1
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Orbell SL, Codario RA, Zupa MF, Estock JL. Severe Insulin Pump-Related Adverse Events: Potential Root Causes and Impact of the COVID-19 Pandemic. J Diabetes Sci Technol 2024:19322968241254521. [PMID: 38804542 DOI: 10.1177/19322968241254521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To explore insulin pump-associated severe adverse events (SAEs) involving intensive care unit (ICU) admissions and deaths and examine the impact of the COVID-19 pandemic on these SAEs. METHODS Qualitative template analysis of narrative data in reported insulin pump-associated SAEs occurring between May 1, 2019, and January 31, 2021, involving MiniMed 670G, MiniMed 630G, Omnipod, Omnipod DASH, and t:slim X2 insulin pumps. RESULTS Over the 21-month measurement period, 460 SAEs involving an ICU admission and 288 SAEs involving a death were reported to the Food and Drug Administration. Problems with the pump or pod reservoir/cartridge were among the most frequently cited potential root causes in SAEs involving ICU admissions and deaths overall. However, problems with the infusion set or site and the pump battery or power emerged in the top three potential root causes of SAEs involving an ICU admission, whereas the patient sleeping at the time of the event and the tasks of changing the pod/infusion set, including reservoir/cartridge and programming the pump emerged in the top three for SAEs involving a death. The median monthly number of reported SAEs involving ICU admissions and deaths decreased during the pandemic, but their potential root causes were unchanged. CONCLUSIONS Although insulin pumps are generally safe, SAEs related to their components and external factors can and do occur. By learning from the potential root causes of insulin pump-associated SAEs, providers and patients can implement corrective actions to prevent future events, thereby reducing harm.
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Affiliation(s)
- Staci L Orbell
- Office of Research and Development, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ronald A Codario
- Department of Endocrinology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Margaret F Zupa
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie L Estock
- Office of Research and Development, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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2
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Lal R, Leelarathna L. Insulin Delivery Hardware: Pumps and Pens. Diabetes Technol Ther 2024; 26:S32-S44. [PMID: 38441453 DOI: 10.1089/dia.2024.2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Rayhan Lal
- Division of Endocrinology, Department of Medicine and Department Pediatrics
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, and Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, United Kingdom
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3
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Gupta S, Ramteke H, Gupta S, Gupta S, Gupta KS. Are People With Type 1 Diabetes Mellitus Appropriately Following Insulin Injection Technique Practices: A Review of Literature. Cureus 2024; 16:e51494. [PMID: 38304656 PMCID: PMC10831209 DOI: 10.7759/cureus.51494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
People with type 1 diabetes mellitus (T1DM) need to take multiple doses of insulin injections daily throughout their lives. However, a notable portion of people with diabetes mellitus (DM) show suboptimal insulin injection technique practices. They are supposed to follow the recommended insulin injection technique guidelines. Our explorative literature search, including studies from the past 30 years, is expected to identify the deficiencies of self-injection insulin techniques and the associated complications in people with T1DM, where we have summarised the overall incidence of complications that have occurred due to nonadherence of the prescribed guidelines, along with their associated risk factors. We have attempted to include multiple systematic reviews, meta-analyses, literature reviews, case reports, and original articles from the search engines and databases like PubMed, Scopus, ScienceDirect, Cochrane Library, Google Scholar, and BioMed Central, and studies with only human participants were included in this search. The knowledge sharing from this research may be utilised for enhancing the structured education diabetes programme and implementing the population-based corrective measures, including the thrust areas in future multi-centre longitudinal research studies and recommendations, which can prevent unnecessary complications and enhance their quality of life. Correct insulin administration technique, abstaining from administration of injection at the areas with lipohypertrophy, rotation of injection sites, and ultrasound scanning can be used as a complimentary method to detect the lipohypertrophy at an early stage. Liposuction is beneficial in reducing the extensive lipohypertrophic tissues but helps achieve only cosmetically satisfactory outcome; thus, empowering people to follow insulin injection technique guidelines is one of the best strategies to reduce the high prevalence of lipohypertrophy. To conclude, education among the people with DM, especially T1DM who have to take insulin regularly, needs to be carried out consistently in the clinical settings, to prevent the severe complications caused due to inappropriate insulin injection techniques.
