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Benioudakis E, Karlafti E, Kalaitzaki A, Kaiafa G, Savopoulos C, Didangelos T. Technological Developments and Quality of Life in Type 1 Diabetes Mellitus Patients: A Review of the Modern Insulin Analogues, Continuous Glucose Monitoring and Insulin Pump Therapy. Curr Diabetes Rev 2022; 18:e031121197657. [PMID: 34732118 DOI: 10.2174/1573399818666211103163208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/15/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disease, which is characterized by an increased prevalence worldwide, which, in fact, tends to take extensive dimensions. The recent rapid development of science and technology has significantly contributed to the improvement of the management of type 1 diabetes mellitus, both in achieving the required euglycaemic regulation and reducing the psychological burden associated with the disease, consequently improving the quality of life of the patients with type 1 diabetes mellitus. METHODS A literature review from 2010, related to the contribution of the modern insulin analogues, continuous glucose monitoring and the insulin pump, was performed using Scopus, ScienceDirect and PubMed databases. RESULTS Studies included in the review support a direct and indirect association of technological innovations with the quality of life. The use of type 1 diabetes mellitus technology was negatively associated with the frequency of the hypoglycaemias and the value of the glycosylated hemoglobin, while at the same time, the development and use of the related technology were highly associated with an improvement in the quality of life. CONCLUSION Patients' quality of life is an indicator of the management of type 1 diabetes mellitus, and it is just as important as glycaemic regulation. Through this review, it was concluded that a better quality of life of T1DM patients was associated with the improvement of glycosylated hemoglobin and hypoglycemic episodes.
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Affiliation(s)
- Emmanouil Benioudakis
- Psychiatric Clinic of the General Hospital of Chania, Chania, Greece
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyroula Kalaitzaki
- Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life, Social Work Department, Health Sciences Faculty, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Georgia Kaiafa
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Savopoulos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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2
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Boggi U, Baronti W, Amorese G, Pilotti S, Occhipinti M, Perrone V, Marselli L, Barsotti M, Campani D, Gianetti E, Insilla AC, Bosi E, Kaufmann E, Terrenzio C, Vistoli F, Marchetti P. Treating Type 1 Diabetes by Pancreas Transplant Alone: A Cohort Study on Actual Long-term (10 Years) Efficacy and Safety. Transplantation 2022; 106:147-157. [PMID: 33909390 DOI: 10.1097/tp.0000000000003627] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physiologically regulated insulin secretion and euglycemia are achievable in type 1 diabetes (T1D) by islet or pancreas transplantation. However, pancreas transplant alone (PTA) remains a debated approach, with uncertainties on its relative benefits and risks. We determined the actual long-term (10 y) efficacy and safety of PTA in carefully characterized T1D subjects. METHODS This is a single-center, cohort study in 66 consecutive T1D subjects who received a PTA between April 2001 and December 2007, and were then all followed until 10 y since transplant. Main features evaluated were patient survival, pancreas graft function, C-peptide levels, glycemic parameters, and the function of the native kidneys. RESULTS Ten-year actual patient survival was 92.4%. Optimal (insulin independence) or good (minimal insulin requirement) graft function was observed in 57.4% and 3.2% of patients, respectively. Six (9.0%) patients developed stage 5 or 4 chronic kidney disease. In the remaining individuals bearing a successful PTA, estimated glomerular filtration rate (eGFR) decline per year was -2.29 ± 2.69 mL/min/1.73 m2. Reduction of eGFR at 1 y post-PTA was higher in those with pre-PTA hyperfiltration and higher HbA1c concentrations; eGFR changes afterward significantly correlated with diabetes duration. In recipients with normoglycemia at 10 y, 74% of normoalbuminuric or microalbuminuric subjects pre-PTA remained stable, and 26% progressed toward a worse stage; conversely, in 62.5% of the macroalbuminuric individuals albuminuria severity regressed. CONCLUSIONS These long-term effects of PTA on patient survival, graft function, and the native kidneys support PTA as a suitable approach to treat diabetes in selected T1D patients.
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Affiliation(s)
- Ugo Boggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Silvia Pilotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Margherita Occhipinti
- Diabetes Unit, Versilia Hospital, Azienda ASL Area Vasta Nord-Ovest, Lido di Camaiore, Lucca, Italy
| | - Vittorio Perrone
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Lorella Marselli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
| | | | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Elena Gianetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Emanuele Bosi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emanuele Kaufmann
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Terrenzio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Vistoli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
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3
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Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord 2021; 22:217-240. [PMID: 33755854 PMCID: PMC7985920 DOI: 10.1007/s11154-021-09635-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.
