Bally Lia, Thabit Hood, Hovorka Roman
University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
BMC Med. 2017 Jan 23;15(1):14. doi: 10.1186/s12916-017-0794-8.
Rapid progress over the past decade has been made with the development of the 'Artificial Pancreas', also known as the closed-loop system, which emulates the feedback glucose-responsive functionality of the pancreatic beta cell. The recent FDA approval of the first hybrid closed-loop system makes the Artificial Pancreas a realistic therapeutic option for people with type 1 diabetes. In anticipation of its advent into clinical care, we provide a primer and appraisal of this novel therapeutic approach in type 1 diabetes for healthcare professionals and non-specialists in the field.
Randomised clinical studies in outpatient and home settings have shown improved glycaemic outcomes, reduced risk of hypoglycaemia and positive user attitudes. User input and interaction with existing closed-loop systems, however, are still required. Therefore, management of user expectations, as well as training and support by healthcare providers are key to ensure optimal uptake, satisfaction and acceptance of the technology. An overview of closed-loop technology and its clinical implications are discussed, complemented by our extensive hands-on experience with closed-loop system use during free daily living.
The introduction of the artificial pancreas into clinical practice represents a milestone towards the goal of improving the care of people with type 1 diabetes. There remains a need to understand the impact of user interaction with the technology, and its implication on current diabetes management and care.
在过去十年中，“人工胰腺”（也称为闭环系统）取得了快速进展，该系统模拟了胰腺β细胞的反馈性葡萄糖反应功能。美国食品药品监督管理局（FDA）最近批准了首个混合闭环系统，这使得人工胰腺成为1型糖尿病患者切实可行的治疗选择。在其即将进入临床护理之际，我们为该领域的医疗专业人员和非专家提供了关于1型糖尿病这种新型治疗方法的入门介绍和评估。
门诊和家庭环境中的随机临床研究表明，血糖结果得到改善，低血糖风险降低，用户态度积极。然而，仍然需要用户输入以及与现有闭环系统进行交互。因此，管理用户期望以及医疗服务提供者的培训和支持是确保该技术得到最佳应用、满意度和接受度的关键。本文讨论了闭环技术及其临床意义，并辅以我们在日常生活中使用闭环系统的丰富实践经验。
将人工胰腺引入临床实践是朝着改善1型糖尿病患者护理这一目标迈出的一个里程碑。仍有必要了解用户与该技术的交互影响及其对当前糖尿病管理和护理的意义。
