成人1型糖尿病和糖化血红蛋白高于目标的混合闭环治疗:一项真实世界的观察研究。

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes Care Pub Date : 2023-10-01 DOI:10.2337/dc23-0635
Thomas S J Crabtree, Tomás P Griffin, Yew W Yap, Parth Narendran, Geraldine Gallen, Niall Furlong, Iain Cranston, Ali Chakera, Chris Philbey, Muhammad Ali Karamat, Sanjay Saraf, Shafie Kamaruddin, Eleanor Gurnell, Alyson Chapman, Sufyan Hussain, Jackie Elliott, Lalantha Leelarathna, Robert E J Ryder, Peter Hammond, Alistair Lumb, Pratik Choudhary, Emma G Wilmot
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引用次数: 0

摘要

目的:我们探讨了在1型糖尿病和HbA1c水平升高的成年人中,尽管使用了间歇性扫描连续血糖监测(isCGM)和胰岛素泵治疗,但与切换到混合闭环(HCL)胰岛素递送系统相关的纵向变化。研究设计和方法:我们对英国国家卫生服务局闭环试点的参与者进行了一项务实的、预先计划的观察性研究。纳入了在英格兰31个糖尿病中心使用isCGM和胰岛素泵且HbA1c≥8.5%且愿意开始HCL治疗的成年人。结果包括HbA1c、传感器血糖测量、糖尿病痛苦评分、黄金评分(低血糖意识)、急性事件发生率和HCL用户意见的变化。结果:总共包括570名HCL使用者(中位年龄40[IQR 29-50]岁,67%为女性,85%为白人)。平均基线HbA1c为9.4±0.9%(78.9±9.1 mmol/mol),中位随访时间为5.1(IQR 3.9-6.6)个月。在520名随访时继续服用HCL的患者中,平均调整后的HbA1c降低了1.7%(95%CI 1.5,1.8;P<0.0001)(18.1mmol/mol[95%CI 16.6,19.6];P<0.0001,以及那些在范围内达到≥70%血糖时间的人。结论:在现实世界中,使用HCL与1型糖尿病患者的HbA1c、范围内时间、低血糖、糖尿病相关的痛苦和生活质量的改善有关。
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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Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study.

Objective: We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy.

Research design and methods: We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed-loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL.

Results: In total, 570 HCL users were included (median age 40 [IQR 29-50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9-6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P < 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P < 0.0001). Time in range (70-180 mg/dL) increased from 34.2 to 61.9% (P < 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P < 0.0001), and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8 to 28.2% (P < 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]).

Conclusions: Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.

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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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