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de Farias JLCB, Bessa WM. Intelligent Control with Artificial Neural Networks for Automated Insulin Delivery Systems. Bioengineering (Basel) 2022; 9:664. [PMID: 36354574 PMCID: PMC9687429 DOI: 10.3390/bioengineering9110664] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Type 1 diabetes mellitus is a disease that affects millions of people around the world. Recent progress in embedded devices has allowed the development of artificial pancreas that can pump insulin subcutaneously to automatically regulate blood glucose levels in diabetic patients. In this work, a Lyapunov-based intelligent controller using artificial neural networks is proposed for application in automated insulin delivery systems. The adoption of an adaptive radial basis function network within the control scheme allows regulation of blood glucose levels without the need for a dynamic model of the system. The proposed model-free approach does not require the patient to inform when they are going to have a meal and is able to deal with inter- and intrapatient variability. To ensure safe operating conditions, the stability of the control law is rigorously addressed through a Lyapunov-like analysis. In silico analysis using virtual patients are provided to demonstrate the effectiveness of the proposed control scheme, showing its ability to maintain normoglycemia in patients with type 1 diabetes mellitus. Three different scenarios were considered: one long- and two short-term simulation studies. In the short-term analyses, 20 virtual patients were simulated for a period of 7 days, with and without prior basal therapy, while in the long-term simulation, 1 virtual patient was assessed over 63 days. The results show that the proposed approach was able to guarantee a time in the range above 95% for the target glycemia in all scenarios studied, which is in fact well above the desirable 70%. Even in the long-term analysis, the intelligent control scheme was able to keep blood glucose metrics within clinical care standards: mean blood glucose of 119.59 mg/dL with standard deviation of 32.02 mg/dL and coefficient of variation of 26.78%, all below the respective reference values.
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Jarosinski MA, Chen YS, Varas N, Dhayalan B, Chatterjee D, Weiss MA. New Horizons: Next-Generation Insulin Analogues: Structural Principles and Clinical Goals. J Clin Endocrinol Metab 2022; 107:909-928. [PMID: 34850005 PMCID: PMC8947325 DOI: 10.1210/clinem/dgab849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 11/19/2022]
Abstract
Design of "first-generation" insulin analogues over the past 3 decades has provided pharmaceutical formulations with tailored pharmacokinetic (PK) and pharmacodynamic (PD) properties. Application of a molecular tool kit-integrating protein sequence, chemical modification, and formulation-has thus led to improved prandial and basal formulations for the treatment of diabetes mellitus. Although PK/PD changes were modest in relation to prior formulations of human and animal insulins, significant clinical advantages in efficacy (mean glycemia) and safety (rates of hypoglycemia) were obtained. Continuing innovation is providing further improvements to achieve ultrarapid and ultrabasal analogue formulations in an effort to reduce glycemic variability and optimize time in range. Beyond such PK/PD metrics, next-generation insulin analogues seek to exploit therapeutic mechanisms: glucose-responsive ("smart") analogues, pathway-specific ("biased") analogues, and organ-targeted analogues. Smart insulin analogues and delivery systems promise to mitigate hypoglycemic risk, a critical barrier to glycemic control, whereas biased and organ-targeted insulin analogues may better recapitulate physiologic hormonal regulation. In each therapeutic class considerations of cost and stability will affect use and global distribution. This review highlights structural principles underlying next-generation design efforts, their respective biological rationale, and potential clinical applications.
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Affiliation(s)
- Mark A Jarosinski
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yen-Shan Chen
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicolás Varas
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Balamurugan Dhayalan
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak Chatterjee
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael A Weiss
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Chemistry, Indiana University, Bloomington, Indiana, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
- Correspondence: Michael A. Weiss, MD, PhD, Dept of Biochemistry and Molecular Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 4053, Indianapolis, IN 46202-3082 USA.
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Pissarnitski DA, Kekec A, Yan L, Zhu Y, Feng DD, Huo P, Madsen-Duggan C, Moyes CR, Nargund RP, Kelly T, Zhang X, Carballo-Jane E, Gorski J, Zafian P, Qatanani M, Kaarsholm N, Meng F, Jia X, Lee KJ, Wang W, Xu S, Hohn MJ, Iammarino MJ, McCoy MA, Okoh GA, Liang Y, Hollingsworth SA, Erion MD, Kelley DE, Garbaccio RM, Zhang A, Mu J, Lin S. Discovery of Insulin Receptor Partial Agonists MK-5160 and MK-1092 as Novel Basal Insulins with Potential to Improve Therapeutic Index. J Med Chem 2022; 65:5593-5605. [PMID: 35298158 DOI: 10.1021/acs.jmedchem.1c02073] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We have identified a series of novel insulin receptor partial agonists (IRPAs) with a potential to mitigate the risk of hypoglycemia associated with the use of insulin as an antidiabetic treatment. These molecules were designed as dimers of native insulin connected via chemical linkers of variable lengths with optional capping groups at the N-terminals of insulin chains. Depending on the structure, the maximal activation level (%Max) varied in the range of ∼20-70% of native insulin, and EC50 values remained in sub-nM range. Studies in minipig and dog demonstrated that IRPAs had sufficient efficacy to normalize plasma glucose levels in diabetes, while providing reduction of hypoglycemia risk. IRPAs had a prolonged duration of action, potentially making them suitable for once-daily dosing. Two lead compounds with %Max values of 30 and 40% relative to native insulin were selected for follow up studies in the clinic.
