Fully closed-loop control with ultra-rapid versus standard insulin lispro: A randomised crossover study simulating missed meal boluses

IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Hood Thabit, Jonathan Lim, Malgorzata E. Willinska, Catherine Fullwood, Roman Hovorka, Lalantha Leelarathna
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引用次数: 0

Abstract

Aims

Ultra-rapid insulin lispro (URIL) is associated with faster insulin absorption and earlier offset than standard insulin lispro (IL). This study evaluated whether URIL improves glucose control in a fully closed-loop setting over an 8-h period compared to IL under conditions simulating a missed meal bolus.

Methods

In this open-label, randomised crossover trial, 18 adults with type 1 diabetes using insulin pump therapy [12 females, age 39.1 (14.2) yrs., HbA1c 57.9 (8.7) mmol/mol] completed two 8-h inpatient sessions (09:00 to 17:00 h). Glucose levels were managed using the CamAPS FX closed-loop system with either URIL or IL, in random order. Participants received a standardised meal at 11:00 h without a meal bolus. The primary endpoint was the percentage of time in range (TIR; 3.9–10 mmol/L) based on sensor glucose.

Results

Data related to the 8-h study period from 17 participants were analysed. TIR was numerically higher but not statistically significant with URIL than IL [49.3 (15.6) vs. 39.9 (18.9)%; p = 0.072], with lower time spent in Level 1 (>10 mM) [50.7 (15.6) vs. 59.5 (19.1)%; p = 0.098] and Level 2 hyperglycaemia (>13.9) [18.7 (17.1) vs. 27.9 (19.8)%; p = 0.136]. Similar trends were observed in the 4-h post-meal period. Time in hypoglycaemia was low and comparable between both periods (p > 0.05).

Conclusion

URIL in a fully closed-loop setting showed a clinically meaningful trend towards improved TIR and reduced hyperglycaemia compared to IL. Further advancements in faster-acting insulins are needed to alleviate the burden of pre-meal bolusing and enhance fully closed-loop performance in the future.

Abstract Image

超快速与标准胰岛素利斯普罗的全闭环控制:模拟错过餐丸的随机交叉研究。
目的:超快速胰岛素lispro (URIL)与标准胰岛素lispro (IL)相比,具有更快的胰岛素吸收和更早的胰岛素偏移。本研究评估了在模拟漏餐的情况下,与IL相比,URIL是否能在8小时的全闭环环境下改善血糖控制。方法:在这项开放标签、随机交叉试验中,18名成人1型糖尿病患者接受胰岛素泵治疗[12名女性,年龄39.1(14.2)岁]。, HbA1c 57.9 (8.7) mmol/mol]完成两次8小时住院治疗(09:00至17:00)。血糖水平管理使用CamAPS FX闭环系统与URIL或IL,随机顺序。参与者在11点吃了一顿标准化的饭,没有额外的食物。主要终点是在范围内的时间百分比(TIR;3.9-10 mmol/L)。结果:分析了17名参与者8小时研究期间的相关数据。URIL组的TIR数值高于IL组,但无统计学意义[49.3(15.6)比39.9 (18.9)%;p = 0.072], 1级(> - 10 mM)的时间较短[50.7(15.6)比59.5 (19.1)%;p = 0.098]和2级高血糖(>13.9)[18.7(17.1)比27.9 (19.8)%;p = 0.136]。在餐后4小时也观察到类似的趋势。两期低血糖持续时间较短且具有可比性(p < 0.05)。结论:与IL相比,URIL在全闭环环境下表现出改善TIR和降低高血糖的临床意义趋势。未来需要进一步发展速效胰岛素来减轻餐前给药的负担并增强全闭环性能。
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
Diabetic Medicine
Diabetic Medicine 医学-内分泌学与代谢
CiteScore
7.20
自引率
5.70%
发文量
229
审稿时长
3-6 weeks
期刊介绍: Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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