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Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy.
| | - Angelo Avogaro
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy
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4
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Lal RA, Maikawa CL, Lewis D, Baker SW, Smith AAA, Roth GA, Gale EC, Stapleton LM, Mann JL, Yu AC, Correa S, Grosskopf AK, Liong CS, Meis CM, Chan D, Garner JP, Maahs DM, Buckingham BA, Appel EA. Full closed loop open-source algorithm performance comparison in pigs with diabetes. Clin Transl Med 2021; 11:e387. [PMID: 33931977 PMCID: PMC8087942 DOI: 10.1002/ctm2.387] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
Understanding how automated insulin delivery (AID) algorithm features impact glucose control under full closed loop delivery represents a critical step toward reducing patient burden by eliminating the need for carbohydrate entries at mealtimes. Here, we use a pig model of diabetes to compare AndroidAPS and Loop open-source AID systems without meal announcements. Overall time-in-range (70-180 mg/dl) for AndroidAPS was 58% ± 5%, while time-in-range for Loop was 35% ± 5%. The effect of the algorithms on time-in-range differed between meals and overnight. During the overnight monitoring period, pigs had an average time-in-range of 90% ± 7% when on AndroidAPS compared to 22% ± 8% on Loop. Time-in-hypoglycemia also differed significantly during the lunch meal, whereby pigs running AndroidAPS spent an average of 1.4% (+0.4/-0.8)% in hypoglycemia compared to 10% (+3/-6)% for those using Loop. As algorithm design for closed loop systems continues to develop, the strategies employed in the OpenAPS algorithm (known as oref1) as implemented in AndroidAPS for unannounced meals may result in a better overall control for full closed loop systems.
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Affiliation(s)
- Rayhan A. Lal
- Division of EndocrinologyDepartment of MedicineStanford UniversityStanfordCaliforniaUSA
- Division of EndocrinologyDepartment of PediatricsStanford UniversityStanfordCaliforniaUSA
- Stanford Diabetes Research CenterStanford UniversityStanfordCaliforniaUSA
| | | | | | - Sam W. Baker
- Department of Comparative MedicineStanford UniversityStanfordCaliforniaUSA
| | - Anton A. A. Smith
- Department of Materials Science & EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Gillie A. Roth
- Department of BioengineeringStanford UniversityStanfordCaliforniaUSA
| | - Emily C. Gale
- Department of BiochemistryStanford UniversityStanfordCaliforniaUSA
| | | | - Joseph L. Mann
- Department of Materials Science & EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Anthony C. Yu
- Department of Materials Science & EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Santiago Correa
- Department of Materials Science & EngineeringStanford UniversityStanfordCaliforniaUSA
| | | | - Celine S. Liong
- Department of BioengineeringStanford UniversityStanfordCaliforniaUSA
| | - Catherine M. Meis
- Department of Materials Science & EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Doreen Chan
- Department of ChemistryStanford UniversityStanfordCaliforniaUSA
| | - Joseph P. Garner
- Department of Comparative MedicineStanford UniversityStanfordCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCaliforniaUSA
| | - David M. Maahs
- Division of EndocrinologyDepartment of PediatricsStanford UniversityStanfordCaliforniaUSA
- Stanford Diabetes Research CenterStanford UniversityStanfordCaliforniaUSA
| | - Bruce A. Buckingham
- Division of EndocrinologyDepartment of PediatricsStanford UniversityStanfordCaliforniaUSA
- Stanford Diabetes Research CenterStanford UniversityStanfordCaliforniaUSA
| | - Eric A. Appel
- Division of EndocrinologyDepartment of PediatricsStanford UniversityStanfordCaliforniaUSA
- Stanford Diabetes Research CenterStanford UniversityStanfordCaliforniaUSA
- Department of BioengineeringStanford UniversityStanfordCaliforniaUSA
- Department of Materials Science & EngineeringStanford UniversityStanfordCaliforniaUSA
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5
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Wang W, Wang S, Wang X, Liu D, Geng Y, Wu T. A Glucose-Insulin Mixture Model and Application to Short-Term Hypoglycemia Prediction in the Night Time. IEEE Trans Biomed Eng 2020; 68:834-845. [PMID: 32776874 DOI: 10.1109/tbme.2020.3015199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Insulin-induced hypoglycemia is recognized as a critical problem for diabetic patients, especially at night. To give glucose prediction and advance warning of hypoglycemia of at least 30 minutes, various glucose-insulin models have been proposed. Recognizing the complementary nature of the models, this research proposes a Glucose-Insulin Mixture (GIM) model to predict the glucose values for hypoglycemia detection, by optimally fusing different models with its adjusted parameters to address the inter- and intra-individual variability. METHODS Two types of classic glucose-insulin models, the Ruan model, with single-compartment glucose kinetics, and the Hovorka model, with two-compartment glucose kinetics, are selected as two candidate models. Based on Bayesian inference, GIM is introduced with quantified contributions from the models with the associated parameters. GIM is then applied to predict the glucose values and hypoglycemia events. RESULTS The proposed model is validated by the nocturnal glucose data collected from 12 participants with type 1 diabetes. The GIM model has promising fitting of RMSE within 0.3465 mmol/L and predicting of RMSE within 0.5571 mmol/L. According to the literature, the hypoglycemia is defined as 3.9 mmol/L, and the GIM model shows good short-term hypoglycemia prediction performance with the data collected within the last hour (accuracy: 95.97%, precision: 91.77%, recall: 95.60%). In addition, the probability of hypoglycemia event in 30 minutes is inferred. CONCLUSION GIM, by fusing various glucose-insulin models via Bayesian inference, has the promise to capture glucose dynamics and predict hypoglycemia. SIGNIFICANCE GIM based short-term hypoglycemia prediction has potential clinical utility for timely intervention.
