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Davoodi P, Lee LY, Xu Q, Sunil V, Sun Y, Soh S, Wang CH. Drug delivery systems for programmed and on-demand release. Adv Drug Deliv Rev 2018; 132:104-138. [PMID: 30415656 DOI: 10.1016/j.addr.2018.07.002] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/25/2018] [Accepted: 07/02/2018] [Indexed: 01/06/2023]
Abstract
With the advancement in medical science and understanding the importance of biodistribution and pharmacokinetics of therapeutic agents, modern drug delivery research strives to utilize novel materials and fabrication technologies for the preparation of robust drug delivery systems to combat acute and chronic diseases. Compared to traditional drug carriers, which could only control the release of the agents in a monotonic manner, the new drug carriers are able to provide a precise control over the release time and the quantity of drug introduced into the patient's body. To achieve this goal, scientists have introduced "programmed" and "on-demand" approaches. The former provides delivery systems with a sophisticated architecture to precisely tune the release rate for a definite time period, while the latter includes systems directly controlled by an operator/practitioner, perhaps with a remote device triggering/affecting the implanted or injected drug carrier. Ideally, such devices can determine flexible release pattern and intensify the efficacy of a therapy via controlling time, duration, dosage, and location of drug release in a predictable, repeatable, and reliable manner. This review sheds light on the past and current techniques available for fabricating and remotely controlling drug delivery systems and addresses the application of new technologies (e.g. 3D printing) in this field.
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Perrier R, Pirog A, Jaffredo M, Gaitan J, Catargi B, Renaud S, Raoux M, Lang J. Bioelectronic organ-based sensor for microfluidic real-time analysis of the demand in insulin. Biosens Bioelectron 2018; 117:253-259. [PMID: 29909196 DOI: 10.1016/j.bios.2018.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022]
Abstract
On-line and real-time analysis of micro-organ activity permits to use the endogenous analytical power of cellular signal transduction algorithms as biosensors. We have developed here such a sensor using only a few pancreatic endocrine islets and the avoidance of transgenes or chemical probes reduces bias and procures general usage. Nutrient and hormone-induced changes in islet ion fluxes through channels provide the first integrative read-out of micro-organ activity. Using extracellular electrodes we captured this read-out non-invasively as slow potentials which reflect glucose concentration-dependent (3-15 mM) micro-organ activation and coupling. Custom-made PDMS-based microfluidics with platinum black micro-electrode arrays required only some tens of islets and functioned at flow rates of 1-10 µl/min which are compatible with microdialysis. We developed hardware solutions for on-line real-time analysis on a reconfigurable Field-Programmable Gate Array (FPGA) that offered resource-efficient architecture and storage of intermediary processing stages. Moreover, real-time adaptive and reconfigurable algorithms accounted for signal disparities and noise distribution. Based on islet slow potentials, this integrated set-up allowed within less than 40 μs the discrimination and precise automatic ranking of small increases (2 mM steps) of glucose concentrations in real time and within the physiological glucose range. This approach shall permit further development in continuous monitoring of the demand for insulin in type 1 diabetes as well as monitoring of organs-on-chip or maturation of stem-cell derived islets.
