期刊
DIABETES CARE
卷 37, 期 5, 页码 1198-1203出版社
AMER DIABETES ASSOC
DOI: 10.2337/dc13-1030
关键词
-
资金
- National Institute for Health Research Cambridge Biomedical Research Centre grant
- Abbott Diabetes Care (FreeStyle Navigator Continuous Glucose Monitoring and sensors)
- Medical Research Council Centre for Obesity and Related Metabolic Diseases
- Addenbrooke's Clinical Research Facility (Cambridge, U.K.)
- Medical Research Council [G0600717, MC_UU_12012/5/B, G0600717B] Funding Source: researchfish
- MRC [G0600717] Funding Source: UKRI
OBJECTIVEClosed-loop insulin delivery offers a promising treatment option, but to date, it has only been evaluated in type 1 diabetes. Our aim was to evaluate the feasibility of fully closed-loop subcutaneous insulin delivery in insulin-naive patients with type 2 diabetes.RESEARCH DESIGN AND METHODSTwelve subjects (seven males, age 57.2 years, BMI 30.5 kg/m(2)) with noninsulin-treated type 2 diabetes (HbA(1c) 8.4% [68 mmol/mol], diabetes duration 7.6 years) underwent two 24-h visits (closed-loop and control) in a randomized crossover design. During closed-loop visits, the subjects' routine diabetes therapy was replaced with model predictive control algorithm-driven subcutaneous insulin pump delivery based on real-time continuous glucose monitoring. Meals were unannounced, and no additional insulin was administered for carbohydrates consumed. During control visits, the usual diabetes regimen was continued (metformin 92%, sulfonylureas 58%, dipeptidyl peptidase-4 inhibitors 33%). On both visits, subjects consumed matched 50- to 80-g carbohydrate meals and optional 15-g carbohydrate snacks and remained largely sedentary. Plasma glucose measurements evaluated closed-loop performance.RESULTSCompared with conventional therapy, 24 h of closed-loop insulin delivery increased overall the median time in target plasma glucose (3.9-8.0 mmol/L) from 24 to 40% (P = 0.016), despite sensor under-reading by a median of 1.2 mmol/L. The benefit of the closed-loop system was more prominent overnight, with greater time in target glucose (median 78 vs. 35%; P = 0.041) and less time in hyperglycemia (22 vs. 65%; P = 0.041). There was no hypoglycemia during either intervention.CONCLUSIONSA closed-loop system without meal announcement and using subcutaneous insulin delivery in insulin-naive patients with type 2 diabetes appears feasible and safe. Improvement in postprandial glucose control may require further optimization of system performance.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据