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Rinehart J, Lee S, Saugel B, Joosten A. Automated Blood Pressure Control. Semin Respir Crit Care Med 2020; 42:47-58. [PMID: 32746471 DOI: 10.1055/s-0040-1713083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Arterial pressure management is a crucial task in the operating room and intensive care unit. In high-risk surgical and in critically ill patients, sustained hypotension is managed with continuous infusion of vasopressor agents, which most commonly have direct α agonist activity like phenylephrine or norepinephrine. The current standard of care to guide vasopressor infusion is manual titration to an arterial pressure target range. This approach may be improved by using automated systems that titrate vasopressor infusions to maintain a target pressure. In this article, we review the evidence behind blood pressure management in the operating room and intensive care unit and discuss current and potential future applications of automated blood pressure control.
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Affiliation(s)
- Joseph Rinehart
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California
| | - Sean Lee
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outcomes Research Consortium, Cleveland, Ohio
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Brussels, Belgium.,Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
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7
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Li M, Song Y, Hou Y, Li N, Jiang Y, Sulaman M, Hao Q. Comparable Investigation of Characteristics for Implant Intra-Body Communication Based on Galvanic and Capacitive Coupling. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:1747-1758. [PMID: 31514153 DOI: 10.1109/tbcas.2019.2940827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Implanted devices have important applications in biomedical monitoring, diagnosis and treatment, where intra-body communication (IBC) has a decent prospect in wireless implant communication technology by using the conductive properties of the human body to transmit a signal. Most of the investigations on implant IBC are focused on galvanic coupling type. Capacitive coupling IBC device seems hard to implant, because the ground electrode of it seemingly has to be exposed to air. Zhang et al. previously proposed an implantable capacitive coupling electrode, which can be totally implanted into the human body [1], but it lacks an overall characteristic investigation. In this paper, a comparable investigation of characteristics for implant intra-body communication based on galvanic and capacitive coupling is conducted. The human arm models are established by finite element method. Meanwhile, aiming to improve the accuracy of the model, electrode polarization impedance (EPI) is incorporated into the model, and the influences of electrode polarization impedance on simulation results are also analyzed. Subsequently, the corresponding measurements using porcine are conducted. We confirm good capacitive coupling communication performances can be achieved. Moreover, some important conclusions have been included by contrastive analysis, which can be used to optimize implant intra-body communication devices performance and provide some hints for practical IBC design. The conclusions also indicate that the implant IBC has promising prospect in healthcare and other related fields.
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize the development of the photoactivated depot (PAD) approach for the minimally invasive and continuously variable delivery of insulin. RECENT FINDINGS Using an insulin PAD, we have demonstrated that we can release native, bioactive insulin into diabetic animals in response to light signals from a small external LED light source. We have further shown that this released insulin retains bioactivity and reduces blood glucose. In addition, we have designed and constructed second generation materials that have high insulin densities, with the potential for multiple day delivery. The PAD approach for insulin therapy holds promise for addressing the pressing need for continuously variable delivery methods that do not rely on pumps, and their myriad associated problems.
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Affiliation(s)
- Simon H Friedman
- Division of Pharmacology and Pharmaceutical Sciences, University of Missouri-Kansas City, School of Pharmacy, 2464 Charlotte Street, Kansas City, MO, 64108, USA.
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9
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Nadendla K, Sarode BR, Friedman SH. Hydrophobic Tags for Highly Efficient Light-Activated Protein Release. Mol Pharm 2019; 16:2922-2928. [PMID: 31117739 DOI: 10.1021/acs.molpharmaceut.9b00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We have previously described the photoactivated depot (PAD) approach for the light-stimulated release of therapeutic proteins such as insulin. The aim of this method is to release insulin from a shallow dermal depot in response to blood glucose information, using transcutaneous irradiation. Our first approach utilized a photocleavable group that linked insulin to an insoluble but injectable polymer bead. The bead conferred insolubility, ensuring that the injected material stayed at the site of injection, until light cleaved the link, and allowed insulin to be absorbed systemically. While this proved to be effective, the use of a polymer to ensure insolubility introduces two major design problems: (1) low concentration of insulin, as a majority of the material is composed of polymer, and (2) upon release of the insulin, the polymer has to be cleared from the system. To address these two problems, in this work, we have pursued "hydrophobic tags", photocleavable small nonpolar molecules that confer insolubility to the modified insulin prior to irradiation without the bulk or need for biodegradation required of polymers. We developed a combined solid- and solution-phase synthetic approach that allowed us to incorporate a range of small nonpolar moieties, including peptides, into the final depot materials. The resulting materials are >90% w/w insulin and have sharply decreased solubilities relative to unmodified insulin (≤1000 × lower). We demonstrated that they can be milled into low micron-sized particles that can be readily injected through a 31G needle. These suspensions can be prepared at an effective concentration of 20 mM insulin, a concentration at which 120 μL contains 7 days of insulin for a typical adult. Finally, upon photolysis, the insoluble particles release soluble, native insulin in a predictable fashion. These combined properties make these new modified insulins nearly ideal as candidates for PAD materials.
