a Wellcome Trust-MRC Institute of Metabolic Science , University of Cambridge , Cambridge , UK.
b Department of Paediatrics , University of Cambridge , Cambridge , UK.
Expert Opin Drug Deliv. 2017 Dec;14(12):1367-1377. doi: 10.1080/17425247.2017.1360866. Epub 2017 Aug 18.
Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements. Areas covered: This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials. Expert opinion: Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.
由于儿童和青少年 1 型糖尿病患者夜间胰岛素需求变化较大，夜间血糖控制仍然具有挑战性。通过基于实时连续血糖测量的葡萄糖反应性胰岛素输送可以解决这个问题。
本文从儿科的角度概述了葡萄糖反应性胰岛素输送系统的最新进展。我们涵盖了基于阈值的暂停应用、预测性低血糖暂停，以及更先进的单激素和双激素闭环系统。这些方法是根据夜间血糖控制进行评估的，特别是在门诊随机对照试验期间。
在过去的十年中，已经在将研究从受控临床中心环境转化为自由生活的无人监督家庭研究方面取得了重大进展。闭环系统可以改善夜间血糖控制，同时降低低血糖的风险。在美国批准首个非儿科人群的混合闭环系统后，正在进行或准备进行大型多国闭环临床试验和关键性研究，包括儿科人群，以促进闭环系统在临床实践中的应用。
