Jacobs Peter G, Levy Carol J, Brown Sue A, Riddell Michael C, Cinar Ali, Boughton Charlotte K, Breton Marc D, Dassau Eyal, Forlenza Greg, Henderson Robert J, Hovorka Roman, Maahs David M, Munshi Medha, Murphy Helen, Polsky Sarit, Pratley Richard, Putman Melissa S, Shah Viral N, Wilson Leah M, Zisser Howard, Ekhlaspour Laya
College of Bioengineering, Oregon State University, Corvallis, OR, USA.
Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
J Diabetes Sci Technol. 2025 Jul;19(4):937-949. doi: 10.1177/19322968251338754. Epub 2025 Jul 1.
BACKGROUND: Since the discovery of the life-saving hormone insulin in 1921 by Dr Frederick Banting in 1921, there have been many critical discoveries and technical breakthroughs that have enabled people living with type 1 diabetes (T1D) to live longer, healthier lives. The development of insulin pumps, continuous glucose monitoring (CGM) systems, and automated insulin delivery (AID) systems have enabled people living with T1D to safely manage their glucose, reduce their HbA1c, and improve their overall health and quality of life. Nevertheless, AID systems are not yet designed for all people with T1D, and they perform best during the overnight period when meals and exercise are not occurring. AID systems are not fully automated in that they require the person using the system to announce meals and exercise to the system to avoid dangerous hyper- or hypoglycemia, respectively. METHODS: In this review, which is one of a collection of manuscripts to commemorate the 75th anniversary of the National Institute for Diabetes and Digestive and Kidney Diseases, we celebrate the commercialization of the AID and discuss the major challenges and research gaps that remain to be solved to enable single- and multi-hormone AID systems to more fully support glucose management in people living with T1D. RESULTS: More research is required to design and evaluate more intelligent AID systems that do not require accurate carbohydrate estimations or announcements for meals and exercise. Current AID systems are also not designed to be used by older adults or pregnant people. Results are presented on new AID systems that can automatically respond to meals and exercise. Results are also presented on evaluations of AID systems in older adults and pregnant people. CONCLUSIONS: Next-generation AID systems will need to support all people, including older adults, people during pregnancy, athletes, and people who may be too busy to announce carbohydrates or exercise to the system. Solutions are now becoming available that will enable AID systems to support a broader range of people living with T1D by leveraging the latest technologies in artificial intelligence and adaptive control.
背景：自1921年弗雷德里克·班廷博士发现挽救生命的激素胰岛素以来，已有许多重大发现和技术突破，使1型糖尿病（T1D）患者能够活得更长、更健康。胰岛素泵、持续葡萄糖监测（CGM）系统和自动胰岛素输送（AID）系统的发展，使T1D患者能够安全地管理血糖、降低糖化血红蛋白（HbA1c）水平，并改善整体健康和生活质量。然而，AID系统尚未针对所有T1D患者进行设计，且在无进餐和运动的夜间时段性能最佳。AID系统并非完全自动化，因为使用该系统的人需要分别向系统告知进餐和运动情况，以避免危险的高血糖或低血糖。 方法：在本综述中，作为纪念美国国立糖尿病、消化和肾脏疾病研究所成立75周年的系列稿件之一，我们对AID的商业化表示庆贺，并讨论了单激素和多激素AID系统更全面支持T1D患者血糖管理仍有待解决的主要挑战和研究空白。 结果：需要开展更多研究来设计和评估更智能的AID系统，这类系统无需精确估算碳水化合物含量，也无需告知进餐和运动情况。目前的AID系统也并非为老年人或孕妇设计。文中呈现了可自动响应进餐和运动的新型AID系统的相关结果，还展示了针对老年人和孕妇的AID系统评估结果。 结论：下一代AID系统需要支持所有人群，包括老年人、孕妇、运动员以及可能太忙而无法向系统告知碳水化合物摄入量或运动情况的人群。利用人工智能和自适应控制的最新技术，现已出现一些解决方案，可使AID系统支持更广泛的T1D患者群体。
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