Συστήματα τεχνητού παγκρέατος μίας και δύο ορμονών σε ασθενείς με διαβήτη τύπου 1 : Μια επισκόπηση συστηματικών ανασκοπήσεων
Creators: name: Κανάκης, Σταύρος Γεωργίου
Publisher: name: Aristotle University of Thessaloniki
Year: 2025
Subjects: διαβήτης τύπου 1
τεχνητό πάγκρεας
ανασκόπηση
type 1 diabetes
artificial pancreas
overview

description: Αυτή η επισκόπηση στοχεύει στην ταυτοποίηση, κριτική αξιολόγηση και σύνοψη συστηματικών ανασκοπήσεων (SRs) με μετα-ανάλυση που εξετάζουν τα συστήματα τεχνητού παγκρέατος (AP), μονο-ορμονικά (SH) ή διπλο-ορμονικά (DH). Τα AP αποτελούν σημαντική πρόοδο στη διαχείριση του σακχαρώδη διαβήτη τύπου 1, βελτιώνοντας σημαντικά τα αποτελέσματα γλυκόζης στο αίμα. Αναζητήθηκαν μελέτες σε PubMed, Cochrane, Epistemonikos.org και Embase έως τις 16 Απριλίου 2024. Η ποιότητα αξιολογήθηκε με το εργαλείο AMSTAR-2, ενώ η επικάλυψη των SRs εκτιμήθηκε με το Corrected Covered Area (CCA). Αναλύθηκαν 10 SRs που σύγκριναν τα AP με SAP, IP, DH, SH, CSII και PGLS. Τα AP αύξησαν τον χρόνο εντός στόχου (70-180 mg/dL) κατά 6.89%-12.91% (24 ώρες) και 15.15% (νύχτα), με μεγαλύτερα οφέλη σε παιδιά (14.37%) και ενήλικες (14.53%). Μείωσαν την υπογλυκαιμία (-2.45% έως -0.67%) και την υπεργλυκαιμία (-3.01% έως -13.2%), ενώ μείωσαν τη γλυκοζυλιωμένη αιμοσφαιρίνη (HbA1c) κατά -0.26% έως -0.40%. Οι DH είχαν καλύτερη απόδοση στην ακραία υπεργλυκαιμία. Συνολικά, τα AP υπερέχουν έναντι των παραδοσιακών συστημάτων, βελτιώνοντας τον γλυκαιμικό έλεγχο και μειώνοντας την ανάγκη για ινσουλίνη. Ωστόσο, απαιτούνται μελέτες υψηλής ποιότητας για πιο αξιόπιστα αποτελέσματα.
description: The purpose of this overview aims to identify, critically appraise and summarize systematic reviews (SRs) (with a meta-analysis) that assess artificial pancreas (AP) systems (either single or dual hormone (SH or DH)). AP systems represent a transformative advancement in type 1 diabetes management, demonstrating significant improvements across multiple glycemic outcomes. An extensive literature search was conducted in PubMed, Cochrane Database of Systematic Reviews (CDSR), Epistemonikos.org and Embase, until April 16, 2024. The methodological quality of included SRs was assessed using the AMSTAR-2 tool. Overlapping SRs and overlapping per outcome was assessed with Corrected Covered Area (CCA). This overview synthesizes findings from 10 SRs evaluating the efficacy of AP systems compared to sensor-augmented pump (SAP), insulin pump (IP), dual-hormone (DH), single-hormone (SH), continuous subcutaneous insulin infusion (CSII), and predictive glucose-level suspend (PGLS) systems. AP systems improve the proportion (%) of time in the target glucose range (between 70 and180 mg/dL (between 3.9 and 10.0 mmol/L)) with a mean difference (MD) range from 6.89% to 12.91% for 24-hour use (I2=0%-89%), and 15.15% (95% CI: 12.21–18.09) overnight (I2=73%). Subgroup analyses reveal even greater benefits for pediatric (14.37%, 95% CI: 7.20–21.54, I2=79%) and adult populations (14.53%, 95% CI: 10.65–18.40, I2=44%). AP systems also effectively reduce the proportion (%) of time in hypoglycemia (below 70 mg/dL (below 3.9 mmol/L)) with MDs ranging from -2.45% to -0.67% (24-hour) with I2= 0%-94% and -2.22% to -1.25% (overnight) with I2= 62%-72%, supported by reductions in extreme hypoglycemia (below 60 mg/dL (below 3.3 mmol/L)). Similarly, significant reductions in proportion (%) of time in hyperglycemia (above 180 mg/dL (above 10.0 mmol/L)) were observed, with 24-hour reductions ranging from -3.01% to -13.2% (I2=55%-95%) and overnight reductions of -11.12% (95% CI: -13.80 to -8.44, I2=71%). Subgroup analyses further highlight enhanced efficacy for DH systems, particularly for extreme hyperglycemia (above 250 mg/dL (above 13.9 mmol/L)), though performance varied under specific conditions. AP systems consistently reduce HbA1c levels (MD: -0.26% to -0.40%, I² = 0%–36%) and mean sensor glucose levels over 24 hours (MD: -0.48% to -14.60%, I2=0%-84%) and overnight (MD: -0.81%, I2=78%). Insulin requirements (units per kg/ hour) were also reduced in some studies, with MDs of -3.43% (95% CI: -4.27 to -2.59, I² = 0%), though findings were inconsistent. Time spent outside euglycemia (below 70mg/dL and above 180 mg/dL (below 3.9 mmol/L and above 10.0 mmol/L)) was significantly reduced, with overall MDs of -6.28% (95% CI: -10.67 to -1.88) and -6.55% (95% CI: -11.26 to -1.84) despite moderate to high heterogeneity (I² = 69%–92.4%). The use of AP systems in people with type 1 diabetes is more effective in managing diabetes compared to SAP, IP, DH, SH, CSII, and PGLS systems. AP systems consistently enhance diabetes management by increasing time in range, reducing hypoglycemia and hyperglycemia, lowering HbA1c and optimizing insulin delivery, offering substantial benefits over traditional approaches. However, the quality of available literature is limited, underscoring the urgent need for high-quality studies.