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Affiliation(s)
- Karthik Nadendla
- Division of Pharmaceutical Sciences , University of Missouri-Kansas City, School of Pharmacy , Kansas City , Missouri 64108 , United States
| | - Bhagyesh R Sarode
- Division of Pharmaceutical Sciences , University of Missouri-Kansas City, School of Pharmacy , Kansas City , Missouri 64108 , United States
| | - Simon H Friedman
- Division of Pharmaceutical Sciences , University of Missouri-Kansas City, School of Pharmacy , Kansas City , Missouri 64108 , United States
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10
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Lim ZW, Ping Y, Miserez A. Glucose-Responsive Peptide Coacervates with High Encapsulation Efficiency for Controlled Release of Insulin. Bioconjug Chem 2018; 29:2176-2180. [DOI: 10.1021/acs.bioconjchem.8b00369] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zhi Wei Lim
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
| | - Yuan Ping
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
| | - Ali Miserez
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551 Singapore
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11
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Bekiari E, Kitsios K, Thabit H, Tauschmann M, Athanasiadou E, Karagiannis T, Haidich AB, Hovorka R, Tsapas A. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis. BMJ 2018; 361:k1310. [PMID: 29669716 PMCID: PMC5902803 DOI: 10.1136/bmj.k1310] [Citation(s) in RCA: 254] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of artificial pancreas treatment in non-pregnant outpatients with type 1 diabetes. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, Cochrane Library, and grey literature up to 2 February 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials in non-pregnant outpatients with type 1 diabetes that compared the use of any artificial pancreas system with any type of insulin based treatment. Primary outcome was proportion (%) of time that sensor glucose level was within the near normoglycaemic range (3.9-10 mmol/L). Secondary outcomes included proportion (%) of time that sensor glucose level was above 10 mmol/L or below 3.9 mmol/L, low blood glucose index overnight, mean sensor glucose level, total daily insulin needs, and glycated haemoglobin. The Cochrane Collaboration risk of bias tool was used to assess study quality. RESULTS 40 studies (1027 participants with data for 44 comparisons) were included in the meta-analysis. 35 comparisons assessed a single hormone artificial pancreas system, whereas nine comparisons assessed a dual hormone system. Only nine studies were at low risk of bias. Proportion of time in the near normoglycaemic range (3.9-10.0 mmol/L) was significantly higher with artificial pancreas use, both overnight (weighted mean difference 15.15%, 95% confidence interval 12.21% to 18.09%) and over a 24 hour period (9.62%, 7.54% to 11.7%). Artificial pancreas systems had a favourable effect on the proportion of time with sensor glucose level above 10 mmol/L (-8.52%, -11.14% to -5.9%) or below 3.9 mmol/L (-1.49%, -1.86% to -1.11%) over 24 hours, compared with control treatment. Robustness of findings for the primary outcome was verified in sensitivity analyses, by including only trials at low risk of bias (11.64%, 9.1% to 14.18%) or trials under unsupervised, normal living conditions (10.42%, 8.63% to 12.2%). Results were consistent in a subgroup analysis both for single hormone and dual hormone artificial pancreas systems. CONCLUSIONS Artificial pancreas systems are an efficacious and safe approach for treating outpatients with type 1 diabetes. The main limitations of current research evidence on artificial pancreas systems are related to inconsistency in outcome reporting, small sample size, and short follow-up duration of individual trials.
