Hovorka Roman
Diabetes Modelling Group, Institute of Medical Science, University of Cambridge, Box 289, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
Curr Diabetes Rev. 2008 Aug;4(3):269-79. doi: 10.2174/157339908785294479.
Improvements in accuracy of real-time continuous glucose monitoring facilitate the development of closed-loop systems consisting of a continuous glucose monitor, a control algorithm, and an insulin pump. Closed-loop systems can be divided according to the way meal delivery is handled as "fully closed-loop" or "closed-loop" with meal announcement systems. Depending on the subcutaneous (sc) or intravenous (iv) body interface, three major types of closed-loop systems are recognised, (i) sc sensing and sc delivery system, (ii) the iv sensing and intraperitoneal delivery system, and (iii) the iv glucose sensing and iv insulin delivery system. Given the current research focus, this review centres on the sc-sc closed-loop approach, which has the greatest potential for a near-future commercial exploitation as recognised by the JDRF Artificial Pancreas Project. Other approaches utilising intraperitoneal or intravenous sensing/delivery are also discussed. Closed-loop systems may revolutionise diabetes management but their introduction is likely to be gradual starting from simpler applications such as hypoglycaemia prevention or overnight glucose control progressing to more complex approaches such as 24/7 glucose control. The most important question is what is achievable with existing technologies and when the first generation of closed-loop systems will find its way into clinical practice.
实时连续血糖监测准确性的提高推动了由连续血糖监测仪、控制算法和胰岛素泵组成的闭环系统的发展。闭环系统可根据处理进餐给药的方式分为“完全闭环”或带有进餐通知系统的“闭环”。根据皮下（sc）或静脉内（iv）身体接口，可识别出三种主要类型的闭环系统：（i）皮下传感和皮下给药系统，（ii）静脉传感和腹膜内给药系统，以及（iii）静脉血糖传感和静脉胰岛素给药系统。鉴于当前的研究重点，本综述聚焦于皮下-皮下闭环方法，正如糖尿病研究与防治基金会人工胰腺项目所认可的，该方法在不久的将来具有最大的商业开发潜力。还讨论了利用腹膜内或静脉内传感/给药的其他方法。闭环系统可能会彻底改变糖尿病管理，但它们的引入可能会从低血糖预防或夜间血糖控制等较简单的应用开始逐步推进，进而发展到24/7血糖控制等更复杂的方法。最重要的问题是现有技术能够实现什么，以及第一代闭环系统何时能够进入临床实践。