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Affiliation(s)
- Swar Gupta
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshal Ramteke
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shlok Gupta
- Internal Medicine, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
| | - Sunil Gupta
- Diabetology, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
| | - Kavita S Gupta
- Nutrition, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
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4
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Huo Q, Zhou J, Tang H, Wu W, Hu S, Dong E, Huang Y, Zhou Y, Gao Y, Bai Y, Liu D. Nanoparticle surface decoration mediated efficient protein and peptide co-encapsulation with precise ratiometric control for self-regulated drug release. NANOSCALE 2023; 15:5063-5073. [PMID: 36807439 DOI: 10.1039/d2nr05744a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Accuratly controlling drug release from a smart "self-regulated" drug delivery system is still an ongoing challenge. Herein, we developed a surface decoration strategy to achieve an efficient drug encapsulation with precise ratiometric control. Thanks to the surface decoration with cationic carrier materials by electrostatic attraction, the surface properties of different protein and peptide nanoparticles were uniformed to those adsorbed carrier materials. These carrier materials endowed protein and peptide nanoparticles with good dispersity in the oil phase and significantly inhibited the drug transfer from oil to water. With uniform surface properties, we realized the co-encapsulation of multiple types of proteins and peptides with precise ratiometric control. The encapsulation efficiency was higher than 87.8% for insulin. After solidification, the adsorbed materials on the surface of nanoparticles formed a solid protection layer, which prolonged the mean residence time of insulin from 3.3 ± 0.1 h (for insulin solution) to 47.5 ± 1.3 h. In type 1 diabetes, the spermine-modified acetalated dextran microparticle co-loaded with insulin, glucose oxidase and catalase maintained the blood glucose level within the normal range for 7 days.
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Affiliation(s)
- Qingqing Huo
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Jun Zhou
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Hui Tang
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Wenbo Wu
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Shuai Hu
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Enpeng Dong
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Yang Huang
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Yunyi Zhou
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Yue Gao
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Yuancheng Bai
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
| | - Dongfei Liu
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing 210009, China.
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, China Pharmaceutical University, Nanjing 210009, China
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5
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Estock JL, Codario RA, Keddem S, Zupa MF, Rodriguez KL, DiNardo MM. Insulin Pump-Associated Adverse Events: A Qualitative Descriptive Study of Clinical Consequences and Potential Root Causes. Diabetes Technol Ther 2023; 25:343-355. [PMID: 36724310 DOI: 10.1089/dia.2022.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: To explore the clinical consequences and potential root causes of insulin pump-associated adverse events (AEs) reported in the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. Research Design and Methods: Qualitative template analysis of narrative data in a 20% stratified random sample (n = 2429) of reported AEs that occurred during the first 6 months of 2020 involving five insulin pump models marketed at that time: (1) MiniMed™ 670G, (2) MiniMed™ 630G, (3) Omnipod®, (4) Omnipod DASH®, and (5) t:slim X2™. Results: Of the 2429 AEs, 92% included a clinical consequence in the narrative description, with critical hyperglycemia (i.e., blood glucose [BG] >400 mg/dL; 47%) and critical hypoglycemia (i.e., BG <54 mg/dL; 24%) being the most common consequence cited. Only 50% of the AE narratives included information to support the identification of a root cause. The most cited root cause informing remarks were issues with the pump or pod reservoir/cartridge (9%), the occurrence of an obstruction of flow alarm (8%), and problems with the infusion set or site (8%). Some clinical consequences and root cause informing remarks were cited more frequently in AE narratives involving specific insulin pump models, but manufacturer variability in the amount and type of information reported may have affected these findings. Conclusions: Our findings show general themes found in insulin pump-associated AE that providers can use to raise patient awareness of potential risks associated with insulin pump use and develop strategies to prevent future AEs. Improvements in AE investigation and reporting processes are still necessary.
