1型糖尿病全自动胰岛素输送系统:系统综述和荟萃分析。

IF 5.4 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Wenqi Fan, Chao Deng, Ruoyao Xu, Zhenqi Liu, Yuhu He, Zhiguang Zhou, Xia Li
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引用次数: 0

摘要

目的:胰岛素递送的前景正在发展,从混合自动胰岛素递送(AID)过渡到更复杂的全AID系统。我们的目的是比较完全AID系统与任何胰岛素递送方法对1型糖尿病(T1D)的疗效。材料和方法:在PROSPERO、CRD42024528669、PubMed、Embase、Cochrane Library和Web of Science注册后,检索截至2025年2月26日比较完全AID系统与任何胰岛素给药方法在T1D中的随机临床试验。对照治疗包括常规胰岛素治疗(每日多次注射、持续皮下胰岛素输注和传感器增强泵)和混合AID系统。主要终点是血糖浓度保持在目标范围(3.9-10.0 mmol/L或4.0-10.0 mmol/L)的时间百分比的平均差异(MD),通过随机效应模型评估。结果:我们确定了1308份报告;排除后,纳入16项试验(669例患者)。全AID处理的范围内时间(TIR)高于对照处理(MD为9.99%[95%可信区间,3.75% ~ 16.22%],p = 0.002)。这种改善伴随着糖尿病治疗满意度的提高(MD为3.70分[95%可信区间,0.22至7.18分],p = 0.04)。与常规胰岛素治疗相比,全AID系统在TIR方面表现出良好的效果,而与混合AID相比则表现出相反的效果(17.44%对-3.05%,p)。结论:与其他非AID方法相比,全AID系统改善了T1D患者的血糖控制和糖尿病治疗满意度,特别是对于年轻患者。然而,为了达到或超过混合AID的预期效益,算法升级以及多种激素的协同整合将是下一代全AID系统的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fully automated insulin delivery systems in type 1 diabetes: A systematic review and meta-analysis.

Aims: The landscape of insulin delivery is evolving, transitioning from hybrid automated insulin delivery (AID) to more sophisticated fully AID systems. We aimed to compare the efficacy of fully AID systems with any insulin delivery method in type 1 diabetes (T1D).

Materials and methods: Following registration in PROSPERO, CRD42024528669, PubMed, Embase, Cochrane Library and Web of Science were searched up to 26 February 2025 for randomised clinical trials comparing fully AID systems to any insulin delivery method in T1D. The control treatments included conventional insulin therapy (multiple daily injections, continuous subcutaneous insulin infusion and sensor-augmented pumps) and hybrid AID systems. The primary outcome was the mean difference (MD) in the percentage of time blood glucose concentration remained in the target range (3.9-10.0 mmol/L or 4.0-10.0 mmol/L), assessed by random-effects models.

Results: We identified 1308 reports; after exclusions, 16 trials (669 patients) were included. Time in range (TIR) was higher using fully AID systems than control treatments (MD 9.99% [95% confidence interval, 3.75% to 16.22%], p = 0.002). This improvement was accompanied by increased diabetes treatment satisfaction (MD 3.70 points [95% confidence interval, 0.22 points to 7.18 points], p = 0.04). Fully AID systems exhibited a favourable effect on TIR when compared with conventional insulin therapy, while exhibiting an opposite effect when compared with hybrid AID (17.44% vs. -3.05%, p < 0.001). Younger patients with T1D, as well as patients with a shorter diabetes duration, exhibited more significant glycaemic improvements with fully AID systems therapy.

Conclusions: Fully AID systems improved glycaemic control and diabetes treatment satisfaction compared with other non-AID methods in patients with T1D, especially for younger patients. However, to achieve or exceed the desired benefits of hybrid AID, algorithm upgradation, along with the synergistic integration of multiple hormones, will be crucial for next-generation fully AID systems.

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来源期刊
Diabetes, Obesity & Metabolism
Diabetes, Obesity & Metabolism 医学-内分泌学与代谢
CiteScore
10.90
自引率
6.90%
发文量
319
审稿时长
3-8 weeks
期刊介绍: Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
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