Efficacy of dual-hormone artificial pancreas to alleviate the carbohydrate-counting burden of type 1 diabetes: A randomized crossover trial

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• 作者：V. Gingras^a ; ^b ; R. Rabasa-Lhoret^a ; ^b ; ^c ; ^d ; ^f ; ^{remi.rabasa-lhoret@ircm.qc.ca" class="auth_mail" title="E-mail the corresponding author} ; V. Messier^a ; M. Ladouceur^d ; L. Legault^e ; A. Haidar^a ; ^f
• 关键词：Artificial pancreas ; Carbohydrate-counting ; Closed-loop hormonal delivery systems ; Continuous glucose monitoring ; Type 1 diabetes
• 刊名：Diabetes & Metabolism
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：42
• 期：1
• 页码：47-54
• 全文大小：867 K

文摘

Carbohydrate-counting is a complex task for many patients with type 1 diabetes. This study examined whether an artificial pancreas, delivering insulin and glucagon based on glucose sensor readings, could alleviate the burden of carbohydrate-counting without degrading glucose control.

Methods

Twelve adults were recruited into a randomized, three-way, crossover trial (ClinicalTrials.gov identifier No. class="interref" data-locatorType="ctgov" data-locatorKey="NCT01930097">NCT01930097). Participants were admitted on three occasions from 7AM to 9PM and consumed a low-carbohydrate breakfast (women: 30 g; men: 50 g), a medium-carbohydrate dinner (women: 50 g; men: 70 g) and a high-carbohydrate lunch (women: 90 g; men: 120 g). At each visit, glucose levels were randomly regulated by: (1) conventional pump therapy; (2) an artificial pancreas (AP) accompanied by prandial boluses, matching the meal's carbohydrate content based on insulin-to-carbohydrate ratios (AP with carbohydrate-counting); or (3) an AP accompanied by prandial boluses based on qualitative categorization (regular or large) of meal size (AP without carbohydrate-counting).

Results

The AP without carbohydrate-counting achieved similar incremental AUC values compared with carbohydrate-counting after the low- (P = 0.54) and medium- (P = 0.38) carbohydrate meals, but yielded higher post-meal excursions after the high-carbohydrate meal (P = 0.004). The AP with and without carbohydrate-counting yielded similar mean glucose levels (8.2 ± 2.1 mmol/L vs. 8.4 ± 1.7 mmol/L; P = 0.52), and both strategies resulted in lower mean glucose compared with conventional pump therapy (9.6 ± 2.0 mmol/L; P = 0.02 and P = 0.03, respectively).

Conclusion

The AP with qualitative categorization of meal size could alleviate the burden of carbohydrate-counting without compromising glucose control, although more categories of meal sizes are probably needed to effectively control higher-carbohydrate meals.