Irsigler K, Kritz H, Lovett R G
Crit Rev Ther Drug Carrier Syst. 1985;1(3):189-280.
Diabetes not only requires correction of an insulin deficiency but it also demands adequate insulin delivery. A short historical review is given over the first 60 years of insulin treatment, where emphasis was mainly on the correction of insulin deficiency. Despite concerted efforts, metabolic results were often poor, and there was a high incidence of late complications, which will be described briefly. A major aim of new treatment approaches, which emphasizes better routes of insulin delivery, is the prevention or reversal of these late complications. Closed-loop systems are infusion systems located outside the body which deliver insulin according to glucose values that are measured continuously. The state of the art for such systems will be described with examples of clinical applications and results. These systems aid and stimulate research, but offer no long-term application for treatment. Open-loop systems are portable, both external and implantable, and lack an accurate glucose sensor so that the loop can be closed. A number of insulin delivery systems have been developed in this category ranging from highly complex, fully implantable units, programable from outside, to simple basal-rate infusion pumps. Various pumps are designed to be used with varying delivery routes, and the evaluation of different routes will be a vital topic in this article. Pros and cons of the intravenous, intraperitoneal, and subcutaneous routes will be discussed, with supporting research referenced. Clinical experience will be cited for both the complex and the simple infusion systems. Other topics to be covered include feasibility of long-term treatment, complications of this new treatment approach, guidelines for patient instruction and supervision, requirements for treatment of large patient groups with pumps in a modern diabetes center, requirements for the physician, the influence of improved metabolic control on late complications (prevention or regression), the possibility for a portable closed-loop system, and future outlook. The primary author is the founder of an international study group on diabetes treatment with implantable insulin delivery devices. The common goals of this study group will also be presented. Special emphasis will be placed on a differentiated approach to treatment of Type I and Type II diabetes with a family of devices. Clinical work and results from a large patient group will be included throughout.
糖尿病不仅需要纠正胰岛素缺乏，还需要足够的胰岛素输送。本文对胰岛素治疗的前60年进行了简要的历史回顾，这一时期主要强调纠正胰岛素缺乏。尽管付出了共同努力，但代谢结果往往不佳，晚期并发症的发生率很高，本文将对此进行简要描述。强调更好的胰岛素输送途径的新治疗方法的一个主要目标是预防或逆转这些晚期并发症。闭环系统是位于体外的输注系统，它根据连续测量的葡萄糖值输送胰岛素。本文将通过临床应用和结果的实例来描述此类系统的技术现状。这些系统有助于并刺激研究，但不提供长期治疗应用。开环系统是便携式的，包括外部和可植入式，并且缺乏精确的葡萄糖传感器，因此无法实现闭环。这一类已经开发了许多胰岛素输送系统，从高度复杂的、可从外部编程的完全植入式装置到简单的基础率输注泵。各种泵设计用于不同的输送途径，不同途径的评估将是本文的一个重要主题。将讨论静脉内、腹膜内和皮下途径的优缺点，并引用相关研究作为支持。将引用复杂和简单输注系统的临床经验。其他要涵盖的主题包括长期治疗的可行性、这种新治疗方法的并发症、患者指导和监督指南、现代糖尿病中心用泵治疗大量患者群体的要求、对医生的要求、改善代谢控制对晚期并发症（预防或逆转）的影响、便携式闭环系统的可能性以及未来展望。第一作者是一个关于可植入胰岛素输送装置治疗糖尿病的国际研究小组的创始人。还将介绍该研究小组的共同目标。将特别强调用一系列装置对I型和II型糖尿病进行差异化治疗的方法。全文将包括大量患者群体的临床工作和结果。
