University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science , Cambridge , UK.
Expert Opin Drug Deliv. 2014 Jun;11(6):943-55. doi: 10.1517/17425247.2014.910192. Epub 2014 Apr 21.
Insulin pump technology has advanced considerably over the past three decades, leading to more favorable metabolic control and less hypoglycemic events when compared with multiple daily injection therapy. The use of insulin pumps is increasing, particularly in children and adolescents with type 1 diabetes.
This review outlines recent developments in insulin pump therapy from a pediatric perspective. 'Smart' pumps, sensor-augmented pump therapy and threshold-suspend feature of insulin pumps are reviewed in terms of efficacy, safety and psychosocial impact. The current status of closed-loop systems focusing on clinical outcomes is highlighted.
Closed-loop insulin delivery is gradually progressing from bench to the clinical practice. Longer and larger studies in home settings are needed to expand on short- to medium-term outpatient evaluations. Predictive low glucose management and overnight closed-loop delivery may be the next applications to be implemented in daily routine. Further challenges include improvements of control algorithms, sensor accuracy, duration of insulin action, integration and size of devices and connectivity and usability. Gradual improvements and increasing sophistication of closed-loop components lie on the path toward unsupervised hands-off fully closed-loop system.
胰岛素泵技术在过去三十年中得到了长足的发展，与多次每日注射治疗相比，它可以更好地控制代谢，减少低血糖事件。胰岛素泵的使用正在增加，特别是在 1 型糖尿病的儿童和青少年中。
本文从儿科角度概述了胰岛素泵治疗的最新进展。从疗效、安全性和心理社会影响方面，对“智能”泵、传感器增强型泵治疗和胰岛素泵的阈值暂停功能进行了综述。重点介绍了关注临床结果的闭环系统的现状。
闭环胰岛素输送正逐渐从实验室走向临床实践。需要在家庭环境中进行更长时间和更大规模的研究，以扩大短期至中期的门诊评估。预测性低血糖管理和夜间闭环输送可能是下一个要在日常实践中实施的应用。进一步的挑战包括改进控制算法、传感器精度、胰岛素作用持续时间、设备的集成和大小以及连接性和可用性。闭环组件的逐步改进和日益复杂，为无需监督、无需人工干预的完全闭环系统铺平了道路。