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Affiliation(s)
- Jamie L Estock
- Office of Research and Development; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Ronald A Codario
- Department of Endocrinology; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Margaret F Zupa
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Monica M DiNardo
- Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Ardilouze JL, Gobeil F, Cheng R, Ménard J, Bovan D, Messier V, Savard M, Baillargeon JP, Rabasa-Lhoret R. Can a Mixture of Insulin and a Nonsteroidal Anti-inflammatory Drug Prolong Insulin Pump Catheter Wear Time in Adults With Type 1 Diabetes? Can J Diabetes 2023; 47:180-184. [PMID: 36050255 DOI: 10.1016/j.jcjd.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jean-Luc Ardilouze
- Endocrinology Division, University of Sherbrooke, Sherbrooke, Québec, Canada; Research Centre of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Fernand Gobeil
- Research Centre of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Pharmacology-Physiology Department, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Ran Cheng
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Endocrinology Division, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julie Ménard
- Research Centre of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Danijela Bovan
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Virginie Messier
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Martin Savard
- Pharmacology-Physiology Department, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean-Patrice Baillargeon
- Endocrinology Division, University of Sherbrooke, Sherbrooke, Québec, Canada; Research Centre of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Endocrinology Division, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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7
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Aleppo G, DeSalvo DJ, Lauand F, Huyett LM, Chang A, Vienneau T, Ly TT. Improvements in Glycemic Outcomes in 4738 Children, Adolescents, and Adults with Type 1 Diabetes Initiating a Tubeless Insulin Management System. Diabetes Ther 2023; 14:593-610. [PMID: 36763329 PMCID: PMC9913031 DOI: 10.1007/s13300-023-01366-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Despite recent advances in diabetes technology, most people living with type 1 diabetes mellitus (T1D) are unable to meet glycemic targets. Real-world evidence can provide insight into outcomes achieved with specific treatment devices when used in clinical practice. The aim of this study was to analyze real-world outcomes collected from a large cohort of people living with T1D and initiating treatment with the Omnipod DASH System. METHODS In this retrospective observational study, real-world outcomes were analyzed from a database of information collected from people with T1D initiating the Omnipod DASH System. Information in the database was either taken directly from the patient's medical record or self-reported if medical records were unavailable. The primary outcome was change in glycated hemoglobin (HbA1c) from baseline (before initiation) to 3 months after initiation. Secondary outcomes were changes in total daily dose of insulin (TDD) and self-reported frequency of hypoglycemic events (< 70 mg/dL). Results are separated for the adult (≥ 18 years, N = 3341) and pediatric (< 18 years, N = 1397) cohorts. RESULTS The change in HbA1c from baseline was - 0.9 ± 1.6% ( - 10 ± 18 mmol/mol; p < 0.0001) in adults and - 0.9 ± 2.0% ( - 10 ± 22 mmol/mol; p < 0.0001) in the pediatric cohort. For those previously using multiple daily injections, HbA1c decreased by - 1.0 ± 1.7% ( - 11 ± 19 mmol/mol) in adults and - 1.0 ± 2.1% ( - 11 ± 23 mmol/mol) in the pediatric cohort (both p < 0.0001). Hypoglycemic events decreased in adults from 2.9 to 1.3 episodes per week ( - 1.6 ± 3.2 events/week; p < 0.0001), and in the pediatric cohort from 2.8 to 1.5 episodes per week ( - 1.3 ± 2.7 events/week; p < 0.0001). In adults, TDD decreased by 19.9% (p < 0.0001), and it remained stable in the pediatric cohort (p > 0.05). CONCLUSIONS Real-world outcomes from this large cohort of people initiating therapy with the Omnipod DASH System showed significant improvement in HbA1c and a substantial reduction in hypoglycemic events after 3 months of use.