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Affiliation(s)
- R Perrier
- Laboratoire de Chimie et Biologie des Membranes et des Nano-Objets (CBMN), UMR CNRS 5248, Univ. Bordeaux, 18 Av Geoffroy St Hilaire, 33600 Pessac, France
| | - A Pirog
- Laboratoire d'Intégration du Matériau au Système (IMS), UMR CNRS 5218, Univ. Bordeaux, Bordeaux INP, 33400 Talence, France
| | - M Jaffredo
- Laboratoire de Chimie et Biologie des Membranes et des Nano-Objets (CBMN), UMR CNRS 5248, Univ. Bordeaux, 18 Av Geoffroy St Hilaire, 33600 Pessac, France
| | - J Gaitan
- Laboratoire de Chimie et Biologie des Membranes et des Nano-Objets (CBMN), UMR CNRS 5248, Univ. Bordeaux, 18 Av Geoffroy St Hilaire, 33600 Pessac, France
| | - B Catargi
- Laboratoire de Chimie et Biologie des Membranes et des Nano-Objets (CBMN), UMR CNRS 5248, Univ. Bordeaux, 18 Av Geoffroy St Hilaire, 33600 Pessac, France; Hôpital St André, Bordeaux University Hospital, Univ. Bordeaux, 1 rue Jean Burguet, 33000 Bordeaux, France
| | - S Renaud
- Laboratoire d'Intégration du Matériau au Système (IMS), UMR CNRS 5218, Univ. Bordeaux, Bordeaux INP, 33400 Talence, France
| | - M Raoux
- Laboratoire de Chimie et Biologie des Membranes et des Nano-Objets (CBMN), UMR CNRS 5248, Univ. Bordeaux, 18 Av Geoffroy St Hilaire, 33600 Pessac, France
| | - J Lang
- Laboratoire de Chimie et Biologie des Membranes et des Nano-Objets (CBMN), UMR CNRS 5248, Univ. Bordeaux, 18 Av Geoffroy St Hilaire, 33600 Pessac, France.
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Hinshaw L, Dalla Man C, Nandy DK, Saad A, Bharucha AE, Levine JA, Rizza RA, Basu R, Carter RE, Cobelli C, Kudva YC, Basu A. Diurnal pattern of insulin action in type 1 diabetes: implications for a closed-loop system. Diabetes 2013; 62:2223-9. [PMID: 23447123 PMCID: PMC3712033 DOI: 10.2337/db12-1759] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We recently demonstrated a diurnal pattern to insulin action (i.e., insulin sensitivity [SI]) in healthy individuals with higher SI at breakfast than at dinner. To determine whether such a pattern exists in type 1 diabetes, we studied 19 subjects with C-peptide-negative diabetes (HbA1c 7.1 ± 0.6%) on insulin pump therapy with normal gastric emptying. Identical mixed meals were ingested during breakfast, lunch, and dinner at 0700, 1300, and 1900 h in randomized Latin square of order on 3 consecutive days when measured daily physical activity was equal. The triple tracer technique enabled measurement of glucose fluxes. Insulin was administered according to the customary insulin:carbohydrate ratio for each participant. Although postprandial glucose excursions did not differ among meals, insulin concentration was higher (P < 0.01) and endogenous glucose production less suppressed (P < 0.049) at breakfast than at lunch. There were no differences in meal glucose appearance or in glucose disappearance between meals. Although there was no statistical difference (P = 0.34) in SI between meals in type 1 diabetic subjects, the diurnal pattern of SI taken across the three meals in its entirety differed (P = 0.016) from that of healthy subjects. Although the pattern in healthy subjects showed decreasing SI between breakfast and lunch, the reverse SI pattern was observed in type 1 diabetic subjects. The results suggest that in contrast to healthy subjects, SI diurnal pattern in type 1 diabetes is specific to the individual and cannot be extrapolated to the type 1 diabetic population as a whole, implying that artificial pancreas algorithms may need to be personalized.
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Affiliation(s)
- Ling Hinshaw
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Ahmed Saad
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Adil E. Bharucha
- Division of Gastroenterology, Mayo Medical School, Rochester, Minnesota
| | - James A. Levine
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Robert A. Rizza
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Rita Basu
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Medical School, Rochester, Minnesota
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Yogish C. Kudva
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Ananda Basu
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
- Corresponding author: Ananda Basu,
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Saad A, Dalla Man C, Nandy DK, Levine JA, Bharucha AE, Rizza RA, Basu R, Carter RE, Cobelli C, Kudva YC, Basu A. Diurnal pattern to insulin secretion and insulin action in healthy individuals. Diabetes 2012; 61:2691-700. [PMID: 22751690 PMCID: PMC3478548 DOI: 10.2337/db11-1478] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Evaluation of the existence of a diurnal pattern of glucose tolerance after mixed meals is important to inform a closed-loop system of treatment for insulin requiring diabetes. We studied 20 healthy volunteers with normal fasting glucose (4.8 ± 0.1 mmol/L) and HbA(1c) (5.2 ± 0.0%) to determine such a pattern in nondiabetic individuals. Identical mixed meals were ingested during breakfast, lunch, or dinner at 0700, 1300, and 1900 h in randomized Latin square order on 3 consecutive days. Physical activity was the same on all days. Postprandial glucose turnover was measured using the triple tracer technique. Postprandial glucose excursion was significantly lower (P < 0.01) at breakfast than lunch and dinner. β-Cell responsivity to glucose and disposition index was higher (P < 0.01) at breakfast than lunch and dinner. Hepatic insulin extraction was lower (P < 0.01) at breakfast than dinner. Although meal glucose appearance did not differ between meals, suppression of endogenous glucose production tended to be lower (P < 0.01) and insulin sensitivity tended to be higher (P < 0.01) at breakfast than at lunch or dinner. Our results suggest a diurnal pattern to glucose tolerance in healthy humans, and if present in type 1 diabetes, it will need to be incorporated into artificial pancreas systems.