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Affiliation(s)
- Eleni Bekiari
- Clinical Research and Evidence Based Medicine Unit, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Konstantinos Kitsios
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hood Thabit
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Martin Tauschmann
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Eleni Athanasiadou
- Clinical Research and Evidence Based Medicine Unit, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Thomas Karagiannis
- Clinical Research and Evidence Based Medicine Unit, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene and Epidemiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roman Hovorka
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Apostolos Tsapas
- Clinical Research and Evidence Based Medicine Unit, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
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12
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Messer LH, Forlenza GP, Wadwa RP, Weinzimer SA, Sherr JL, Hood KK, Buckingham BA, Slover RH, Maahs DM. The dawn of automated insulin delivery: A new clinical framework to conceptualize insulin administration. Pediatr Diabetes 2018; 19:14-17. [PMID: 28656656 DOI: 10.1111/pedi.12535] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 01/19/2023] Open
Affiliation(s)
- Laurel H Messer
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - Gregory P Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - R Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Bruce A Buckingham
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Robert H Slover
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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13
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Vargas-Uricoechea H. Efficacy and Safety of Insulin Glargine 300 U/mL versus 100 U/mL in Diabetes Mellitus: A Comprehensive Review of the Literature. J Diabetes Res 2018; 2018:2052101. [PMID: 29619381 PMCID: PMC5830021 DOI: 10.1155/2018/2052101] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/28/2017] [Indexed: 12/15/2022] Open
Abstract
To achieve good metabolic control in diabetes and maintain it in the long term, a combination of changes in lifestyle and pharmacological treatment is necessary. The need for insulin depends upon the balance between insulin secretion and insulin resistance. Insulin is considered the most effective glucose-lowering therapy available and is required by people with type 1 diabetes mellitus to control their blood glucose levels; yet, many people with type 2 diabetes mellitus will also eventually require insulin therapy, due to the progressive nature of the disease. A variety of long-acting insulins is currently used for basal insulin therapy (such as insulin glargine, degludec, and detemir), each having sufficient pharmacodynamic and pharmacokinetic profiles to afford lower intrapatient variability and an extended duration of action. The new glargine-300 formulation was developed to have a flatter and more extended time-action profile than the original glargine-100, and these characteristics may translate into more stable and sustained glycemic control over a 24 h dosing interval. The objective of this comprehensive review was to summarize the available evidence on the clinical efficacy and safety of glargine-300 versus glargine-100 from the EDITION clinical trial program, in patients with type 1 and type 2 diabetes mellitus.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Division of Endocrinology and Metabolism, Department of Internal Medicine, Universidad del Cauca, Popayán, Cauca, Colombia
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14
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Abstract
In recent years, continuous intraperitoneal insulin infusion (CIPII) has become a favored treatment alternative for patients with subcutaneous insulin resistance, mainly due to its ability of mimicking physiological conditions of insulin absorption. CIPII has been shown to improve glycemic control as well as to reduce hypoglycemic events and to lead to increased patient satisfaction and quality of life (QoL). Among CIPII delivery systems, Diaport stands out due to its low side effects, its demonstrated clinical efficacy and the potential for integration into closed-loop systems.
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Affiliation(s)
| | | | - Oliver Schnell
- Sciarc Institute, Baierbrunn, Germany
- Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany
- Oliver Schnell, MD, Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764 Munich-Neuherberg, Germany.
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15
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Fico G, Hernández L, Cancela J, Isabel MM, Facchinetti A, Fabris C, Gabriel R, Cobelli C, Arredondo Waldmeyer MT. Exploring the Frequency Domain of Continuous Glucose Monitoring Signals to Improve Characterization of Glucose Variability and of Diabetic Profiles. J Diabetes Sci Technol 2017. [PMID: 28627250 PMCID: PMC5588824 DOI: 10.1177/1932296816685717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) devices measure interstitial glucose concentrations (normally every 5 minutes), allowing observation of glucose variability (GV) patterns during the whole day. This information could be used to improve prescription of treatments and of insulin dosages for people suffering diabetes. Previous efforts have been focused on proposing indices of GV either in time or glucose domains, while the frequency domain has been explored only partially. The aim of this work is to explore the CGM signal in the frequency domain to understand if new indexes or features could be identified and contribute to a better characterization of glucose variability. METHODS The direct fast Fourier transform (FFT) and the Welch method were used to analyze CGM signals from three different profiles: people at risk of developing type 2 diabetes (P@R), T2D patients, and type 1 diabetes (T1D) patients. RESULTS The results suggests that features extracted from the FFT (ie, the localization and power of the maximum peak of the power spectrum and the bandwidth at 3 dB) are able to provide a characterization for all the three populations under study compared with the Welch approach. CONCLUSIONS Such preliminary results can represent a good insight for futures investigations with the possibility of building and using new indexes of glucose variability based on the frequency features.
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Affiliation(s)
- Giuseppe Fico
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Ciudad Universitaria, Madrid, Spain
- Giuseppe Fico, PhD, Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, ETSI Telecomunicación, Ciudad Universitaria, Av, Complutense, 30, Madrid 28040, Spain.