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Affiliation(s)
- Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 530, Chicago, IL, 60611, USA
| | - Daniel J DeSalvo
- Baylor College of Medicine, 1 Moursund St., Houston, TX, 77030, USA
| | - Felipe Lauand
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | | | - Albert Chang
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Todd Vienneau
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Trang T Ly
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
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8
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Heinemann L. Air Bubbles in Insulin Pumps: A Clinically Relevant Issue? J Diabetes Sci Technol 2022; 16:1351-1355. [PMID: 35658552 PMCID: PMC9631536 DOI: 10.1177/19322968221101885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lutz Heinemann
- Science Consulting in Diabetes GmbH, Kaarst,
Germany
- Lutz Heinemann, PhD, Science Consulting in Diabetes
GmbH, Geranienweg 7a, 41564 Kaarst, Germany.
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9
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Brazg R, Garg SK, Bhargava A, Thrasher JR, Latif K, Bode BW, Bailey TS, Horowitz BS, Cavale A, Kudva YC, Kaiserman KB, Grunberger G, Reed JC, Chattaraj S, Zhang G, Shin J, Chen V, Lee SW, Cordero TL, Rhinehart AS, Vigersky RA, Buckingham BA. Evaluation of Extended Infusion Set Performance in Adults with Type 1 Diabetes: Infusion Set Survival Rate and Glycemic Outcomes from a Pivotal Trial. Diabetes Technol Ther 2022; 24:535-543. [PMID: 35263188 PMCID: PMC9353978 DOI: 10.1089/dia.2021.0540] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Standard insulin infusion sets (IISs) are to be replaced every 2 to 3 days to avoid complications and diabetic ketosis due to set failure. This pivotal trial evaluated the safety and performance of a new extended-wear infusion set (EIS) when used for 7 days by adults with type 1 diabetes (T1D). Methods: This single-arm, nonrandomized trial enrolled adults (18-80 years of age) with T1D, who used their own MiniMed™ 670G system with insulin lispro or insulin aspart and the EIS for up to 7 days, across 12 consecutive wears. Safety endpoints included incidence of serious adverse events (SAEs), serious adverse device effects (SADEs), unanticipated adverse device effects (UADEs), severe hypoglycemia (SevHypo), severe hyperglycemia (SevHyper), diabetic ketoacidosis (DKA), and skin infection. The EIS failure rate due to unexplained hyperglycemia (i.e., suspected occlusion), the overall EIS survival rate, glycemic control outcomes (i.e., A1C, mean sensor glucose and time spent in established glucose ranges), total daily insulin delivered, and satisfaction with the EIS were determined. Results: The intention to treat population (n = 259, 48% men, 45.0 ± 14.1 years) wore a total of 3041 EIS devices. No SADE, UADE, or DKA events was reported. Overall rates of SAEs, SevHypo, SevHyper, and skin infection were 3.8, 2.5, 104.1, and 20.1 events per 100 participant-years. The rate of EIS failure due to unexplained hyperglycemia at the end of day 7 was 0.1% (95% confidence interval [CI]: 0.03-0.51) and 0.4% (95% CI: 0.16-1.00) for insulin lispro and aspart use, respectively. Overall EIS survival rate at the end of day 7 was 77.8% (95% CI: 76.2-79.3), glycemic control did not change, and participants reported greater satisfaction with the EIS compared with standard IISs worn before the study (P < 0.001). Conclusions: This investigation demonstrates that the EIS, when worn for up to 7 days, was safe and rated with high satisfaction, without adversely affecting glycemic control in adults with T1D. Clinical Trial Registration number: NCT04113694 (https://clinicaltrials.gov/ct2/show/NCT04113694).