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Affiliation(s)
- Ahmed Saad
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Via Gradenigo 6B, Padova, Italy
| | - Debashis K. Nandy
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - James A. Levine
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Adil E. Bharucha
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Robert A. Rizza
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Rita Basu
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo College of Medicine, Rochester, Minnesota
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Via Gradenigo 6B, Padova, Italy
| | - Yogish C. Kudva
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Ananda Basu
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
- Corresponding author: Ananda Basu,
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Albaugh VL, Singareddy R, Mauger D, Lynch CJ. A double blind, placebo-controlled, randomized crossover study of the acute metabolic effects of olanzapine in healthy volunteers. PLoS One 2011; 6:e22662. [PMID: 21857944 PMCID: PMC3153475 DOI: 10.1371/journal.pone.0022662] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 06/28/2011] [Indexed: 12/15/2022] Open
Abstract
Background and Rationale Atypical antipsychotics exhibit metabolic side effects including diabetes mellitus and obesity. The adverse events are preceded by acute worsening of oral glucose tolerance (oGTT) along with reduced plasma free fatty acids (FFA) and leptin in animal models. It is unclear whether the same acute effects occur in humans. Methodology/Principal Findings A double blind, randomized, placebo-controlled crossover trial was conducted to examine the potential metabolic effects of olanzapine in healthy volunteers. Participants included male (8) and female (7) subjects [18–30 years old, BMI 18.5–25]. Subjects received placebo or olanzapine (10 mg/day) for three days prior to oGTT testing. Primary endpoints included measurement of plasma leptin, oral glucose tolerance, and plasma free fatty acids (FFA). Secondary metabolic endpoints included: triglycerides, total cholesterol, high- and low-density lipoprotein cholesterol, heart rate, blood pressure, body weight and BMI. Olanzapine increased glucose Area Under the Curve (AUC) by 42% (2808±474 vs. 3984±444 mg/dl·min; P = 0.0105) during an oGTT. Fasting plasma leptin and triglycerides were elevated 24% (Leptin: 6.8±1.3 vs. 8.4±1.7 ng/ml; P = 0.0203) and 22% (Triglycerides: 88.9±10.1 vs. 108.2±11.6 mg/dl; P = 0.0170), whereas FFA and HDL declined by 32% (FFA: 0.38±0.06 vs. 0.26±0.04 mM; P = 0.0166) and 11% (54.2±4.7 vs. 48.9±4.3 mg/dl; P = 0.0184), respectively after olanzapine. Other measures were unchanged. Conclusions/Significance Olanzapine exerts some but not all of the early endocrine/metabolic changes observed in rodent models of the metabolic side effects, and this suggest that antipsychotic effects are not limited to perturbations in glucose metabolism alone. Future prospective clinical studies should focus on identifying which reliable metabolic alterations might be useful as potential screening tools in assessing patient susceptibility to weight gain and diabetes caused by atypical antipsychotics. Trial Registration ClinicalTrials.gov NCT00741026
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Affiliation(s)
- Vance L. Albaugh
- Department of Cellular and Molecular Physiology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Ravi Singareddy
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - David Mauger
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Christopher J. Lynch
- Department of Cellular and Molecular Physiology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
- * E-mail:
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Mandal AS, Biswas N, Karim KM, Guha A, Chatterjee S, Behera M, Kuotsu K. Drug delivery system based on chronobiology—A review. J Control Release 2010; 147:314-25. [DOI: 10.1016/j.jconrel.2010.07.122] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 07/28/2010] [Indexed: 11/29/2022]
