Feasibility of Closed- Loop Insulin Delivery in Type 2 Diabetes: A Randomized Controlled Study

被引:44
作者
Kumareswaran, Kavita
Thabit, Hood
Leelarathna, Lalantha
Caldwell, Karen
Elleri, Daniela
Allen, Janet M.
Nodale, Marianna
Wilinska, Malgorzata E.
Evans, Mark L.
Hovorka, Roman [1 ]
机构
[1] Univ Cambridge, Metab Res Labs, Cambridge, England
基金
英国医学研究理事会;
关键词
ARTIFICIAL PANCREAS; REAL-TIME; CARE; HYPERGLYCEMIA; EFFICACY;
D O I
10.2337/dc13-1030
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVEClosed-loop insulin delivery offers a promising treatment option, but to date, it has only been evaluated in type 1 diabetes. Our aim was to evaluate the feasibility of fully closed-loop subcutaneous insulin delivery in insulin-naive patients with type 2 diabetes.RESEARCH DESIGN AND METHODSTwelve subjects (seven males, age 57.2 years, BMI 30.5 kg/m(2)) with noninsulin-treated type 2 diabetes (HbA(1c) 8.4% [68 mmol/mol], diabetes duration 7.6 years) underwent two 24-h visits (closed-loop and control) in a randomized crossover design. During closed-loop visits, the subjects' routine diabetes therapy was replaced with model predictive control algorithm-driven subcutaneous insulin pump delivery based on real-time continuous glucose monitoring. Meals were unannounced, and no additional insulin was administered for carbohydrates consumed. During control visits, the usual diabetes regimen was continued (metformin 92%, sulfonylureas 58%, dipeptidyl peptidase-4 inhibitors 33%). On both visits, subjects consumed matched 50- to 80-g carbohydrate meals and optional 15-g carbohydrate snacks and remained largely sedentary. Plasma glucose measurements evaluated closed-loop performance.RESULTSCompared with conventional therapy, 24 h of closed-loop insulin delivery increased overall the median time in target plasma glucose (3.9-8.0 mmol/L) from 24 to 40% (P = 0.016), despite sensor under-reading by a median of 1.2 mmol/L. The benefit of the closed-loop system was more prominent overnight, with greater time in target glucose (median 78 vs. 35%; P = 0.041) and less time in hyperglycemia (22 vs. 65%; P = 0.041). There was no hypoglycemia during either intervention.CONCLUSIONSA closed-loop system without meal announcement and using subcutaneous insulin delivery in insulin-naive patients with type 2 diabetes appears feasible and safe. Improvement in postprandial glucose control may require further optimization of system performance.
引用
收藏
页码:1198 / 1203
页数:6
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