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Affiliation(s)
- Ron Brazg
- Rainier Clinical Research Center, Renton, Washington, USA
| | - Satish K. Garg
- Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Anuj Bhargava
- Iowa Diabetes and Endocrinology Center, West Des Moines, Iowa, USA
| | | | - Kashif Latif
- AM Diabetes and Endocrinology Center, Bartlett, Tennessee, USA
| | | | | | | | - Arvind Cavale
- Diabetes and Endocrinology Consultants of Pennsylvania, Feasterville Trevose, Pennsylvania, USA
| | | | | | | | | | | | | | - John Shin
- Medtronic, Northridge, California, USA
| | | | | | | | | | | | - Bruce A. Buckingham
- Stanford University School of Medicine, Palo Alto, California, USA
- Address correspondence to: Bruce A. Buckingham, MD, Professor Emeritus - Active, Center for Academic Medicine, Pediatric Endocrinology, MC: 5660, Stanford University School of Medicine, 453 Quarry Road, Room 354, Palo Alto, CA 94304, USA
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10
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Ucieklak D, Mrozinska S, Wojnarska A, Malecki MT, Klupa T, Matejko B. Insulin-induced Lipohypertrophy in Patients with Type 1 Diabetes Mellitus Treated with an Insulin Pump. Int J Endocrinol 2022; 2022:9169296. [PMID: 35111222 PMCID: PMC8803446 DOI: 10.1155/2022/9169296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lipohypertrophy (LH) of subcutaneous tissue is an insulin-induced complication occurring in patients with diabetes. We aimed to define the prevalence of LH and identify its risk factors in type 1 diabetes (T1DM) patients treated with continuous subcutaneous insulin infusion (CSII). MATERIALS AND METHODS The study included 79 consecutive CSII-treated T1DM patients. The diagnose of LH was based on ultrasonography (US) as a reference method, physical examination was also performed. Clinical characteristics were available from the medical records. RESULTS The median age of patients was 28 years (interquartile range [IQR], 24-30.5) with a body mass index (BMI) of 24.5 ± 3.5 kg/m2, HbA1c 7.1% (IQR, 6.7-8.1), T1DM duration 15 (9-20) years, and CSII use duration of 8 year (IQR, 5-11). LH was detected by US in 75 (94.9%) patients. This value was much higher than this obtained by visual assessment (n = 39, 49.4%) or palpation (n = 59, 74.7%). In univariate analyses, the following risk factors for occurrence of 5 and more LH lesions were identified: the ratio of insulin dose to body mass exceeding 0.7 IU/kg (OR, 3.69; 95% CI, 1.43-10.01) and the total daily insulin dose (OR, 1.05; 95% CI, 1.02-1.09). A higher dose of insulin per kg remained a significant risk factor of LH amount in multivariate analysis. CONCLUSION This selected T1DM cohort treated with CSII had a very high prevalence of LH. US assessment should be considered as a reference method for LH screening in T1DM patients. The identified risk factors for the number of LH lesions were related to insulin dosing.
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Affiliation(s)
- Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Sandra Mrozinska
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Aleksandra Wojnarska
- University Hospital, Krakow, Poland
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
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11
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Jick SS, Oleske DM, Persson R, Zamudio J, Facheris MF. Epidemiology of skin event rates among users of pumps for the subcutaneous administration of drugs for chronic conditions. Curr Med Res Opin 2021; 37:1563-1571. [PMID: 34241571 DOI: 10.1080/03007995.2021.1953971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To provide the epidemiology of skin events occurring during long-term administration of medications delivered by continuous subcutaneous infusion pump (CSIP) systems as background rates for the development of novel CSIP treatments to use in community-based settings. METHODS Using a United Kingdom general practice database, we conducted a study to assess the rates of skin events among new users of apomorphine and insulin delivered by CSIP in patients with Parkinson's disease or diabetes, respectively. Skin events included skin infections, skin nodules/localized swelling, dermatitis/eczema, urticaria/erythema, and rash/other non-specific skin eruptions. RESULTS Five hundred and fifty-seven adults (age 30+) were included in this descriptive cohort. The median duration of CSIP use was 17 months among 255 apomorphine users and 41 months among 302 insulin users. By 60 months, ∼40% of both cohorts experienced skin events. Repeated skin events occurred in 11% of the apomorphine cohort and 14% of the insulin cohort at any time during follow-up. The overall skin event rate in the apomorphine cohort was 17 per 1000 person-months (PM) and 13 per 1000 PM in the insulin cohort. The most common skin events in both cohorts were infection and rash/unspecified skin eruptions. The highest rates of skin events occurred soon after apomorphine CSIP initiation (36 per 1000 PM in weeks 1-2 and 50 per 1000 PM in weeks 3-4), with lower rates after 4 weeks. Insulin CSIP users' skin event rates were consistent over the treatment duration. CONCLUSIONS Clinically important skin events are common during long-term administration of medications by CSIP.