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Affiliation(s)
| | - Ahmet Kekec
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Lin Yan
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Yuping Zhu
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Danqing D Feng
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Pei Huo
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | | | | | - Ravi P Nargund
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Terri Kelly
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Xiaoping Zhang
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | | | - Judith Gorski
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Peter Zafian
- Merck & Co., Inc., West Point, Pennsylvania 19486, United States
| | - Mo Qatanani
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Niels Kaarsholm
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Fanyu Meng
- Merck & Co., Inc., Rahway, New Jersey 07065, United States
| | - Xiujuan Jia
- Merck & Co., Inc., Rahway, New Jersey 07065, United States
| | - Keun-Joong Lee
- Merck & Co., Inc., Rahway, New Jersey 07065, United States
| | - Weixun Wang
- Merck & Co., Inc., Rahway, New Jersey 07065, United States
| | - Sherrie Xu
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Michael J Hohn
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | | | - Mark A McCoy
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Grace A Okoh
- Merck & Co., Inc., Rahway, New Jersey 07065, United States
| | - Yingkai Liang
- Merck & Co., Inc., West Point, Pennsylvania 19486, United States
| | | | - Mark D Erion
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - David E Kelley
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | | | - Amy Zhang
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - James Mu
- Merck & Co., Inc., South San Francisco, California 94080, United States
| | - Songnian Lin
- Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
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Idili A, Montón H, Medina-Sánchez M, Ibarlucea B, Cuniberti G, Schmidt OG, Plaxco KW, Parolo C. Continuous monitoring of molecular biomarkers in microfluidic devices. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2022; 187:295-333. [PMID: 35094779 DOI: 10.1016/bs.pmbts.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The ability to monitor molecular targets is crucial in fields ranging from healthcare to industrial processing to environmental protection. Devices employing biomolecules to achieve this goal are called biosensors. Over the last half century researchers have developed dozens of different biosensor approaches. In this chapter we analyze recent advances in the biosensing field aiming at adapting these to the problem of continuous molecular monitoring in complex sample streams, and how the merging of these sensors with lab-on-a-chip technologies would be beneficial to both. To do so we discuss (1) the components that comprise a biosensor, (2) the challenges associated with continuous molecular monitoring in complex sample streams, (3) how different sensing strategies deal with (or fail to deal with) these challenges, and (4) the implementation of these technologies into lab-on-a-chip architectures.
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Affiliation(s)
- Andrea Idili
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, CA, United States; Department of Chemical Science and Technologies, University of Rome, Tor Vergata, Rome, Italy
| | - Helena Montón
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, CA, United States
| | | | - Bergoi Ibarlucea
- Institute for Materials Science and Max Bergmann Center for Biomaterials, Technische Universität Dresden, Dresden, Germany; Center for Advancing Electronics Dresden (CFAED), Technische Universität Dresden, Dresden, Germany
| | - Gianaurelio Cuniberti
- Institute for Materials Science and Max Bergmann Center for Biomaterials, Technische Universität Dresden, Dresden, Germany; Center for Advancing Electronics Dresden (CFAED), Technische Universität Dresden, Dresden, Germany
| | - Oliver G Schmidt
- Institute for Integrative Nanosciences, Leibniz IFW Dresden, Dresden, Germany; Research Center for Materials, Architectures and Integration of Nanomembranes (MAIN), Chemnitz, Germany; School of Science, TU Dresden, Dresden, Germany
| | - Kevin W Plaxco
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, CA, United States; Interdepartmental Program in Biomolecular Science and Engineering University of California, Santa Barbara, CA, United States
| | - Claudio Parolo
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, CA, United States; Barcelona Institute for Global Health (ISGlobal) Hospital Clínic, Barcelona, Spain.
