The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes
| العنوان: | The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes |
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| المؤلفون: | Amélie Roy-Fleming, Laurent Legault, Rémi Rabasa-Lhoret, Nadine Taleb, Véronique Gingras |
| المصدر: | Diabetes, Obesity and Metabolism. 20:245-256 |
| بيانات النشر: | Wiley, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Adult, Blood Glucose, Pancreas, Artificial, Insulin pump, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Bioinformatics, Artificial pancreas, Article, 03 medical and health sciences, Carbohydrate counting, 0302 clinical medicine, Endocrinology, Internal medicine, Diabetes mellitus, Diet, Diabetic, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Child, Meals, Type 1 diabetes, business.industry, Insulin, digestive, oral, and skin physiology, Postprandial Period, medicine.disease, Combined Modality Therapy, Pramlintide, Hypoglycemia, Diabetes Mellitus, Type 1, Postprandial, Hyperglycemia, business, Algorithms, medicine.drug |
| الوصف: | For patients with type 1 diabetes, closed-loop delivery systems (CLS) combining an insulin pump, a glucose sensor and a dosing algorithm allowing a dynamic hormonal infusion have been shown to improve glucose control when compared to conventional therapy. Yet, reducing glucose excursion as well as simplification of prandial insulin doses remains a challenge. The objective of this literature review is to examine current meal-time strategies in the context of automated delivery systems in adults and children with type 1 diabetes. Current challenges and considerations for post-meal glucose control will also be discussed. Despite promising results with meal detection, the fully automated CLS has yet failed to provide comparable glucose control to CLS with CHO-matched bolus in the post-meal period. The latter strategy has been efficient to control post-meal glucose control using different algorithms and in various settings; yet, at the cost of meal carbohydrate counting burden for patients. Further improvements in meal detection algorithms or simplified meal priming boluses may represent interesting avenues. The greatest challenges remain in regards to the pharmacokinetic and –dynamic profiles of available rapid insulins as well as sensor accuracy and lag-time. New and upcoming faster acting insulins could provide important benefits. Multi-hormone CLS (e.g. dual-hormone combining insulin with glucagon or pramlintide) and adjunctive therapy (e.g. GLP-1 and SGLT2 inhibitors) also represent promising options. Meal glucose control with the artificial pancreas remains an important challenge for which the optimal strategy is still to be determined. |
| تدمد: | 1463-1326 1462-8902 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::02910b4dba4b6c108d0bb3d705284b41Test https://doi.org/10.1111/dom.13052Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....02910b4dba4b6c108d0bb3d705284b41 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14631326 14628902 |
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