Yafi Michael, Shah Avni, Velez Katherine
Division of Endocrinology, Department of Pediatrics, McGovern Medical School at the University Texas Health Houston, Houston, TX, USA.
Transl Pediatr. 2023 Sep 18;12(9):1725-1734. doi: 10.21037/tp-23-145. Epub 2023 Sep 14.
Type 1 diabetes, the most common cause of diabetes in pediatrics, is defined by the hyperglycemia that results from the permanent autoimmune damage to the pancreas. The Diabetes Control and Complications Trial (DCCT) demonstrated that strict glycemic control targeting lower HbA1c goals can both delay the onset and progression of its complications that include diabetic neuropathy, nephropathy, retinopathy, and increased cardiovascular events. Our primary objective is to review the literature available regarding the technology applied for the treatment of diabetes, not only aiding patients' quality of life but addressing its effects on hypoglycemia and reduced risk of the long-term complications. It will synthesize the evolution of glucose monitoring devices; the development of insulin: from animal to recombinant engineering, smart insulin in the future; the development of algorithm-driven insulin delivery devices, the closed loop system/artificial pancreas; and the future utilization of technology to support islet cell transplant with the goal of a long-term cure. Emphasis will be made on what is known about the impact on its outcomes in children and adolescents.
A literature search was conducted using PubMed for publications from 1985 to present. Keywords used: type 1 diabetes, children, adolescents, pediatrics, continuous glucose monitoring (CGM), insulin pumps. Referenced articles include other reviews, current care guidelines as supported by cross sectional studies, cohort studies and randomized clinical trials.
Understanding the pathophysiology of type 1 diabetes has led to the design of technology that facilitates glucose monitoring and insulin administration in a personalized manner. The current technology has improved outcomes and quality of life by decreasing hypoglycemic events and decreasing risk of long-term metabolic complications. Barriers remain, for children and adults, often driven by patient's preference as well as their understanding of the limitations of what they are wearing.
With the progressive evolution of this technology, it is now realistic to lower the burden of diabetes self-management while reducing hypoglycemia and risk of complications that otherwise impact daily life from academics, physical activity, career choices and even life expectancy.
1型糖尿病是儿科糖尿病最常见的病因，其定义为胰腺因永久性自身免疫损伤导致的高血糖。糖尿病控制与并发症试验（DCCT）表明，以更低的糖化血红蛋白（HbA1c）目标为导向的严格血糖控制，可延缓其并发症的发生和发展，这些并发症包括糖尿病神经病变、肾病、视网膜病变以及心血管事件增加。我们的主要目的是回顾现有关于糖尿病治疗技术的文献，这些技术不仅有助于提高患者生活质量，还能解决其对低血糖的影响以及降低长期并发症风险。它将综合葡萄糖监测设备的演变；胰岛素的发展：从动物胰岛素到重组工程胰岛素，未来的智能胰岛素；算法驱动胰岛素输送设备、闭环系统/人工胰腺的发展；以及未来利用技术支持胰岛细胞移植以实现长期治愈的目标。重点将放在已知的该技术对儿童和青少年治疗效果的影响上。
使用PubMed对1985年至今的出版物进行文献检索。使用的关键词：1型糖尿病、儿童、青少年、儿科、持续葡萄糖监测（CGM）、胰岛素泵。参考文献包括其他综述、横断面研究、队列研究和随机临床试验支持的当前护理指南。
对1型糖尿病病理生理学的理解促使了个性化血糖监测和胰岛素给药技术的设计。当前技术通过减少低血糖事件和降低长期代谢并发症风险，改善了治疗效果和生活质量。障碍依然存在，对于儿童和成人来说，这些障碍往往由患者的偏好以及他们对所佩戴设备局限性的理解所驱动。
随着这项技术的不断发展，现在降低糖尿病自我管理负担、同时减少低血糖以及并发症风险是现实可行的，否则这些并发症会影响日常生活，包括学业、体育活动、职业选择甚至预期寿命。