| | - Liss Hernández
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Ciudad Universitaria, Madrid, Spain
| | - Jorge Cancela
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Ciudad Universitaria, Madrid, Spain
| | - Miguel María Isabel
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Ciudad Universitaria, Madrid, Spain
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Chiara Fabris
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Rafael Gabriel
- Asociación Española para el Desarrollo de la Epidemiología Clínica, Madrid, Spain
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - María Teresa Arredondo Waldmeyer
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Ciudad Universitaria, Madrid, Spain
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16
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Affiliation(s)
| | - Tadej Battelino
- 2 UMC-University Children's Hospital Ljubljana , Slovenia
- 3 Faculty of Medicine, University of Ljubljana , Ljubljana, Slovenia
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17
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Rinehart J, Ma M, Calderon MD, Cannesson M. Feasibility of automated titration of vasopressor infusions using a novel closed-loop controller. J Clin Monit Comput 2017; 32:5-11. [PMID: 28124225 DOI: 10.1007/s10877-017-9981-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/05/2017] [Indexed: 12/28/2022]
Abstract
Blood pressure management is a central concern in critical care patients. For a variety of reasons, titration of vasopressor infusions may be an ideal use-case for computer assistance. Using our previous experience gained in the bench-to-bedside development of a computer-assisted fluid management system, we have developed a novel controller for this purpose. The aim of this preliminary study was to assess the feasibility of using this controller in simulated patients to maintain a target blood pressure in both stable and variable blood-pressure scenarios. We tested the controller in two sets of simulation scenarios: one with stable underlying blood pressure and a second with variable underlying blood pressure. In addition, in the variable phase of the study, we tested infusion-line delays of 8-60 s. The primary outcome for both testing conditions (stable and variable) was % case time in target range. We determined a priori that acceptable performance on the first phase of the protocol would require greater than 95% case-time in-target given the simple nature of the protocol, and for the second phase of the study 80% or greater given the erratic nature of the blood pressure changes taking place. 250 distinct cases for each simulation condition, both managed and unmanaged, were run over 4 days. In the stable hemodynamic conditions, the unmanaged group had an MAP of 57.5 ± 4.6 mmHg and spent only 5.6% of case time in-target. The managed group had an MAP of 70.3 ± 2.6 and spent a total of 99.5% of case time in-target (p < 0.00001 for both comparisons between groups). In the variable hemodynamic conditions, the unmanaged group had an MAP of 53.1 ± 5.0 mmHg and spent 0% of case time in-target. The managed group had an MAP of 70.5 ± 3.2 mmHg (p < 0.00001 compared to unmanaged group) and spent 88.6% of case time in-target (p < 0.00001 compared to unmanaged group), with 6.4% of case time over and 5.1% of case time under target. Increasing infusion lag increased coefficient of variation by about 10% per 15 s of lag (p = 0.001). This study demonstrated that this novel controller for vasopressor administration is able to main a target mean arterial pressure in a simulated physiologic model in the face of random disturbances and infusion-line lag.
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Affiliation(s)
- Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Dr. South, Orange, CA, 92868, USA.
| | - Michael Ma
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Dr. South, Orange, CA, 92868, USA
| | - Michael-David Calderon
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Dr. South, Orange, CA, 92868, USA
| | - Maxime Cannesson
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA, USA
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18
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Sarode BR, Kover K, Tong PY, Zhang C, Friedman SH. Light Control of Insulin Release and Blood Glucose Using an Injectable Photoactivated Depot. Mol Pharm 2016; 13:3835-3841. [PMID: 27653828 PMCID: PMC5101575 DOI: 10.1021/acs.molpharmaceut.6b00633] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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In this work we demonstrate
that blood glucose can be controlled
remotely through light stimulated release of insulin from an injected
cutaneous depot. Human insulin was tethered to an insoluble but injectable
polymer via a linker, which was based on the light cleavable di-methoxy
nitrophenyl ethyl (DMNPE) group. This material was injected
into the skin of streptozotocin-treated diabetic rats. We observed
insulin being released into the bloodstream after a 2 min trans-cutaneous
irradiation of this site by a compact LED light source. Control animals
treated with the same material, but in which light was blocked from
the site, showed no release of insulin into the bloodstream. We also
demonstrate that additional pulses of light from the light source
result in additional pulses of insulin being absorbed into circulation.
A significant reduction in blood glucose was then observed. Together,
these results demonstrate the feasibility of using light to allow
for the continuously variable control of insulin release. This in
turn has the potential to allow for the tight control of blood glucose
without the invasiveness of insulin pumps and cannulas.
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Affiliation(s)
- Bhagyesh R Sarode
- Division of Pharmaceutical Sciences, School of Pharmacy University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
| | - Karen Kover
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States.,Department of Medicine, School of Medicine, University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
| | - Pei Y Tong
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States
| | - Chaoying Zhang
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States
| | - Simon H Friedman
- Division of Pharmaceutical Sciences, School of Pharmacy University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
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19
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Anderson SM, Raghinaru D, Pinsker JE, Boscari F, Renard E, Buckingham BA, Nimri R, Doyle FJ, Brown SA, Keith-Hynes P, Breton MD, Chernavvsky D, Bevier WC, Bradley PK, Bruttomesso D, Del Favero S, Calore R, Cobelli C, Avogaro A, Farret A, Place J, Ly TT, Shanmugham S, Phillip M, Dassau E, Dasanayake IS, Kollman C, Lum JW, Beck RW, Kovatchev B. Multinational Home Use of Closed-Loop Control Is Safe and Effective. Diabetes Care 2016; 39:1143-50. [PMID: 27208316 PMCID: PMC5876016 DOI: 10.2337/dc15-2468] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/16/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy of a portable, wearable, wireless artificial pancreas system (the Diabetes Assistant [DiAs] running the Unified Safety System) on glucose control at home in overnight-only and 24/7 closed-loop control (CLC) modes in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS At six clinical centers in four countries, 30 participants 18-66 years old with type 1 diabetes (43% female, 96% non-Hispanic white, median type 1 diabetes duration 19 years, median A1C 7.3%) completed the study. The protocol included a 2-week baseline sensor-augmented pump (SAP) period followed by 2 weeks of overnight-only CLC and 2 weeks of 24/7 CLC at home. Glucose control during CLC was compared with the baseline SAP. RESULTS Glycemic control parameters for overnight-only CLC were improved during the nighttime period compared with baseline for hypoglycemia (time <70 mg/dL, primary end point median 1.1% vs. 3.0%; P < 0.001), time in target (70-180 mg/dL: 75% vs. 61%; P < 0.001), and glucose variability (coefficient of variation: 30% vs. 36%; P < 0.001). Similar improvements for day/night combined were observed with 24/7 CLC compared with baseline: 1.7% vs. 4.1%, P < 0.001; 73% vs. 65%, P < 0.001; and 34% vs. 38%, P < 0.001, respectively. CONCLUSIONS CLC running on a smartphone (DiAs) in the home environment was safe and effective. Overnight-only CLC reduced hypoglycemia and increased time in range overnight and increased time in range during the day; 24/7 CLC reduced hypoglycemia and increased time in range both overnight and during the day. Compared with overnight-only CLC, 24/7 CLC provided additional hypoglycemia protection during the day.