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Shariatinia Z. Big family of nano- and microscale drug delivery systems ranging from inorganic materials to polymeric and stimuli-responsive carriers as well as drug-conjugates. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zhang Q, Li S, Cai L, Zhu Y, Duan X, Jiang P, Zhong L, Guo K, Tong R. Microenvironment Activatable Nanoprodrug Based on Gripper-like Cyclic Phenylboronic Acid to Precisely and Effectively Alleviate Drug-induced Hepatitis. Theranostics 2021; 11:8301-8321. [PMID: 34373743 PMCID: PMC8344015 DOI: 10.7150/thno.61214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-induced hepatitis (DIH), which seriously interferes with disease treatment, is one of the most common reasons for termination of new drugs during preclinical studies or post-marketing surveillance. Although antioxidants and anti-inflammatory agents are promising, their nonspecific distribution and insolubility limit their application. Therefore, precise drug release at the disease site is an important way to alleviate DIH and avoid side effects. Methods: A gripper-like hydrophilic cyclic phenylboronic acid (cPBA) was synthesized and a nanoprodrug (cPBA-BE) was established by coupling cPBA with hydrophobic baicalein (BE). The stimuli-responsive release properties and therapeutic effect of cPBA-BE on drug-injured hepatocyte were investigated. The biodistribution and therapeutic effect of cPBA-BE both in acetaminophen-induced acute hepatitis model and rifampicin-induced chronic hepatitis model were further evaluated. Results: cPBA-BE conjugate could self-assemble into nanoprodrug with cPBA as the hydrophilic external layer and BE as the hydrophobic core. In HepaRG cells, cPBA-BE showed stronger cellular uptake. Due to the H2O2- and acid-sensitivity, cPBA-BE could achieve adequate BE release, significantly resist the depletion of GSH, mitochondrial dysfunction, downregulation of inflammation and cell apoptosis in the acetaminophen injured HepaRG cells. Biodistribution showed that cPBA-BE specifically increased the concentration of BE in the liver of DIH mice. cPBA-BE could alleviate acetaminophen-induced acute hepatitis or rifampicin-induced chronic hepatitis more effectively through relieving the oxidative stress, inflammation and block the neutrophil infiltration in liver. Conclusions: cPBA is expected to be a good platform for constructing injectable nanoprodrug with both H2O2 and pH-responsive properties by coupling a wide range of drugs containing o-diol. In this study, the nanoprodrug cPBA-BE was determined to be effective for alleviating the DIH.
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Riddell MC, Davis EA, Mayer-Davis EJ, Kahkoska A, Zaharieva DP. Advances in Exercise and Nutrition as Therapy in Diabetes. Diabetes Technol Ther 2021; 23:S131-S142. [PMID: 34061626 PMCID: PMC8336238 DOI: 10.1089/dia.2021.2509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Michael C Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Elizabeth A Davis
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- University of Western Australia Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Elizabeth J Mayer-Davis
- Department of Nutrition and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anna Kahkoska
- Department of Nutrition and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dessi P Zaharieva
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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8
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Corduas F, Mancuso E, Lamprou DA. Long-acting implantable devices for the prevention and personalised treatment of infectious, inflammatory and chronic diseases. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ahmed SH, Chowdhury TA, Hussain S, Syed A, Karamat A, Helmy A, Waqar S, Ali S, Dabhad A, Seal ST, Hodgkinson A, Azmi S, Ghouri N. Ramadan and Diabetes: A Narrative Review and Practice Update. Diabetes Ther 2020; 11:2477-2520. [PMID: 32909192 PMCID: PMC7480213 DOI: 10.1007/s13300-020-00886-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Fasting in the Islamic month of Ramadan is obligatory for all sane, healthy adult Muslims. The length of the day varies significantly in temperate regions-typically lasting ≥ 18 h during peak summer in the UK. The synodic nature of the Islamic calendar means that Ramadan migrates across all four seasons over an approximately 33-year cycle. Despite valid exemptions, there is an intense desire to fast during this month, even among those who are considered to be at high risk, including many individuals with diabetes mellitus. In this review we explore the current scientific and clinical evidence on fasting in patients with diabetes mellitus, focussing on type 2 diabetes mellitus and type 1 diabetes mellitus, with brief reviews on pregnancy, pancreatic diabetes, bariatric surgery, the elderly population and current practice guidelines. We also make recommendations on the management of diabetes patients during the month of Ramadan. Many patients admit to a do-it-yourself approach to diabetes mellitus management during Ramadan, largely due to an under-appreciation of the risks and implications of the rigors of fasting on their health. Part of the issue may also lie with a healthcare professional's perceived inability to grasp the religious sensitivities of Muslims in relation to disease management. Thus, the pre-Ramadan assessment is crucial to ensure a safe Ramadan experience. Diabetes patients can be risk-stratified from low, medium to high or very high risk during the pre-Ramadan assessment and counselled accordingly. Those who are assessed to be at high to very high risk are advised not to fast. The current COVID-19 pandemic upgrades those in the high-risk category to very high risk; hence a significant number of diabetes patients may fall under the penumbra of the 'not to fast' advisory. We recognize that fasting is a personal choice and if a person chooses to fast despite advice to the contrary, he/she should be adequately supported and monitored closely during Ramadan and for a brief period thereafter. Current advancements in insulin delivery and glucose monitoring technologies are useful adjuncts to strategies for supporting type 1 diabetes patients considered to be high risk as well as 'high-risk' type 2 patients manage their diabetes during Ramadan. Although there is a lack of formal trial data, there is sufficient evidence across the different classes of therapeutic hypoglycaemic agents in terms of safety and efficacy to enable informed decision-making and provide a breadth of therapeutic options for the patient and the healthcare professional, even if the professional advice is to abstain. Thus, Ramadan provides an excellent opportunity for patient engagement to discuss important aspects of management, to improve control in the short term during Ramadan and to help the observants understand that the metabolic gains achieved during Ramadan are also sustainable in the other months of the year by maintaining a dietary and behavioural discipline. The application of this understanding can potentially prevent long-term complications.
