Artificial Pancreas - Adolescent Physiology and Psychology Longitudinal Evaluation (A.P. APPLE)

摘要/摘要 该项目解决了1型糖尿病(T1D)临床护理中可能面临的最大挑战： 在11-15岁的青春期，HbA1c水平令人难以置信地上升。这一涨势似乎是 部分由生理变化(胰岛素抵抗增加)驱动，这些变化没有得到充分的解决 因为心理社会挑战(包括家庭冲突、同伴影响和糖尿病困扰)。我们 建议对青少年进行为期两年的纵向跟踪，评估这些生理因素和 探索性目标遵循心理社会因素，以及测试一种有前景的人工干预 胰腺(AP)。这项研究题为《人工胰腺青少年生理学和心理社会研究》 纵向评估。 我们假设长期使用AP系统(Tandem的控制智商，与通常的护理+CGM相比) 这将在一定程度上削弱通常可以看到的HbA1c的上升。然而，即使是测试这种干预，这也是 项目提供了关于控制组参与者所见变化自然历史的有价值的观察数据 一群人。我们将按身体部位(肝脏与肌肉/脂肪组织)追踪胰岛素抵抗的变化。 在青春期发育过程中使用稳定同位素三示踪混合餐测试，揭示了新的信息 关于青春期相关的胰岛素抵抗是如何通过身体各部分随时间演变的，以及AP如何 可能会对这些变化做出反应。我们还将跟踪家庭冲突的关键心理社会过程，同龄人 影响、糖尿病痛苦、抑郁和生活质量评估他们的时间关系 最优控制。遵循这些过程可能有助于药理学或心理学的应用 改善青少年控制的方法--无论是否使用AP。最后，我们将遵循现代 T1D控制的标记，包括范围内时间和血糖变异性，以记录提供商如何实现这些 青春期发育过程中的因素变化及其与生理和心理社会变化的关系。 这项研究利用弗吉尼亚大学糖尿病技术中心作为环境 在血糖、生理和心理社会因素的每一个领域都有专业知识-以及 开发一种在短期试验中有效降低HbA1c的AP系统。 在最近的研究中，青春期的次优控制变得更加明显，并有助于 长期并发症。该项目将为AP使用的持久性提供有价值的线索 青少年以及胰岛素抵抗增加和心理社会障碍的贡献-长期 改善青少年T1D的控制和长期健康的目标。

SUMMARY / ABSTRACT This project addresses what is perhaps the biggest challenge in the clinical care of Type 1 diabetes (T1D): the incredible rise in HbA1c levels seen during the adolescent age span of 11-15 years. This rise appears to be driven by physiologic changes (an increase in insulin resistance) that are not adequately addressed, in part because of psychosocial challenges (including family conflict, peer influence, and diabetes distress). We propose to follow adolescents longitudinally for two years, with assessment of these physiologic factors and exploratory aim following psychosocial factors, as well as testing a promising intervention in the artificial pancreas (AP). This study is titled A.P. APPLE for Artificial Pancreas Adolescent Physiology and Psychosocial Longitudinal Evaluation. We hypothesize that long-term use of an AP system (Tandem's Control-IQ, compared to Usual Care+CGM) will in part blunt the rise in HbA1c that is typically seen. However, even apart from testing this intervention, this project offers valuable observational data on the natural history of changes seen in participants in the control group. We will follow changes in insulin resistance by body compartment (liver vs. muscle/adipose tissue) during pubertal progression using stable-isotope triple-tracer mixed meal tests, revealing novel information about how puberty-related insulin resistance evolves over time by body compartment—as well as how the AP might respond to these changes. We will also follow key psychosocial processes of family conflict, peer influence, diabetes distress, depression and quality of life to evaluate their temporal relationships to sub- optimal control. Following these processes may help in the application of pharmacologic or psychologic approaches to improve adolescent control—either with or without AP use. Finally, we will follow modern markers of T1D control, including time-in-range and glycemic variability to document for providers how these factors change during pubertal progression and how they are related to physiologic and psychosocial changes. This study takes advantage of the University of Virginia Center for Diabetes Technology as an environment with expertise in each of the domains of glycemia, physiology and psychosocial factors—as well as development of an AP system that is effective in short-term trials at reducing HbA1c. The sub-optimal control during adolescence has gotten more pronounced in recent studies and contributes to long-term complications. This project will provide valuable clues about the durability of AP use among adolescents as well the contribution of rising insulin resistance and psychosocial barriers—with a long-term goal of improving control and long-term health of adolescents with T1D.