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Affiliation(s)
- Susan S Jick
- Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | | | - Rebecca Persson
- Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
| | - Jorge Zamudio
- Global Medical Affairs, AbbVie, Inc., North Chicago, IL, USA
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Taleb N, Quintal A, Rakheja R, Messier V, Legault L, Racine E, Rabasa-Lhoret R. Perceptions and expectations of adults with type 1 diabetes for the use of artificial pancreas systems with and without glucagon addition: Results of an online survey. Nutr Metab Cardiovasc Dis 2021; 31:658-665. [PMID: 33358714 PMCID: PMC7886941 DOI: 10.1016/j.numecd.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The first hybrid artificial pancreas (AP) systems with insulin only (mono-hormonal) have recently reached the market while next generations systems are under development including those with glucagon addition (bi-hormonal). Understanding the expectations and impressions of future potential users about AP systems is important for optimal use of this clinically effective emerging technology. METHODS AND RESULTS An online survey about AP systems which consisted of 50 questions was addressed to people with type 1 diabetes in the province of Quebec, Canada. Surveys were completed by 123 respondents with type 1 diabetes (54% women, mean (SD) age 40.2 (14.4) y.o., diabetes duration 23.7 (14.1) years, 58% insulin pump users and 43% glucose sensor users). Of the respondents, 91% understood how AP systems work, 79% trusted them with correct insulin dosing, 73% were willing to replace their current treatment with AP and 80% expected improvement in quality of life. Anxiety about letting an algorithm control their glucose levels was expressed by 18% while the option of ignoring or modifying AP instructions was favoured by 88%. As for bi-hormonal AP systems, 83% of respondents thought they would be useful to further reduce hypoglycemic risks. CONCLUSIONS Overall, respondents expressed positive views about AP systems use and high expectations for a better quality of life, glycemic control and hypoglycemia reduction. Data from this survey could be useful to health care professionals and developers of AP systems.
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Affiliation(s)
- Nadine Taleb
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, 2900, Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Ariane Quintal
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada
| | - Rohan Rakheja
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada
| | - Virginie Messier
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada
| | - Laurent Legault
- Division of Endocrinology, McGill University, 1001 Decarie Blvd., Montreal, Quebec, H4A 1J4, Canada
| | - Eric Racine
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada; Department of Neurology and Neurosurgery, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada; Experimental Medicine, McGill University, 1001 Décarie Blvd., Montreal, QC, H4A 1J4, Canada; Biomedical Ethics Unit, McGill University, 3647 Peel, Montréal, QC, H3A 1X1, Canada; Départment de Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd., Montreal, QC, H3T 1J4, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Experimental Medicine, McGill University, 1001 Décarie Blvd., Montreal, QC, H4A 1J4, Canada; Départment de Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd., Montreal, QC, H3T 1J4, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, 2405 chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada; Montreal Diabetes Research Center & Endocrinology Division, 900 Saint-Denis, Montréal, QC, H2X 0A9, Canada.
