英国剑桥大学研究人员日前报告说，他们研发出一种智能“人工胰腺”，这种装置可以随着人体内血糖浓度的变化自动调整胰岛素的输入量，从而使糖尿病患者更好地控制血糖。
剑桥大学研究人员在最新一期《柳叶刀》杂志上报告说，这种“人工胰腺”使用的是市面上已有的血糖检测装置和胰岛素泵，但控制它们的是一种新的软件，可以根据监测到的人体血糖浓度实时调整，计算出所需要的胰岛素量，从而实现智能化补充胰岛素。
研究人员对17名患有I型糖尿病的青少年进行了临床测试，结果发现与普通的定时定量补充胰岛素的装置相比，智能“人工胰腺”可以在60%的时间里将血糖浓度控制在正常范围，而普通装置的这一比例仅为40%。
此外，睡眠时血糖过低是I型糖尿病患者接受胰岛素治疗时常出现的问题，尤其是在晚上大吃一顿或是进行体育活动之后，身体对胰岛素的需求量都会发生变化，普通装置无法适应这一变化，而新装置解决了这一问题。
参与研究的剑桥大学博士霍沃尔卡说，这是首次通过临床测试证实，可以利用良好的软件程序将常见的血糖检测和胰岛素补充装置结合在一起，实现胰岛素的智能化补充，这将有助于糖尿病患者保持健康。
推荐原始出处：
The Lancet, Early Online Publication, 5 February 2010doi:10.1016/S0140-6736(09)61998-X
Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: a phase 2 randomised crossover trial
Dr Roman Hovorka PhD a b , Janet M Allen RN a b, Daniela Elleri MD a b, Ludovic J Chassin PhD a b, Julie Harris RN b, Dongyuan Xing MPH c, Craig Kollman PhD c, Tomas Hovorka MSc a, Anne Mette F Larsen MSc a b, Marianna Nodale MSc a, Alessandra De Palma MD a, Malgorzata E Wilinska PhD a b, Carlo L Acerini MD a b, Prof David B Dunger MD a b
Background
Closed-loop systems link continuous glucose measurements to insulin delivery. We aimed to establish whether closed-loop insulin delivery could control overnight blood glucose in young people.
Methods
We undertook three randomised crossover studies in 19 patients aged 5―18 years with type 1 diabetes of duration 64 years (SD 40). We compared standard continuous subcutaneous insulin infusion and closed-loop delivery (n=13; APCam01); closed-loop delivery after rapidly and slowly absorbed meals (n=7; APCam02); and closed-loop delivery and standard treatment after exercise (n=10; APCam03). Allocation was by computer-generated random code. Participants were masked to plasma and sensor glucose. In APCam01, investigators were masked to plasma glucose. During closed-loop nights, glucose measurements were fed every 15 min into a control algorithm calculating rate of insulin infusion, and a nurse adjusted the insulin pump. During control nights, patients' standard pump settings were applied. Primary outcomes were time for which plasma glucose concentration was 391―800 mmol/L or 390 mmol/L or lower. Analysis was per protocol. This trial is registered, number ISRCTN18155883.
Findings
17 patients were studied for 33 closed-loop and 21 continuous infusion nights. Primary outcomes did not differ significantly between treatment groups in APCam01 (12 analysed; target range, median 52% [IQR 43―83] closed loop vs 39% [15―51] standard treatment, p=006; ≤390 mmol/L, 1% [0―7] vs 2% [0―41], p=013), APCam02 (six analysed; target range, rapidly 53% [48―57] vs slowly absorbed meal 55% [37―64], p=097; ≤390 mmol/L, 0% [0―4] vs 0% [0―0], p=016]), and APCam03 (nine analysed; target range 78% [60―92] closed loop vs 43% [25―65] control, p=00245, not significant at corrected level; ≤390 mmol/L, 10% [2―15] vs 6% [0―44], p=027). A secondary analysis of pooled data documented increased time in the target range (60% [51―88] vs 40% [18―61]; p=00022) and reduced time for which glucose concentrations were 390 mmol/L or lower (21% (00―100) vs 41% (00―420); p=00304). No events with plasma glucose concentration lower than 30 mmol/L were recorded during closed-loop delivery, compared with nine events during standard treatment.
Interpretation
Closed-loop systems could reduce risk of nocturnal hypoglycaemia in children and adolescents with type 1 diabetes.
Funding
Juvenile Diabetes Research Foundation; European Foundation for Study of Diabetes; Medical Research Council Centre for Obesity and Related Metabolic Diseases; National Institute for Health Research Cambridge Biomedical Research Centre.
