Fuchs Julia, Hovorka Roman
Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.
Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.
Front Pediatr. 2021 Apr 30;9:679484. doi: 10.3389/fped.2021.679484. eCollection 2021.
Recent advances in diabetes technology have led to the development of closed-loop insulin delivery systems for the management of type 1 diabetes. Several such systems are now commercially available for children and young people. While all available systems have been shown to improve glycaemic control and quality of life in this population, qualitative data also highlights the challenges in using closed-loop systems, which vary among different pediatric age-groups. Very young children require systems that are able to cope with low insulin doses and significant glycaemic variability due to their high insulin sensitivity and unpredictable eating and exercise patterns. Adolescents' compliance is often related to size and number of devices, usability of the systems, need for calibrations, and their ability to interact with the system. Given the speed of innovations, understanding the capabilities and key similarities and differences of current systems can be challenging for healthcare professionals, caregivers and young people with type 1 diabetes alike. The aim of this review is to summarize the key evidence on currently available closed-loop systems for children and young people with type 1 diabetes, as well as commenting on user experience, where real-world data are available. We present findings on a system-basis, as well as identifying specific challenges in different pediatric age-groups and commenting on how current systems might address these. Finally, we identify areas for future research with regards to closed-loop technology tailored for pediatric use and how these might inform reimbursement and alleviate disease burden.
糖尿病技术的最新进展推动了用于1型糖尿病管理的闭环胰岛素输送系统的发展。目前有几种这样的系统已在市场上供儿童和年轻人使用。虽然所有可用系统都已被证明能改善这一人群的血糖控制和生活质量，但定性数据也凸显了使用闭环系统所面临的挑战，这些挑战在不同的儿科年龄组中各不相同。非常年幼的儿童需要能够应对低胰岛素剂量以及由于其高胰岛素敏感性和不可预测的饮食及运动模式导致的显著血糖波动的系统。青少年的依从性通常与设备的大小和数量、系统的易用性、校准需求以及他们与系统交互的能力有关。鉴于创新速度之快，对于医疗保健专业人员、护理人员以及1型糖尿病青少年患者来说，了解当前系统的功能以及关键的异同点可能具有挑战性。本综述的目的是总结目前针对1型糖尿病儿童和青少年可用的闭环系统的关键证据，并在有实际数据的情况下对用户体验进行评论。我们基于系统呈现研究结果，识别不同儿科年龄组中的特定挑战，并评论当前系统如何应对这些挑战。最后，我们确定了针对儿科使用的闭环技术未来的研究领域，以及这些研究如何为报销政策提供依据并减轻疾病负担。