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McGowan CM, Frost R, Pfeiffer DU, Neiger R. Serum insulin concentrations in horses with equine Cushing's syndrome: response to a cortisol inhibitor and prognostic value. Equine Vet J 2004; 36:295-8. [PMID: 15147141 DOI: 10.2746/0425164044877288] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Serum insulin concentration and its use as a prognostic indicator in horses with equine Cushing's syndrome (ECS) have been poorly documented. OBJECTIVES To examine daily insulin variations in horses with ECS and the effect of treatment using trilostane, a competitive inhibitor of 3beta-hydroxysteroid dehydrogenase. Further, we aimed to examine the relationship between baseline serum insulin concentration and survival in horses with ECS. METHODS Basal serum insulin concentrations were measured in 20 confirmed ECS cases by taking blood at regular 4 h intervals for 24 h (1200, 1600, 2000, 2400, 0400 and 0800 h) before treatment (Day 0) and 10 days, and 30 days and 1-2 years after the onset of trilostane therapy. The temporal pattern of insulin was analysed using a linear mixed model approach, and the prognostic value of measurements on Day 0 assessed using receiver-operating characteristic analysis. RESULTS Horses with ECS showed a diurnal pattern of serum insulin concentration, highest value at 1200 h, and this pattern was not altered by treatment with trilostane. Furthermore, despite a mild increase of serum insulin concentrations after 10 days of trilostane therapy, insulin concentration was unaffected in the long-term. Low serum insulin concentrations at the beginning of the trial were significantly associated with improved survival to 1-2 years. The 1200 h sampling before treatment had the highest prognostic value for prediction of survival with a sensitivity and specificity of at least 90% for serum insulin at < 62 and > 188 microu/ml to predict survival and nonsurvival, respectively. CONCLUSIONS AND POTENTIAL RELEVANCE Insulin is a useful prognostic indicator for ECS, but potentially large variations can occur throughout a 24 h period, indicating a single sample may not be representative. Serum insulin concentration did not increase over 1-2 years in horses receiving trilostane therapy.
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Affiliation(s)
- C M McGowan
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
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Youan BBC. Chronopharmaceutics: gimmick or clinically relevant approach to drug delivery? J Control Release 2004; 98:337-53. [PMID: 15312991 DOI: 10.1016/j.jconrel.2004.05.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Accepted: 05/25/2004] [Indexed: 10/26/2022]
Abstract
Due to advances in chronobiology, chronopharmacology, and global market constraints, the traditional goal of pharmaceutics (e.g. design drug delivery systems with a constant drug release rate) is becoming obsolete. However, the major bottleneck in the development of drug delivery systems that match the circadian rhythm (chronopharmaceutical drug delivery systems: ChrDDS) may be the availability of appropriate technology. The last decade has witnessed the emergence of ChrDDS against several diseases. The increasing research interest surrounding ChrDDS may lead to the creation of a new sub-discipline in pharmaceutics known as chronopharmaceutics. This review introduces the concept of chronopharmaceutics, addresses theoretical/formal approaches to this sub-discipline, underscores potential disease-targets, revisits existing technologies and examples of ChrDDS. Future development in chronopharmaceutics may be made at the interface of other emerging disciplines such as system biology and nanomedicine. Such novel and more biological approaches to drug delivery may lead to safer and more efficient disease therapy in the future.
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Affiliation(s)
- Bi-Botti C Youan
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center School of Pharmacy, Amarillo 1300, Coulter, TX 79106, USA.
