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Pi L, Shi X, Wang Z, Zhou Z. Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A meta-analysis. Front Public Health 2023; 11:1074946. [PMID: 37064701 PMCID: PMC10097897 DOI: 10.3389/fpubh.2023.1074946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesAchieving glycemic control is a great challenge for young patients with type 1 diabetes (T1D), especially during the transition from childhood to adulthood. As various smartphone apps have been developed to improve glycemic control in T1D, we performed a meta-analysis of randomized controlled trials to assess the effect of smartphone apps on glycemic control in young patients with T1D.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing combined usual care and smartphone app treatment to usual care alone. This meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The primary outcomes were the weighted difference in means (WMD) of HbA1c change from baseline and the person-years incidence of mild hypoglycemia or severe hypoglycemia between intervention and control groups. We assessed pooled data by use of a random-effects model.ResultsOf 1,190 identified studies, nine were eligible and included in our analysis (N = 748 participants). Relative to the control, using smartphone apps yielded a non-significant reduction in glycated hemoglobin (HbA1c) (WMD = −0.26, 95% CI: −0.56 to 0.05; p = 0.10) and no increased frequency of mild hypoglycemia (WMD = 1.87, 95% CI: −1.52 to 5.27; p = 0.49) or severe hypoglycemia (WMD = −0.04, 95% CI: −0.35 to 0.27; p = 0.80). In further subgroup analysis, compared with the recording-style app group, the auxiliary-style app group exhibited a significant reduction in HbA1c (WMD = −0.83, 95% CI: −1.10 to −0.56, p < 0.001).ConclusionThe current pooled data analysis did not reveal a significant reduction in HbA1c in young patients with T1D undergoing treatment with smartphone apps and usual care in combination. However, auxiliary-style apps with insulin or carbo calculators were beneficial in reducing HbA1c.
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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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Tascini G, Berioli MG, Cerquiglini L, Santi E, Mancini G, Rogari F, Toni G, Esposito S. Carbohydrate Counting in Children and Adolescents with Type 1 Diabetes. Nutrients 2018; 10:E109. [PMID: 29361766 PMCID: PMC5793337 DOI: 10.3390/nu10010109] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 11/16/2022] Open
Abstract
Carbohydrate counting (CC) is a meal-planning tool for patients with type 1 diabetes (T1D) treated with a basal bolus insulin regimen by means of multiple daily injections or continuous subcutaneous insulin infusion. It is based on an awareness of foods that contain carbohydrates and their effect on blood glucose. The bolus insulin dose needed is obtained from the total amount of carbohydrates consumed at each meal and the insulin-to-carbohydrate ratio. Evidence suggests that CC may have positive effects on metabolic control and on reducing glycosylated haemoglobin concentration (HbA1c). Moreover, CC might reduce the frequency of hypoglycaemia. In addition, with CC the flexibility of meals and snacks allows children and teenagers to manage their T1D more effectively within their own lifestyles. CC and the bolus calculator can have possible beneficial effects in improving post-meal glucose, with a higher percentage of values within the target. Moreover, CC might be integrated with the counting of fat and protein to more accurately calculate the insulin bolus. In conclusion, in children and adolescents with T1D, CC may have a positive effect on metabolic control, might reduce hypoglycaemia events, improves quality of life, and seems to do so without influencing body mass index; however, more high-quality clinical trials are needed to confirm this positive impact.
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Affiliation(s)
- Giorgia Tascini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Maria Giulia Berioli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Laura Cerquiglini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Elisa Santi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giulia Mancini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Francesco Rogari
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giada Toni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
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QIN SY, CHEN ND, WANG Q, HUANG J, HE XX, LIU JB, GUO QP, YANG XH, WANG KM. Application of Nucleic Acid Aptamers in Polypeptides Researches. CHINESE JOURNAL OF ANALYTICAL CHEMISTRY 2017. [DOI: 10.1016/s1872-2040(17)61055-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Abstract
Although not curable, type 1 diabetes is eminently controllable. IIT, as guided by the results of landmark studies such as the DCCT, provides primary care providers with a blueprint for reducing the frequency of the devastating complications of diabetes that were all too common in the recent past. Considering the remarkable advances in contemporary therapy, including MDI and CSII, the likelihood of even greater future improvements in quality of life and survivability can be anticipated. Success requires patient engagement and education, an informed primary care provider, and an interdisciplinary team to maximize the benefits of insulin therapy and avoid the risks of hypoglycemia.
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Affiliation(s)
- Elizabeth Stephens
- Providence Medical Group NE-Medical Education, 5050 Northeast Hoyt, Suite 540, Portland, OR 97213, USA; Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR, USA.
