Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
Diabet Med. 2023 Jun;40(6):e15092. doi: 10.1111/dme.15092. Epub 2023 Mar 28.
Fully closed-loop insulin delivery has been shown in clinical trials to be safe and improve glucose control compared with standard insulin therapy in the inpatient setting. We investigated the feasibility of implementing the approved CamAPS HX fully closed-loop system in a hospital setting.
This implementation project was conducted in a large teaching hospital in Cambridge, UK. Healthcare professional training was multimodal including face-to-face workshops, online learning modules and supported by standard operating procedures. Set-up and maintenance of closed-loop devices were undertaken by the inpatient diabetes team. Selection of suitable patients was multidisciplinary and prioritised those with more challenging diabetes management. Demographic and clinical data were collected from electronic health records and diabetes data management platforms.
In the 12 months since the closed-loop system was implemented, 32 inpatients (mean ± SD age 61 ± 16 years, 8 females, 24 males) used closed-loop insulin delivery during their admission, across medical and surgical wards in the hospital with a total of 555 days of closed-loop glucose control (median [IQR]: 14 [6, 22] days per inpatient). The time spent in target glucose range 3.9-10.0 mmol/L was 53.3 ± 18.3%. Mean glucose was 10.7 ± 1.9 mmol/L with 46.0 ± 18.2% of time spent with glucose >10.0 mmol/L. Time spent with sensor glucose below 3.9 mmol/L was low (median [IQR]: 0.38 [0.00, 0.85]). There were no episodes of severe hypoglycaemia or diabetic ketoacidosis during closed-loop use.
We have demonstrated that the fully closed-loop system can be safely and effectively implemented by a diabetes outreach team in complex medical and surgical inpatients with challenging glycaemic control.
与标准胰岛素治疗相比，临床试验已经证明全闭环胰岛素输送在住院环境中是安全的，并能改善血糖控制。我们研究了在医院环境中实施经批准的 CamAPS HX 全闭环系统的可行性。
该实施项目在英国剑桥的一家大型教学医院进行。医护人员培训是多模式的，包括面对面研讨会、在线学习模块，并得到标准操作程序的支持。闭环设备的设置和维护由住院糖尿病团队负责。闭环患者的选择是多学科的，并优先选择那些血糖管理更具挑战性的患者。从电子健康记录和糖尿病数据管理平台收集人口统计学和临床数据。
在闭环系统实施后的 12 个月中，共有 32 名住院患者（平均年龄±标准差为 61±16 岁，女性 8 名，男性 24 名）在医院的内科和外科病房住院期间使用闭环胰岛素输送，共进行了 555 天的闭环血糖控制（中位数[IQR]：每名住院患者 14[6,22]天）。目标血糖范围 3.9-10.0mmol/L 的时间占 53.3±18.3%。平均血糖为 10.7±1.9mmol/L，血糖>10.0mmol/L 的时间占 46.0±18.2%。传感器血糖低于 3.9mmol/L 的时间很短（中位数[IQR]：0.38[0.00,0.85]）。闭环使用期间无严重低血糖或糖尿病酮症酸中毒发作。
我们已经证明，在血糖控制具有挑战性的复杂内科和外科住院患者中，糖尿病外展团队可以安全有效地实施全闭环系统。
