medicina61巻1号

2024年01月発行

特集 その知見は臨床を変える?—エキスパートが解説! 内科における最新論文

糖尿病・内分泌・代謝

糖尿病マネジメントにおけるハイブリッドクローズドループインスリンポンプと持続グルコースモニタリングの活用

著者： 小谷紀子¹

所属機関： ¹国立国際医療研究センター病院糖尿病内分泌代謝科

ページ範囲：P.82 - P.87

文献概要

Point
◎ハイブリッドクローズドループ（hybrid closed loop：HCL）インスリンポンプは1型糖尿病の血糖管理に有効である．
◎インスリンを必要とする糖尿病では持続グルコースモニタリング（continuous glucose monitoring：CGM）を用いた血糖管理を検討すべきである．

参考文献

1）Bosi E, et al：Efficacy and safety of suspend-before-low insulin pump technology in hypoglycaemia-prone adults with type 1 diabetes（SMILE）；An open-label randomised controlled trial. Lancet Diabetes Endocrinol 7：462-472, 2019 PMID 31047902

670G system in Europe. Diabetes Obes Metab 23：1942-1949, 2021 PMID 33961340

3）Collyns OJ, et al：Improved glycemic outcomes with medtronic MiniMed advanced hybrid closed-loop delivery；Results from a randomized crossover trial comparing automated insulin delivery with predictive low glucose suspend in people with type 1 diabetes. Diabetes Care 44：969-975, 2021 PMID 33579715

advanced hybrid closed-loop delivery compared to predictive low glucose suspend in people with Type 1 Diabetes in a randomized crossover trial. Acta Diabetol 59：31-37, 2022 PMID 34453208

4 sensor. Diabetes Technol Ther 2023（Online adeahd of print）PMID 37252734

780G system achieves clinical targets for CGM in adults with type 1 diabetes regardless of previous insulin strategy and baseline glucose control. Acta Diabetol 59：1309-1315, 2022 PMID 35857108

7）ElSayed NA, et al：7. Diabetes technology；Standards of care in diabetes-2023. Diabetes Care 46：S111-S127, 2023 PMID 36507635

8）Sherr JL, et al：Automated insulin delivery；Benefits, challenges, and recommendations. A consensus report of the Joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association. Diabetologia 66：3-22, 2023 PMID 36198829

9）Urakami T, et al：Frequent scanning using flash glucose monitoring contributes to better glycemic control in children and adolescents with type1 diabetes. J Diabetes Investig 13：185-190, 2022 PMID 34143544

10）Lameijer A, et al：Flash glucose monitoring in the netherlands；Increased monitoring frequency is associated with improvement of glycemic parameters. Diabetes Res Clin Pract 177：108897, 2021 PMID 34098059

11）Elbalshy M, et al：Effect of divergent continuous glucose monitoring technologies on glycaemic control in type 1 diabetes mellitus；A systematic review and meta-analysis of randomised controlled trials. Diabet Med 39：e14854, 2022 PMID 35441743

12）Visser MM, et al：Effect of switching from intermittently scanned to real-time continuous glucose monitoring in adults with type 1 diabetes；24-month results from the randomised ALERTT1 trial. Lancet Diabetes Endocrinol 11：96-108, 2023 PMID 36702566

13）Beck RW, et al：Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections；The DIAMOND Randomized Clinical Trial. JAMA 317：371-378, 2017 PMID 28118453

14）Puhr S, et al：Real-world hypoglycemia avoidance with a continuous glucose monitoring system's predictive low glucose alert. Diabetes Technol Ther 21：155-158, 2019 PMID 30896290

15）Feig DS, et al：Continuous glucose monitoring in pregnant women with type 1 diabetes（CONCEPTT）；A multicentre international randomised controlled trial. Lancet 390：2347-2359, 2017 PMID 28923465

16）Martens T, et al：Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with Basal insulin；A randomized clinical trial. JAMA 325：2262-2272, p 2021 PMID 34077499

17）Grace T, Salyer J：Use of real-time continuous glucose monitoring improves glycemic control and other clinical outcomes in type 2 diabetes patients treated with less intensive therapy. Diabetes Technol Ther 24：26-31, 2022 PMID 34524013

18）Holt RIG, et al：The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association（ADA）and the European Association for the Study of Diabetes（EASD）. Diabetes Care 44：2589-2625, 2021 PMID 34593612