Bio-Behavioral Feedback and Control of Type 1 Diabetes

1 型糖尿病的生物行为反馈和控制

基本信息

批准号：
7643331
负责人：
BORIS P KOVATCHEV
金额：
$ 48.3万
依托单位：
UNIVERSITY OF VIRGINIA
依托单位国家：
美国
项目类别：
财政年份：
1996
资助国家：
美国
起止时间：
1996-07-24 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7643331
关键词：
Adverse event Affect Automobile Driving Awareness Behavior Control Behavior Therapy Behavioral Blood Circulation Blood Glucose Self-Monitoring Blood Vessels Blood capillaries Characteristics Chronic Clinical Computer Simulation Data Data Collection Development Endocrine Endocrine system Endothelium Environment Epinephrine Exercise Failure Feedback Frequencies Fright Glucagon Glucose Glycosylated hemoglobin A Grant Health Hormonal Hormones Hyperglycemia Hypoglycemia Impairment Incidence Individual Insulin Insulin-Dependent Diabetes Mellitus Intervention Investigation Laboratories Maintenance Measures Methods Modeling Monitor Muscle Outcome Outcome Study Patients Pattern Perfusion Permeability Phase Physiological Principal Investigator Process Protocols documentation Recording of previous events Recruitment Activity Recurrence Regulation Relative (related person)Research Risk Stochastic Processes Symptoms System Systems Biology Testing Time Translating Ultrasonography Work base biobehavior capillary counterregulation design experience field study glycemic control high risk hospital laboratories improved indexing insight insulin sensitivity interstitial model development network models programs prospective research study response

项目摘要

DESCRIPTION (provided by applicant): This proposal continues ten years of research on biobehavioral monitoring methods with proven utility to the assessment of Type 1 diabetes (T1DM), by taking the next logical step - from monitoring to feedback. We plan to test and validate the following general hypothesis: The optimization of glycemic control in T1DM, i.e. the maintenance of near-normal HbA1c without increasing the risk of hypoglycemia, is almost entirely dependent on the quality of two levels of feedback: (1) External behavioral level defined as the availability and utilization by patients of information about symptoms, awareness, risk of hypoglycemia, and HbA1c, and (2) Internal endocrine system level defined as the feedback networks of microvascular recruitment, hormonal counter regulation, and insulin-glucose interaction. Consequently, the proposed research plan includes field investigation of the utility of behavioral feedback (Phase 1) and hospital laboratory investigations of the internal feedback loops of insulin transfer (Phase 2) and counter regulation (Phase 3). Specifically: Phase 1 will create an Integrated Biobehavioral Monitoring and Feedback (IBMF) system and will investigate its clinical utility to improve glycemic control in a field outcomes study of T1 DM patients in their natural environment, assuming that the everyday behavioral control of T1DM depends on the quality of 4 sequential steps: monitoring -> assessment -> feedback to the patient -> behavioral optimization. Phase 2 will investigate, in T1DM subjects at low vs. high risk for hypoglycemia as determined in Phase 1, the time course of insulin transfer from circulation to iterstitium using a stochastic process model of insulin-induced microvascular recruitment and subsequent insulin transport through the capillary endothelium. Phase 3 will use a dynamical network model to investigate the time course of development, and the dynamical characteristics of hypoglycemia-associated autonomic failure (HAAF) in T1DM subjects at low vs. high risk for hypoglycemia as determined in Phase 1. Transferring the results from Phases 2 and 3 into Phase 1 we will clarify: (1) the relative contribution of insulin sensitivity and HAAF to risk for recurrent hypoglycemia in the field, and (2) the ability of IBMF to reverse HAAF and reduce risk of hypoglycemia, thereby contributing to improved glycemic control.

描述（由申请人提供）：该提案继续进行十年的生物行为监测方法研究，并通过采取下一个逻辑步骤从监视到反馈，对1型糖尿病（T1DM）进行了证明的效用，以评估1型糖尿病（T1DM）。 We plan to test and validate the following general hypothesis: The optimization of glycemic control in T1DM, i.e. the maintenance of near-normal HbA1c without increasing the risk of hypoglycemia, is almost entirely dependent on the quality of two levels of feedback: (1) External behavioral level defined as the availability and utilization by patients of information about symptoms, awareness, risk of hypoglycemia, and HbA1c, and （2）内分泌系统水平定义为微血管募集，激素反调节和胰岛素 - 葡萄糖相互作用的反馈网络。因此，拟议的研究计划包括对行为反馈（第1阶段）和医院实验室对胰岛素转移（第2阶段）和反调节（第3阶段）的内部反馈回路的实用性的现场调查。具体来说：第1阶段将创建一个综合的生物行为监测和反馈（IBMF）系统，并将研究其临床实用性，以在其自然环境中T1 DM患者的现场结果研究中改善血糖控制，并假设T1DM的日常行为控制T1DM的日常行为控制取决于4个顺序步骤的质量：监测 - >评估 - >评估 - >评估 - >评估 - >对患者的反馈 - >反馈对患者的反馈 - >“优化行为”。阶段2将在第1阶段确定的低血糖的T1DM受试者中调查，使用胰岛素诱导的微血管募集的随机过程模型，并通过毛细管内皮细胞内层胰岛素通过胰岛素诱导的微血管募集和随后的胰岛素转运，从阶段1确定的胰岛素时间过程。第3阶段将使用动态网络模型来研究发育的时间过程，以及在T1DM受试者中低血糖相关的自主神经失败（HAAF）的动态特征，该受试者的低血糖和高风险低血糖的风险如阶段1所确定。从第2和3阶段将结果转移到第1阶段，我们将澄清：（1）胰岛素敏感性和HAAF对现场复发性低血糖症的风险的相对贡献，以及（2）IBMF反向HAAF并降低低血糖症的风险，从而有助于改善口腔山口腔控制。