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Affiliation(s)
| | | | | | | | - Eric Renard
- Department of Endocrinology, Diabetes, and Nutrition and INSERM 1411 Clinical Investigation Center, Montpellier University Hospital, and UMR CNRS 5203/INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Bruce A Buckingham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Revital Nimri
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, and Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Francis J Doyle
- Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | | | - Patrick Keith-Hynes
- University of Virginia, Charlottesville, VA TypeZero Technologies, LLC, Charlottesville, VA
| | | | | | | | | | | | | | | | | | | | - Anne Farret
- Department of Endocrinology, Diabetes, and Nutrition and INSERM 1411 Clinical Investigation Center, Montpellier University Hospital, and UMR CNRS 5203/INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Jerome Place
- Department of Endocrinology, Diabetes, and Nutrition and INSERM 1411 Clinical Investigation Center, Montpellier University Hospital, and UMR CNRS 5203/INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Trang T Ly
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Satya Shanmugham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Moshe Phillip
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, and Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Eyal Dassau
- Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Isuru S Dasanayake
- Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA
| | | | - John W Lum
- Jaeb Center for Health Research, Tampa, FL
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
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20
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Maiorino MI, Casciano O, Della Volpe E, Bellastella G, Giugliano D, Esposito K. Reducing glucose variability with continuous subcutaneous insulin infusion increases endothelial progenitor cells in type 1 diabetes: an observational study. Endocrine 2016; 52:244-52. [PMID: 26184417 DOI: 10.1007/s12020-015-0686-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/06/2015] [Indexed: 12/30/2022]
Abstract
Circulating endothelial progenitor cells (EPCs) are involved in the repairing mechanisms of vascular damage. Glucose variability may contribute to the development of chronic vascular complications of diabetes. We evaluated whether reducing glucose variability with continuous subcutaneous insulin infusion (CSII) would increase circulating levels of EPCs in type 1 diabetes. The study population consisted of 106 type 1 diabetic patients: 41 subjects considered eligible for CSII completed a 6-month follow-up. Sixty-five patients on intensified insulin therapy with multiple daily injections served as control group. Seven EPCs phenotypes were assessed by flow cytometry, and glucose variability by mean amplitude of glycemic excursions (MAGE). Both CD34+KDR+ [difference between groups 32.0, 95 % CI (19.6-44.4) number/10(6) cells, P < 0.001] and CD34+KDR+CD133+ [12.5 (5.5-19.5), P < 0.001)] cell count increased at endpoint in the CSII group, associated with a reduction of MAGE [-1.1 (-2.1 to -0.1), P = 0.026]. No changes occurred in the control group. In multivariate analyses, changes in MAGE were independently associated with changes in both CD34+KDR+ (P = 0.019) and CD34+KDR+CD133+ (P = 0.022) cell count. Reducing glucose variability with CSII in type 1 diabetes increases circulating EPCs levels, suggesting a novel mechanism of vascular damage by oscillating glucose.