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Rabbone I, Scaramuzza AE, Ignaccolo MG, Tinti D, Sicignano S, Redaelli F, De Angelis L, Bosetti A, Zuccotti GV, Cerutti F. Carbohydrate counting with an automated bolus calculator helps to improve glycaemic control in children with type 1 diabetes using multiple daily injection therapy: an 18-month observational study. Diabetes Res Clin Pract 2014; 103:388-94. [PMID: 24447811 DOI: 10.1016/j.diabres.2013.12.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/22/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
AIMS This study aimed to investigate the effect of carbohydrate counting (carbC), with or without an automated bolus calculator (ABC), in children with type 1 diabetes treated with multiple daily insulin injections. METHODS We evaluated 85 children, aged 9-16 years, with type 1 diabetes, divided into four groups: controls (n=23), experienced carbC (n=19), experienced carbC+ABC (n=18) and non-experienced carbC+ABC (n=25). Glycated haemoglobin (HbA1c), insulin use, and glycaemic variability - evaluated as high blood glucose index (HBGI) and low blood glucose index (LBGI) - were assessed at baseline and after 6 and 18 months. RESULTS At baseline, age, disease duration, BMI, HbA1c, insulin use, and HBGI (but not LBGI; p=0.020) were similar for all groups. After 6 months, HbA1c improved from baseline, although not significantly - patients using ABC (according to manufacturer's recommendations) HbA1c 7.14 ± 0.41% at 6 months vs. 7.35 ± 0.53% at baseline, (p=0.136) or without carbC experience HbA1c 7.61±0.62% vs. 7.95 ± 0.99% (p=0.063). Patients using ABC had a better HBGI (p=0.001) and a slightly worse LBGI (p=0.010) than those not using ABC. ABC settings were then personalised. At 18 months, further improvements in HbA1c were seen in children using the ABC, especially in the non-experienced carbC group (-0.42% from baseline; p=0.018). CONCLUSIONS CarbC helped to improve glycaemic control in children with type 1 diabetes using multiple daily injections. ABC use led to greater improvements in HbA1c, HBGI and LBGI compared with patients using only carbC, regardless of experience with carbC.
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Affiliation(s)
- Ivana Rabbone
- Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy
| | - Andrea E Scaramuzza
- Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy.
| | | | - Davide Tinti
- Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy
| | - Sabrina Sicignano
- Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy
| | - Francesca Redaelli
- Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy
| | - Laura De Angelis
- Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy
| | - Alessandra Bosetti
- Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy
| | - Gian Vincenzo Zuccotti
- Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy
| | - Franco Cerutti
- Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy
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Affiliation(s)
- Satish K Garg
- 1 Barbara Davis Center for Diabetes, University of Colorado Denver , Aurora, Colorado
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Malik R, Roy I. Stabilization of bovine insulin against agitation-induced aggregation using RNA aptamers. Int J Pharm 2013; 452:257-65. [PMID: 23680729 DOI: 10.1016/j.ijpharm.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/03/2013] [Accepted: 05/04/2013] [Indexed: 02/06/2023]
Abstract
Stabilization of monomeric insulin is a primary requirement for preserving the efficacy of the final formulation. Degraded and/or aggregated protein as well as the presence of any of the conventional excipients can result in immunogenic or anaphylactic reactions, and reduced bioavailability of the protein drug. The aim of this work was to select novel RNA-based stabilizers of bovine insulin which would recognize and bind to the monomeric protein and help retain its bioactivity. RNA aptamers were selected by an in vitro selection method. They were screened for their ability to inhibit insulin fibrillation using agitation as a stress condition. The in vitro activity of insulin was determined by phosphorylation of downstream proteins in the cell. In vivo bioactivity was determined in a diabetic rat model. RNA aptamers, which bound to insulin with very low dissociation constants and high specificity, were selected. These sequences were aligned and consensus regions were found. The RNA sequences had no effect on the signalling cascade initiated by insulin. The bioactivity of insulin, as measured by its ability to lower plasma glucose level in a diabetic rat model, also remained unchanged. RNA aptamers are a novel class of protein stabilizers which have the ability to disrupt protein-protein interactions and hence inhibit protein aggregation. Their non-toxic and non-immunogenic nature makes such formulations safe for use.
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Affiliation(s)
- Ravinder Malik
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, S.A.S. Nagar, Punjab 160 062, India
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Jain PK, Karunakaran D, Friedman SH. Construction of a Photoactivated Insulin Depot. Angew Chem Int Ed Engl 2012. [DOI: 10.1002/ange.201207264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jain PK, Karunakaran D, Friedman SH. Construction of a photoactivated insulin depot. Angew Chem Int Ed Engl 2012. [PMID: 23208858 DOI: 10.1002/anie.201207264] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Piyush K Jain
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri, Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
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