Yale Study of Closed-Loop Automated Glucose Control for Hypoglycemia Prevention

尽管1型糖尿病（T1 D）的管理有所改善，包括胰岛素类似物、胰岛素泵 治疗，以及最近的连续葡萄糖监测，低血糖的风险继续作为一个重要因素。 实现接近正常血糖控制的主要障碍。接近正常的两个常见障碍 血糖控制仍然是夜间低血糖和餐后血糖不稳定。激素减少 夜间和低血糖反复发作后对低血糖的反调节反应 由于以下原因，T1 D患者试图实现严格控制，因此存在严重低血糖的高风险 低血糖无意识。非生理性胰岛素输送经常导致餐后早期胰岛素缺乏。 高血糖和餐后高胰岛素血症，不仅影响血糖控制， 也会导致不可预测的白天低血糖。很可能没有手动“开环” 治疗性胰岛素方案将能够最佳地控制T1 D患者的胰岛素水平， 电池更换目前是不可行的。“闭环”自动化人工胰腺系统，包括 一个胰岛素泵，精确地输送不同量的胰岛素，一个连续葡萄糖传感器， 确定葡萄糖水平，以及基于实时测量来确定胰岛素输送速率的有效算法。 血糖读数，仍然是控制血糖和减少低血糖的最有希望的干预措施 exposure.本研究的目的是（1）确定夜间闭环治疗是否可以 减少或消除夜间低血糖，恢复反调节激素反应， 在患有复发性夜间低血糖的受试者中的低血糖;和（2）研究是否使用 肠促胰岛素如普兰林肽和艾塞那肽，当与闭环疗法联合使用时，可 优化餐后血糖控制，消除或减少早期餐后高血糖和晚期 餐后低血糖这些研究将使用Medtronic ePID系统进行， 几项研究表明，作为第一代闭环装置，我们中心有一个 在临床T1 D研究中表现出良好的记录，并在以下研究中成为公认的领导者： 低血糖和闭环治疗。拟议的研究是新颖的，重要的，可能会取得进展 我们不仅了解T1 D和低血糖，而且还了解一般的闭环血糖控制。

Despite improvements in the management of type 1 diabetes (T1D), including insulin analogs, insulin pump therapy, and most recently, continuous glucose monitoring, the risk of hypoglycemia continues to serve as a major barrier to the achievement of near-normal glucose control. Two common obstacles to near-normal glucose control remain night-time hypoglycemia and post-prandial glycemic instability. Decreased hormonal counter-regulatory responsiveness to hypoglycemia at night and after repeated episodes of hypoglycemia places patients with T1D attempting to achieve tight control at high risk of severe hypoglycemia due to hypoglycemia unawareness. Non-physiological insulin delivery frequently results in early post-prandial hyperglycemia and late post-prandial hyperinsulinemia, affecting not only glycemic control but also contributing as well to unpredictable daytime hypoglycemia. It is likely that no manual, "open-loop" therapeutic insulin regimen will be able to optimally control glycemia in patients with T1D, and biological islet- cell replacement is presently unfeasible. "Closed-loop" automated artificial pancreas systems, consisting of an insulin pump to precisely deliver variable amounts of insulin, a continuous glucose sensor to accurately determine the glucose levels, and effective algorithms to determine insulin delivery rates based on real-time glucose readings, remains the most promising intervention to control glycemia and reduce hypoglycemia exposure. The objectives of this study are (1) to determine whether night-time closed-loop therapy can reduce or eliminate nocturnal hypoglycemia and restore counter-regulatory hormone responsiveness to hypoglycemia in subjects with recurrent nocturnal hypoglycemia; and (2) to investigate whether the use of incretins such as pramlintide and exenatide, when used in conjunction with closed-loop therapy, can optimize prandial glycemic control, eliminating or reducing both early post-prandial hyperglycemia and late post-prandial hypoglycemia. These studies will be performed with the Medtronic ePID system, which in several studies, has shown promise as a first-generation closed-loop device. Our center has a demonstrated track record in clinical T1D research and a well-recognized leader in studies involving hypoglycemia and closed-loop therapy. The proposed studies are novel, important, and likely to advance our understanding not only of T1D and hypoglycemia, but also closed-loop glucose control in general.