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

研究问题：这个建议将帮助我回答三个关键的研究问题：在老年1型糖尿病患者中，人工胰腺：a）改善血糖控制，B）降低心律失常风险，c）与常规护理相比改善睡眠参数？背景资料：1型糖尿病（T1D）是一种终身疾病，受影响的个体需要每日胰岛素治疗才能生存并避免严重并发症。随着T1D患者预期寿命的增加，患有这种疾病的老年人数量也在增加。针对特定年龄组T1D患者的推荐治疗目标已经发表，但由于始终存在低血糖水平（低血糖）的风险，实现这些目标仍然具有挑战性。此外，老年糖尿病患者往往由于无法平等获得新的治疗和技术而处于不利地位。老年1型糖尿病患者通常面临独特的挑战，并且由于缺乏常见的低血糖症状（如饥饿感或焦虑感，在某些情况下可能是致命的）而具有更高的重度低血糖风险（极低血糖导致意识丧失）。 一些研究人员推测，频繁和严重的低血糖会使心脏跳动过快或不规则，从而导致死亡。许多研究试图证明两者之间的联系。然而，直到最近，很少同时连续监测血糖水平和心律，特别是在老年T1D患者中。与较年轻的年龄组相比，患有重度低血糖的老年人数量不成比例，这可能是T1D老年人猝死或心脏相关死亡的机制。 一些研究表明，与没有T1D的人相比，T1D患者的睡眠障碍（睡眠质量差和睡眠时间短）发生率更高，这可能对血糖水平和心理健康产生负面影响。睡眠障碍对T1D老年人的影响，特别是与自我管理和依从行为有关的影响，尚不清楚。当前的连续葡萄糖监测和胰岛素泵装置不自动改变胰岛素输送或胰岛素剂量，并且仍然需要人对其胰岛素进行自我调整。这可能导致潜在的高或低血糖水平及其相关风险。相比之下，人工胰腺会自动控制胰岛素的输送，并根据连续血糖监测仪检测到的血糖水平的每分钟变化，通过计算机软件仔细改变胰岛素的输送。然而，老年人获得这项旨在减轻糖尿病负担的技术的机会仍然有限。需要对新的治疗策略进行评估，以改善这一服务不足人群的健康状况。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，在老年T1D患者（>60岁）中比较人工胰腺血糖控制与常规胰岛素治疗，并研究该组中的低血糖和高血糖水平是否影响心率、节律和睡眠模式的变化。将邀请最多40名参与者参加研究。每位参与者将在研究期间佩戴人工胰腺装置和便携式心脏和睡眠监测仪，以分别记录和分析他们的葡萄糖，睡眠和心律。 预期影响和结论：这些结果将提高我们对人工胰腺在这个年龄组中的影响的理解，并确定葡萄糖水平，心律失常和睡眠特征之间的联系。预计这些结果将对T1D老年人、他们的照顾者、医疗保健提供者和政策制定者产生重大益处。这项建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.