl （P = 0.04）。两组夜间控制相似（111 +/- 27 vs 112 +/- 28 mg/dl）。结论：使用外部传感器和胰岛素泵的闭环血糖控制为青年I型糖尿病患者夜间血糖浓度达到接近正常水平提供了一种手段。在餐前15分钟给予少量胰岛素，可改善餐后血糖波动。
OBJECTIVE - The most promising P-cell replacement therapy for children with type 1 diabetes is a closed-loop artificial pancreas incorporating continuous glucose sensors and insulin pumps. The Medtronic MiniMed external physiological insulin delivery (ePID) system combines an external pump and sensor with a variable insulin infusion rate algorithm designed to emulate the physiological characteristics of the beta-cell. However, delays in insulin absorption associated with the subcutaneous route of delivery inevitably lead to large postprandial glucose excursions.RESEARCH DESIGN AND METHODS - We studied the feasibility of the Medtronic ePID system in youth with type 1 diabetes and hypothesized that small manual premeal "priming" boluses would reduce postprandial excursions during closed-loop control. Seventeen adolescents (aged 15.9 +/- 1.6 years; AlC 7.1 +/- 0.8%) underwent 34 h of closed-loop control, 8 with full closed-loop (FCL) control and 9 with hybrid closed-loop (HCL) control (premeal priming bolus).RESULTS - Mean glucose levels were 135 +/- 45 mg/dl in the HCL group versus 141 +/- 55 mg/dl in the FCL group (P = 0.09); daytime glucose levels averaged 149 +/- 47 mg/dl in the HCL group versus 159 +/- 59 mg/dl in the FCL group (P = 0.03). Peak postprandial glucose levels averaged 194 +/- 47 mg/dl in the HCL group versus 226 +/- 51 mg/dl in the FCL group (P = 0.04). Nighttime control was similar in both groups (111 +/- 27 vs. 112 +/- 28 mg/dl).CONCLUSIONS - Closed-loop glucose control using an external sensor and insulin pump provides a means to achieve near-normal glucose concentrations in youth with type I diabetes during the overnight period. The addition of small manual priming bolus doses of insulin, given 15 min before meals, improves postprandial glycemic excursions.