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Feldhahn JR, Rand JS, Kinnaird E. The effect of interday variation and a short-term stressor on insulin sensitivity in clinically normal cats. J Feline Med Surg 1999; 1:233-40. [PMID: 11714240 PMCID: PMC10822368 DOI: 10.1053/jfms.1999.0056] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/1999] [Indexed: 11/11/2022]
Abstract
To determine whether there is a day-to-day variation in insulin sensitivity in cats, we subjected six clinically normal cats to four insulin-modified frequently sampled intravenous glucose tolerance tests (FSIVGTTs) over 7 days. The insulin-modified FSIVGTTs were analysed by the minimal model method. Minimal model insulin sensitivity (S(I)) averaged 2.9+/-0.4 x 10(-4) min(-1)/microU/ml (range 1.9-4.6 x 10(-4) min(-1)/microU/ml), with a mean interday coefficient of variation (CV) of 35.4+/-6.4% (range 12.8-58.5%). Glucose effectiveness (S(G)) averaged 0.029+/-0.002 min(-1)(range 0.024-0.037 min(-1)), and showed less interday variability with a mean CV of 24.7+/-4.3% (range 7.9-39.3%). Insulin sensitivity was also measured after a short-term stressor (5-min spray bath) of sufficient magnitude to elevate blood glucose levels. The mean insulin sensitivity after the stressor was 3.6+/-0.8 x 10(-4) min(-1)/microU/ml (range 1.6-7.3 x 10(-4) min(-1)/microU/ml), which was not significantly different to the mean insulin sensitivity before the short-term stressor (P=0.237). The mean glucose effectiveness after the stressor was 0.046+/-0.004 min(-1)(range 0.032-0.057 min(-1)), which was significantly different from mean glucose effectiveness before the short-term stressor (P=0.003). We conclude that insulin sensitivity is highly variable from day to day in normal cats, and that hyperglycaemia in response to short-term stressors is probably due to increased hepatic glucose production, rather than peripheral insulin resistance.
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Affiliation(s)
- J R Feldhahn
- Companion Animal Science, School of Veterinary Science and Animal Production, The University of Queensland, St Lucia 4072, Brisbane, Queensland, Australia
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Simell T, Mäenpää J, Kaprio EA, Hakulinen A, Hakalax J, Sipilä I, Akerblom HK, Simell O. Serum insulin profiles in consecutive children 2 years after the diagnosis of IDDM. Diabetologia 1995; 38:97-105. [PMID: 7744234 DOI: 10.1007/bf02369358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We studied associations of 24-h serum insulin profiles with insulin dose, age, gender, haemoglobin A1c (HbA1c) and C-peptide values, as well as blood glucose profiles in 77 consecutive children-nine aged 2-4, 14 aged 5-8, 26 aged 9-12, and 28 aged 13-17 years--2 years after the onset of insulin-dependent diabetes mellitus (IDDM). Mean weight-based insulin doses in the four age groups were similar (0.7 +/- 0.2 U.kg-1.day-1 in all); body surface-area-based doses differed. Insulin doses correlated significantly with the 24-h mean and area-under-the-curve (AUC) values, and with mean values at 03.00 hours of serum insulin in the children aged 5-8 and 13-17 years. The mean insulin concentrations of the age groups (95% confidence intervals) increased with age [6.1 (3.8, 9.7), 7.6 (5.9, 9.8), 10.4 (8.6, 12.4), and 14.0 (11.6, 16.8) mU/l; p < 0.0002]. The 24-h mean of serum insulin together with HbA1c concentration predicted 32% of the variation of mean blood glucose concentrations. Of children aged less than 9 years, 50% had insulin values less than 5 mU/l (healthy subjects' lower reference limit), and 14% were of less than 2 mU/l (detection limit of the assay) at 03.00 hours. At 07.00 hours, 82% had insulin values of less than 5 mU/l, and 36% were of less than 2 mU/l, respectively. Some young children had night-time hypoglycaemia with simultaneous hypoinsulinaemia. Insulin profiles correlated poorly with the HbA1c and peak C-peptide values.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T Simell
- I Department of Paediatrics, Children's Hospital, University of Helsinki, Finland
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