Department of Endocrinology and Nutrition and Diabetes Technology Unit, Badajoz University Hospital. Badajoz, Spain.
Department of Paediatrics, Diabetes Technology Unit, Badajoz University Hospital. Badajoz, Spain.
Diabetes Technol Ther. 2021 Sep;23(9):609-615. doi: 10.1089/dia.2021.0037. Epub 2021 Apr 20.
Advanced hybrid closed-loop (AHCL) systems represent the next step of automation intended to maximize normoglycemia in people with type 1 diabetes (T1D). In the AHCL MiniMed 780G system, different algorithm glucose targets for insulin infusion are available and autocorrection boluses are delivered. The aim was to prospectively evaluate the impact of the implementation of this AHCL system in a clinical setting. T1D subjects using a sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS) were upgraded to AHCL. Baseline, every 3 days, 2-week and 1-month sensor and pump data were downloaded. Glucose target was set to 100 mg/dL and active insulin time to 2 h for all the subjects. Time in different glucose ranges was compared. Fifty-two T1D subjects were included (age: 43 ± 12 years, 73% females, diabetes duration: 27 ± 11 years, HbA1c: 7.2% ± 0.9%, time in SAP-PLGS: 5 ± 2 years). Time in range (TIR) 70-180 mg/dL increased from 67.3% ± 13.6% at baseline to 79.6% ± 7.9% at 1 month ( = 0.001). Time in hyperglycemia >180 and >250 mg/dL decreased from 29.4% ± 15.1% to 17.3% ± 8.6% and from 6.9% ± 7.8% to 2.5% ± 2.4%, respectively ( = 0.001). No differences in time in hypoglycemia <70 or <54 mg/dL were found. Time in Auto Mode was 97% ± 4%, and autocorrection insulin was 31% ± 14% of bolus insulin. Four hours postprandial glucose was improved from 162 ± 26 mg/dL at baseline to 142 ± 16 mg/dL at 1 month ( = 0.001). No severe hypoglycemia or diabetic ketoacidosis episodes occurred. AHCL systems allow well-controlled T1D patients to rapidly increase their TIR. The most aggressive settings allow optimal outcomes in TIR, without increasing hypoglycemia frequency.
高级混合闭环 (AHCL) 系统代表了自动化的下一步，旨在最大限度地使 1 型糖尿病 (T1D) 患者的血糖正常化。在 MiniMed 780G 系统中，有不同的胰岛素输注算法血糖目标，并进行自动校正推注。目的是前瞻性评估在临床环境中实施这种 AHCL 系统的影响。 使用具有预测性低血糖暂停 (SAP-PLGS) 的传感器增强型泵的 T1D 患者升级为 AHCL。下载基线、每 3 天、2 周和 1 个月的传感器和泵数据。所有受试者的血糖目标设定为 100mg/dL，有效胰岛素时间为 2h。比较不同血糖范围的时间。 52 名 T1D 患者入选（年龄：43±12 岁，73%为女性，糖尿病病程：27±11 年，HbA1c：7.2%±0.9%，SAP-PLGS 时间：5±2 年）。70-180mg/dL 的时间（TIR）从基线时的 67.3%±13.6%增加到 1 个月时的 79.6%±7.9%（ = 0.001）。高血糖 >180 和 >250mg/dL 的时间从 29.4%±15.1%降至 17.3%±8.6%和 6.9%±7.8%降至 2.5%±2.4%（ = 0.001）。低血糖 <70 或 <54mg/dL 的时间无差异。自动模式时间为 97%±4%，自动校正胰岛素为推注胰岛素的 31%±14%。餐后 4 小时血糖从基线时的 162±26mg/dL 改善至 1 个月时的 142±16mg/dL（ = 0.001）。未发生严重低血糖或糖尿病酮症酸中毒事件。 AHCL 系统允许血糖控制良好的 T1D 患者迅速增加 TIR。最激进的设置可以在不增加低血糖频率的情况下获得最佳 TIR 结果。
