An article published online first and in a next issue of the Lancet that the use of "artificial pancreas" closed-loop carrier systems can improve insulin glucose control in patients with diabetes be reports, 1. Insulin in response to the development of blood glucose will be delivered in these systems. The article is the work of Dr. Roman Hovorka, Institute for metabolic Sciences, University of Cambridge and Addenbrooke hospital, Cambridge, and colleagues.
The incidence of diabetes, type 1 has doubled in the last ten years. It is one of the most common chronic childhood disease. Children and young people must be the life of insulin treatment for blood sugar control is sufficient to prevent the long-term complications.
The combination of continuous glucose-insulin pumps and systems for monitoring can form closed systems. Then, the insulin is executed in real time after glucose sensor. Algorithm, it is a control instead of pre-programmed course Director. Some prototypes of closed-loop have been developed. Progress delayed not optimal accuracy and reliability of the monitoring of devices, slow absorption of insulin analogues managed subcutaneous swift action and insufficient tax and control algorithms. The authors, that in this study to study, closed-loop systems can reduce the risk of nocturnal hypoglycemia. You have also examined whether good blood glucose in children and adolescents after variables take dinner and delay exercise patterns can be achieved.
A total of seventeen children and young people were investigated in the nights of 54 in the hospital. They were in the age from 5 to 18 years and had all type 1 diabetes. Researchers measured how well the system controlled pancreas glucose levels with pump infusion (subcutaneous) than continue regular subcutaneous insulin of the children. The pump delivers insulin on the selected rate.
Nights as children after a large meal or make the exercise went to bed early in the evening, were included in the study. These cases are difficult to manage. Can a big dinner to what "stack insulin" is called and thus later in the night potentially dangerous cause a decrease in blood glucose levels. In the late afternoon or early evening, increase the need for the body to glucose early in the morning. Therefore, they may increase the risk of hypoglycemia at night.
Has shown that children maintains blood glucose levels in the normal range for 60% of the time, compared to 40% for the subcutaneous pump with artificial pancreas. The automated pancreas cut in half of the time that blood sugar not 3 9mmol / l, the level as mild hypoglycemia. It also prevents that in 3 0mmol / l, defined as significant Hypoglycemia is the glucose levels fall, compared with nine events of hypoglycemia in the studies of the control.
The authors of the comments: "our results show that night can manually closed insulin delivery improve glucose control and reduce the risk of hypoglycemia in young patients of diabetes type 1″."
They explain: "the management of type 1 diabetes could transform closed-loop systems, but their introduction is 24 h. expected to gradually, from simple applications such as the closure off the coast of the pump in low concentrations of glucose or delivery during the night, to more complex applications, closed control closed delivery while the night is attractive, because it dealt with the question of nocturnal hypoglycemia.".
Finally, they write: "Advances in technologies for the detection of glucose closed-loop systems could improve." The pump must replace wireless data transmission delivery of fully automatic closed-loop control by nurses. These technological steps are important, routine and should affect not closed. »
A related note, Dr. Eric Fox, Centre hospitalier universitaire de Montpellier, France, will review the various technological issues surrounding closed insulin delivery. He says: "from the night before is meals and activities, addressing the most rational way." "This seems the way to the progressive implementation of the delivery of insulin, the automated home".