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Benioudakis ES, Georgiou ED, Barouxi ED, Armagos AM, Koutsoumani V, Anastasiou-Veneti F, Koutsoumani E, Brokalaki M. The diabetes quality of life brief clinical inventory in combination with the management strategies in type 1 diabetes mellitus with or without the use of insulin pump. Diabetol Int 2020; 12:217-228. [PMID: 33786276 DOI: 10.1007/s13340-020-00477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Aims The aims of this study are to evaluate any differences in the Quality of life among Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Dose Injection (MDI) insulin delivery, applying the Diabetes Quality of life Brief Clinical Inventory (DQoL-BCI) questionnaire, and assess the diabetes management strategies between the two groups. Methods One hundred and ten adult participants (male/female ratio 1:2.7) with type 1 diabetes were recruited in this online survey. Forty-eight of them were using CSII and the rest 62 (were using) MDI insulin delivery. A 23-item socio-demographic/diabetes management strategies questionnaire and the 15-item DQoL-BCI were administered. Results CSII users scored statistically, significantly better at the satisfaction treatment subscale (p = 0.032) of the DQoL-BCI and emerged that they were implemented more management strategies such as dietician guidance services (p = 0.002), carbohydrate education seminars (p = 0.03). Predictive factors were also detected regarding the HbA1c < 7% (53 mmol/mol) and β-coefficients in relation to DQoL-BCI questionnaire with the subscales of a negative impact and satisfaction treatment. Conclusion Diabetes self-management education plays a key role to a better compliance with the treatment. Client-centered multidisciplinary centers in T1DM education are essential so that they be applicable for all T1DM patients irrespective of the type of insulin delivery they used.
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Affiliation(s)
- Emmanouil S Benioudakis
- Department of Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, General Hospital of Chania, Chania, Greece
| | - Evangelos D Georgiou
- Statistical Methods in Medicine and Pharmacy, Athens University of Economics and Business, Athens, Greece.,Department of Psychology, University of Cyprus Centre for Field Studies, University of Cyprus, Nicosia, Cyprus
| | | | - Athanasios M Armagos
- Health Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, Naval Hospital of Athens (NNA), Athens, Greece
| | | | | | | | - Maria Brokalaki
- Nutrition and Dietetics, Technological Educational Institute of Crete, Sitia, Greece
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Bhidayasiri R, Phokaewvarangkul O, Sakdisornchai K, Boonpang K, Chaudhuri KR, Parsons J, Lolekha P, Chairangsaris P, Srivanitchapoom P, Benedierks S, Panyakaew P, Boonmongkol T, Thongchuam Y, Kantachadvanich N, Phumphid S, Evans AH, Viriyavejakul A, Pisarnpong A, van Laar T, Jagota P. Establishing apomorphine treatment in Thailand: understanding the challenges and opportunities of Parkinson's disease management in developing countries. Expert Rev Neurother 2020; 20:523-537. [PMID: 32421371 DOI: 10.1080/14737175.2020.1770598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The increasing global burden of Parkinson's disease (PD) poses a particular challenge for developing countries, such as Thailand, when delivering care to a geographically diverse populace with limited resources, often compounded by a lack of expertise in the use of certain PD medications, such as device-aided therapies (DAT). AREAS COVERED A panel of local, regional, and international PD experts convened to review the unmet needs of PD in Thailand and share insights into effective delivery of DAT, focusing on experience with apomorphine infusion. Despite its proven efficacy and safety, implementation of apomorphine infusion as a new option was not straightforward. This has prompted a range of health-care professional and patient-focused initiatives, led by the Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders in Bangkok, to help establish a more coordinated approach to PD management throughout the country and ensure patients have access to suitable treatments. EXPERT OPINION Overcoming the challenges of education, proficiency, resource capacity and standard of care for PD patients in developing countries requires a coordinated effort both nationally and beyond. The best practices identified in Thailand following the introduction of apomorphine infusion might be helpful for other countries when implementing similar programs.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Karn Sakdisornchai
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital , London, UK
| | - Jan Parsons
- The Walton Centre for Neurology and Neurosurgery , Liverpool, UK
| | - Praween Lolekha
- Division of Neurology, Department of Medicine, Thammasat University Hospital , Pathumthani, Thailand
| | - Parnsiri Chairangsaris
- Division of Neurology, Department of Medicine, Phra Mongkutklao Hospital , Bangkok, Thailand
| | - Prachaya Srivanitchapoom
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | | | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Thanatat Boonmongkol
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Yuwadee Thongchuam
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Nitinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Andrew H Evans
- Department of Neurology, Royal Melbourne Hospital , Melbourne, Australia
| | | | - Apichart Pisarnpong
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Teus van Laar
- Department of Neurology, University of Groningen , Groningen, The Netherlands
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
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