PDF(Pubmed)
Abstract：
BACKGROUND: Longer outpatient studies have demonstrated that hybrid closed loop (HCL) use has led to a concomitant reduction in glycated hemoglobin(HbA1c) by 0.3%-0.7%. However, reports have also indicated that HbA1c levels are not declined in the long-term use of HCL. Therefore, we wonder that 3 months use of HCL could improve glycated hemoglobin levels in adolescents and children with T1D.
METHODS: Relevant studies were searched electronically in the Cochrane Library, PubMed, and Embase utilizing the key words \"Pediatrics or Child or Adolescent\", \"Insulin Infusion Systems\" and \"Diabetes Mellitus\" from inception to 17th March 2024 to evaluate the performance of HCL on HbA1c in adolescents, and children with T1D.
RESULTS: Nine studies involving 927 patients were identified. Three months use of HCL show a beneficial effect on HbA1c management (p <0.001) as compared to standard of care in adolescents and children with T1D, without evidence of heterogeneity between articles (I2 = 40%, p = 0.10). HCL did significantly increase the overall average percentage of hypoglycemic time between 70 and 180 mg/dL (TIR) (p <0.001; I2 = 51%). HCL did not show a beneficial effect on hypoglycemic time <70 mg/dL and <54 mg/dL (p >0.05). The overall percentage of hyperglycemic time was significantly decreased in HCL group compared to the control group when it was defined as >180 mg/dL (p <0.001; I2 = 83%), >250 mg/dL (p = 0.007, I2 = 86%) and >300 mg/dL (p = 0.005; I2 = 76%). The mean glucose level was significantly decreased by HCL (p <0.001; I2 = 58%), however, no significant difference was found in coefficient of variation of sensor glucose (p = 0.82; I2 = 71%) and daily insulin dose (p = 0.94; I2 <0.001) between the HCL group and the control group.
CONCLUSIONS: HCL had a beneficial effect on HbA1c management and TIR without increased hypoglycemic time as compared to standard of care in adolescents and children with T1D when therapy duration of HCL was not less than three months.
UNASSIGNED: CRD42022367493; https://www.crd.york.ac.uk/PROSPERO, Principal investigator: Zhen-feng Zhou, Date of registration: October 30, 2022.
METHODS: Relevant studies were searched electronically in the Cochrane Library, PubMed, and Embase utilizing the key words \"Pediatrics or Child or Adolescent\", \"Insulin Infusion Systems\" and \"Diabetes Mellitus\" from inception to 17th March 2024 to evaluate the performance of HCL on HbA1c in adolescents, and children with T1D.
RESULTS: Nine studies involving 927 patients were identified. Three months use of HCL show a beneficial effect on HbA1c management (p <0.001) as compared to standard of care in adolescents and children with T1D, without evidence of heterogeneity between articles (I2 = 40%, p = 0.10). HCL did significantly increase the overall average percentage of hypoglycemic time between 70 and 180 mg/dL (TIR) (p <0.001; I2 = 51%). HCL did not show a beneficial effect on hypoglycemic time <70 mg/dL and <54 mg/dL (p >0.05). The overall percentage of hyperglycemic time was significantly decreased in HCL group compared to the control group when it was defined as >180 mg/dL (p <0.001; I2 = 83%), >250 mg/dL (p = 0.007, I2 = 86%) and >300 mg/dL (p = 0.005; I2 = 76%). The mean glucose level was significantly decreased by HCL (p <0.001; I2 = 58%), however, no significant difference was found in coefficient of variation of sensor glucose (p = 0.82; I2 = 71%) and daily insulin dose (p = 0.94; I2 <0.001) between the HCL group and the control group.
CONCLUSIONS: HCL had a beneficial effect on HbA1c management and TIR without increased hypoglycemic time as compared to standard of care in adolescents and children with T1D when therapy duration of HCL was not less than three months.
UNASSIGNED: CRD42022367493; https://www.crd.york.ac.uk/PROSPERO, Principal investigator: Zhen-feng Zhou, Date of registration: October 30, 2022.
摘要：
背景：长期的门诊研究表明，混合闭环（HCL）的使用导致糖化血红蛋白（HbA1c）降低了0.3％-0.7％。然而,报告还显示,在长期使用HCL的过程中,HbA1c水平没有下降.因此,我们怀疑使用HCL3个月可以改善T1D青少年和儿童的糖化血红蛋白水平.
方法：相关研究在Cochrane图书馆进行了电子检索，PubMed,和Embase利用关键词“儿科或儿童或青少年”，“胰岛素输注系统”和“糖尿病”从开始到2024年3月17日，以评估HCL对青少年HbA1c的影响，和T1D的孩子。
结果：确定了9项研究，涉及927名患者。与T1D青少年和儿童的护理标准相比，三个月使用HCL对HbA1c管理有有益的影响（p<0.001），没有文章之间异质性的证据(I2=40%，p=0.10)。HCL确实显着增加了70至180mg/dL（TIR）之间的低血糖时间的总体平均百分比（p<0.001；I2=51％）。HCL对<70mg/dL和<54mg/dL的降血糖时间没有显示有益效果(p>0.05)。当定义为>180mg/dL时，与对照组相比，HCL组的高血糖时间总百分比显着降低（p<0.001；I2=83％），>250mg/dL(p=0.007,I2=86%)和>300mg/dL(p=0.005;I2=76%)。HCL显著降低了平均葡萄糖水平(p<0.001;I2=58%),然而,HCL组与对照组之间的传感器葡萄糖变异系数（p=0.82；I2=71％）和每日胰岛素剂量（p=0.94；I2<0.001）没有显着差异。
结论：HCL治疗时间不少于3个月时，与T1D青少年和儿童的标准治疗相比，HCL对HbA1c管理和TIR具有有益效果，而不会增加低血糖时间。
■CRD42022367493;https://www.crd.约克。AC.英国/PROSPERO,首席调查员:周振峰，注册日期：2022年10月30日。
方法：相关研究在Cochrane图书馆进行了电子检索，PubMed,和Embase利用关键词“儿科或儿童或青少年”，“胰岛素输注系统”和“糖尿病”从开始到2024年3月17日，以评估HCL对青少年HbA1c的影响，和T1D的孩子。
结果：确定了9项研究，涉及927名患者。与T1D青少年和儿童的护理标准相比，三个月使用HCL对HbA1c管理有有益的影响（p<0.001），没有文章之间异质性的证据(I2=40%，p=0.10)。HCL确实显着增加了70至180mg/dL（TIR）之间的低血糖时间的总体平均百分比（p<0.001；I2=51％）。HCL对<70mg/dL和<54mg/dL的降血糖时间没有显示有益效果(p>0.05)。当定义为>180mg/dL时，与对照组相比，HCL组的高血糖时间总百分比显着降低（p<0.001；I2=83％），>250mg/dL(p=0.007,I2=86%)和>300mg/dL(p=0.005;I2=76%)。HCL显著降低了平均葡萄糖水平(p<0.001;I2=58%),然而,HCL组与对照组之间的传感器葡萄糖变异系数（p=0.82；I2=71％）和每日胰岛素剂量（p=0.94；I2<0.001）没有显着差异。
结论：HCL治疗时间不少于3个月时，与T1D青少年和儿童的标准治疗相比，HCL对HbA1c管理和TIR具有有益效果，而不会增加低血糖时间。
■CRD42022367493;https://www.crd.约克。AC.英国/PROSPERO,首席调查员:周振峰，注册日期：2022年10月30日。
