The impact of closed-loop automated insulin delivery systems on hypoglycaemia awareness in people living with type 1 diabetes: A systematic review and meta-analysis.

IF 1.8 Q4 ENDOCRINOLOGY & METABOLISM Journal of Diabetes and Metabolic Disorders Pub Date : 2024-09-05 eCollection Date: 2024-12-01 DOI:10.1007/s40200-024-01492-6
Agathoklis Efthymiadis, Anastasios Bastounis, Linda Liu, Marianthi Bourlaki, Dimitrios Spinos, Konstantinos Tsikopoulos
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Abstract

Objectives: Impaired awareness of hyperglycaemia (IAH) affects approximately 20-40% of people living with type 1 diabetes (T1D), predisposing them to severe hypoglycaemia. This systematic review evaluated the efficacy of closed-loop automated insulin delivery systems (CL-AID) in restoring IAH compared with standard diabetes care, including other diabetes technologies.

Methods: Six electronic databases were searched for published and unpublished observational and randomised-control studies (RCTs) from inception to 29th of May 2024. The results of observational studies and RCTs were meta-analysed separately to calculate the effect of CL-AID on IAH in people living with T1D. Quality assessment of studies was performed using the Joanna-Briggs appraisal tool for cohort studies and the Risk of Bias (Rob-2) tool for RCTs.

Results: Meta-analysis of four prospective observations studies (n = 583) demonstrated a statistically significant improvement in hypoglycaemia awareness upon transition to a hybrid closed-loop (HCL) system compared with standard diabetes care in people with T1D, Clarke score mean difference (MD) of -0.45 (-0.69 to -0.22, p = 0.0001). However, this was less than 1 point, which is the minimum clinically important difference (MCID) of Clarke score. Meta-analysis of three RCTs (n = 55) comparing standard diabetes care did not demonstrate any statistically significant effect on hypoglycaemia awareness, Clarke score MD of -0.69 (-1.89 to 0.50, p = 0.26).

Conclusions: This systematic review demonstrated that transition from standard diabetes care to HCL has the potential to improve hypoglycaemia awareness in people with T1D and IAH, but this might not be of major clinical significance. Hence, psychoeducational interventions continue to be the cornerstone of IAH management. Novel therapeutic modalities, such as bi-hormonal automated delivery systems, need to be further explored to help restore hypoglycaemia awareness.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01492-6.

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闭环自动胰岛素输送系统对1型糖尿病患者低血糖意识的影响:一项系统综述和荟萃分析
高血糖意识受损影响了大约20-40%的1型糖尿病(T1D)患者,使他们易患严重的低血糖。本系统综述评估了闭环自动胰岛素输送系统(CL-AID)与标准糖尿病护理(包括其他糖尿病技术)相比在恢复IAH方面的疗效。方法:检索6个电子数据库,检索自成立至2024年5月29日已发表和未发表的观察性和随机对照研究(rct)。观察性研究和随机对照试验的结果分别进行meta分析,以计算CL-AID对T1D患者IAH的影响。采用队列研究的Joanna-Briggs评估工具和随机对照试验的偏见风险(rob2)工具对研究进行质量评估。结果:四项前瞻性观察研究(n = 583)的meta分析显示,与标准糖尿病治疗相比,T1D患者过渡到混合闭环(HCL)系统后低血糖意识有统计学意义的改善,Clarke评分平均差异(MD)为-0.45(-0.69至-0.22,p = 0.0001)。然而,这小于1分,这是克拉克评分的最小临床重要差异(MCID)。3个rct (n = 55)比较标准糖尿病护理的meta分析未显示对低血糖意识有统计学意义的影响,Clarke评分MD为-0.69 (-1.89 ~ 0.50,p = 0.26)。结论:本系统综述表明,从标准糖尿病护理到HCL的转变有可能改善T1D和IAH患者的低血糖意识,但这可能没有主要的临床意义。因此,心理教育干预仍然是IAH管理的基石。新的治疗方式,如双激素自动输送系统,需要进一步探索,以帮助恢复低血糖意识。补充资料:在线版本提供补充资料,网址为10.1007/s40200-024-01492-6。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Diabetes and Metabolic Disorders
Journal of Diabetes and Metabolic Disorders Medicine-Internal Medicine
CiteScore
4.80
自引率
3.60%
发文量
210
期刊介绍: Journal of Diabetes & Metabolic Disorders is a peer reviewed journal which publishes original clinical and translational articles and reviews in the field of endocrinology and provides a forum of debate of the highest quality on these issues. Topics of interest include, but are not limited to, diabetes, lipid disorders, metabolic disorders, osteoporosis, interdisciplinary practices in endocrinology, cardiovascular and metabolic risk, aging research, obesity, traditional medicine, pychosomatic research, behavioral medicine, ethics and evidence-based practices.As of Jan 2018 the journal is published by Springer as a hybrid journal with no article processing charges. All articles published before 2018 are available free of charge on springerlink.Unofficial 2017 2-year Impact Factor: 1.816.
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