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Affiliation(s)
- Maria Ida Maiorino
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Science and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy.
| | - Ofelia Casciano
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Science and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy
| | - Elisabetta Della Volpe
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Science and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy
| | - Giuseppe Bellastella
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Science and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy
| | - Dario Giugliano
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Science and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, via Pansini n° 5, 80131, Naples, Italy
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21
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Affiliation(s)
- Darrell M Wilson
- Department of Pediatrics, Stanford University , Stanford, California
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22
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Taylor M, Gregory R, Tomlins P, Jacob D, Hubble J, Sahota T. Closed-loop glycaemic control using an implantable artificial pancreas in diabetic domestic pig ( Sus scrofa domesticus ). Int J Pharm 2016; 500:371-8. [DOI: 10.1016/j.ijpharm.2015.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 01/30/2023]
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23
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Imbalanced insulin action in chronic over nutrition: Clinical harm, molecular mechanisms, and a way forward. Atherosclerosis 2016; 247:225-82. [PMID: 26967715 DOI: 10.1016/j.atherosclerosis.2016.02.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 02/08/2023]
Abstract
The growing worldwide prevalence of overnutrition and underexertion threatens the gains that we have made against atherosclerotic cardiovascular disease and other maladies. Chronic overnutrition causes the atherometabolic syndrome, which is a cluster of seemingly unrelated health problems characterized by increased abdominal girth and body-mass index, high fasting and postprandial concentrations of cholesterol- and triglyceride-rich apoB-lipoproteins (C-TRLs), low plasma HDL levels, impaired regulation of plasma glucose concentrations, hypertension, and a significant risk of developing overt type 2 diabetes mellitus (T2DM). In addition, individuals with this syndrome exhibit fatty liver, hypercoagulability, sympathetic overactivity, a gradually rising set-point for body adiposity, a substantially increased risk of atherosclerotic cardiovascular morbidity and mortality, and--crucially--hyperinsulinemia. Many lines of evidence indicate that each component of the atherometabolic syndrome arises, or is worsened by, pathway-selective insulin resistance and responsiveness (SEIRR). Individuals with SEIRR require compensatory hyperinsulinemia to control plasma glucose levels. The result is overdrive of those pathways that remain insulin-responsive, particularly ERK activation and hepatic de-novo lipogenesis (DNL), while carbohydrate regulation deteriorates. The effects are easily summarized: if hyperinsulinemia does something bad in a tissue or organ, that effect remains responsive in the atherometabolic syndrome and T2DM; and if hyperinsulinemia might do something good, that effect becomes resistant. It is a deadly imbalance in insulin action. From the standpoint of human health, it is the worst possible combination of effects. In this review, we discuss the origins of the atherometabolic syndrome in our historically unprecedented environment that only recently has become full of poorly satiating calories and incessant enticements to sit. Data are examined that indicate the magnitude of daily caloric imbalance that causes obesity. We also cover key aspects of healthy, balanced insulin action in liver, endothelium, brain, and elsewhere. Recent insights into the molecular basis and pathophysiologic harm from SEIRR in these organs are discussed. Importantly, a newly discovered oxide transport chain functions as the master regulator of the balance amongst different limbs of the insulin signaling cascade. This oxide transport chain--abbreviated 'NSAPP' after its five major proteins--fails to function properly during chronic overnutrition, resulting in this harmful pattern of SEIRR. We also review the origins of widespread, chronic overnutrition. Despite its apparent complexity, one factor stands out. A sophisticated junk food industry, aided by subsidies from willing governments, has devoted years of careful effort to promote overeating through the creation of a new class of food and drink that is low- or no-cost to the consumer, convenient, savory, calorically dense, yet weakly satiating. It is past time for the rest of us to overcome these foes of good health and solve this man-made epidemic.
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24
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Abstract
Continuous glucose monitoring (CGM) provides information unattainable by intermittent capillary blood glucose, including instantaneous real-time display of glucose level and rate of change of glucose, alerts and alarms for actual or impending hypo- and hyperglycemia, "24/7" coverage, and the ability to characterize glycemic variability. Progressively more accurate and precise, reasonably unobtrusive, small, comfortable, user-friendly devices connect to the Internet to share information and are sine qua non for a closed-loop artificial pancreas. CGM can inform, educate, motivate, and alert people with diabetes. CGM is medically indicated for patients with frequent, severe, or nocturnal hypoglycemia, especially in the presence of hypoglycemia unawareness. Surprisingly, despite tremendous advances, utilization of CGM has remained fairly limited to date. Barriers to use have included the following: (1) lack of Food and Drug Administration approval, to date, for insulin dosing ("nonadjuvant use") in the United States and for use in hospital and intensive care unit settings; (2) cost and variable reimbursement; (3) need for recalibrations; (4) periodic replacement of sensors; (5) day-to-day variability in glycemic patterns, which can limit the predictability of findings based on retrospective, masked "professional" use; (6) time, implicit costs, and inconvenience for uploading of data for retrospective analysis; (7) lack of fair and reasonable reimbursement for physician time; (8) inexperience and lack of training of physicians and other healthcare professionals regarding interpretation of CGM results; (9) lack of standardization of software methods for analysis of CGM data; and (10) need for professional medical organizations to develop and disseminate additional clinical practice guidelines regarding the role of CGM. Ongoing advances in technology and clinical research have addressed several of these barriers. Use of CGM in conjunction with an insulin pump with automated suspension of insulin infusion in response to actual observed or predicted hypoglycemia, as well as progressive refinement of closed-loop systems, is expected to dramatically enhance the clinical utility and utilization of CGM.
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Affiliation(s)
- David Rodbard
- Biomedical Informatics Consultants LLC , Potomac, Maryland
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