Thabit Hood, Hovorka Roman
Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
Curr Opin Endocrinol Diabetes Obes. 2014 Apr;21(2):95-101. doi: 10.1097/MED.0000000000000048.
To highlight the recent advances in closed-loop research, the development and progress towards utilizing closed loop outside of the clinical research setting and at patients' homes.
In spite of the modern insulin therapy in type 1 diabetes, hypoglycaemia is still a major limiting factor. This often leads to suboptimal glycaemic control and risk of diabetes complications. Closed loop has been shown to improve glycaemic control whilst avoiding hypoglycaemia. Incremental progress has been made in this field, from the use of automated systems and bihormonal closed-loop systems in clinical research facility settings under close supervision to the use of ambulatory closed-loop prototype at patients' homes in free-living conditions. Different population of patients with type 1 diabetes and control algorithm approaches have been studied, assessing the efficacy and safety. Transitional and home studies present different challenges at achieving better glycaemic outcome with closed loop. Improved glucose sensor reliability may accelerate the clinical use and faster insulin analogues increase the clinical utility.
Results and experience with closed-loop insulin delivery have been encouraging, leading the way for future improvements and development in the field, to make closed loop suitable for use in clinical practice.
强调闭环研究的最新进展，以及在临床研究环境之外和患者家中使用闭环的发展与进步。
尽管1型糖尿病有现代胰岛素疗法，但低血糖仍是一个主要限制因素。这常常导致血糖控制不理想以及糖尿病并发症风险。已证明闭环可改善血糖控制，同时避免低血糖。该领域已取得渐进式进展，从在密切监督下的临床研究机构环境中使用自动化系统和双激素闭环系统，发展到在自由生活条件下患者家中使用动态闭环原型。已对不同人群的1型糖尿病患者和控制算法方法进行了研究，评估其疗效和安全性。过渡性研究和家庭研究在通过闭环实现更好的血糖结果方面面临不同挑战。葡萄糖传感器可靠性的提高可能会加速临床应用，更快起效的胰岛素类似物会增加临床实用性。
闭环胰岛素给药的结果和经验令人鼓舞，为该领域未来的改进和发展指明了方向，以使闭环适用于临床实践。