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Affiliation(s)
- Syed H Ahmed
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK.
- School of Medicine, University of Liverpool, Liverpool, UK.
| | | | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Ateeq Syed
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ali Karamat
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Helmy
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Salman Waqar
- Nuffield Department of Primary Care Health Sciences, University Oxford, Oxford, UK
| | - Samina Ali
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Susan T Seal
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Anna Hodgkinson
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- NHS South East London Clinical Commissioning Group, London, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
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Ahmed SH, Gallo S. Looping with Do-It-Yourself Artificial Pancreas Systems During Ramadan Fasting in Type 1 Diabetes Mellitus: Perspectives of a User and a Physician. Diabetes Ther 2020; 11:1-11. [PMID: 32922559 PMCID: PMC7480212 DOI: 10.1007/s13300-020-00901-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 11/28/2022] Open
Abstract
Hybrid closed-loop automated insulin delivery systems have helped type 1 diabetes (T1D) users close the loop between glucose monitoring and insulin delivery, a very important step in efforts to simulate the glucose-responsive insulin secretory function of a healthy pancreas. Do-It-Yourself Artificial Pancreas Systems (DIY APS) are a form of hybrid closed-loop system that use open-source algorithms, which govern the delivery of insulin in response to interstitial glucose and other variables that are personalized to an individual. The flexibility and customization afforded by these systems make them amenable for use in different worldly circumstances, one of which is fasting during the annual occurrence of Ramadan for observant Muslims. Here, we present the views of a DIY APS user who was able to fast successfully on most days of Ramadan after adopting this system, and the overview of a physician on these systems, with a focus on fasting during Ramadan with T1D.
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Affiliation(s)
- Syed Haris Ahmed
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
- School of Medicine, University of Liverpool, Liverpool, UK
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Hanaire H, Franc S, Borot S, Penfornis A, Benhamou PY, Schaepelynck P, Renard E, Guerci B, Jeandidier N, Simon C, Hannaert P, Xhaard I, Doron M, Huneker E, Charpentier G, Reznik Y. Efficacy of the Diabeloop closed-loop system to improve glycaemic control in patients with type 1 diabetes exposed to gastronomic dinners or to sustained physical exercise. Diabetes Obes Metab 2020; 22:324-334. [PMID: 31621186 DOI: 10.1111/dom.13898] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
AIMS To compare closed-loop (CL) and open-loop (OL) systems for glycaemic control in patients with type 1 diabetes (T1D) exposed to real-life challenging situations (gastronomic dinners or sustained physical exercise). METHODS Thirty-eight adult patients with T1D were included in a three-armed randomized pilot trial (Diabeloop WP6.2 trial) comparing glucose control using a CL system with use of an OL device during two crossover 72-hour periods in one of the three following situations: large (gastronomic) dinners; sustained and repeated bouts of physical exercise (with uncontrolled food intake); or control (rest conditions). Outcomes included time in spent in the glucose ranges of 4.4-7.8 mmol/L and 3.9-10.0 mmol/L, and time in hypo- and hyperglycaemia. RESULTS Time spent overnight in the tight range of 4.4 to 7.8 mmol/L was longer with CL (mean values: 63.2% vs 40.9% with OL; P ≤ .0001). Time spent during the day in the range of 3.9 to 10.0 mmol/L was also longer with CL (79.4% vs 64.1% with OL; P ≤ .0001). Participants using the CL system spent less time during the day with hyperglycaemic excursions (glucose >10.0 mmol/L) compared to those using an OL system (17.9% vs 31.9%; P ≤ .0001), and the proportions of time spent during the day with hyperglycaemic excursions of those using the CL system in the gastronomic dinner and physical exercise subgroups were of similar magnitude to those in the control subgroup (18.1 ± 6.3%, 17.2 ± 8.1% and 18.4 ± 12.5%, respectively). Finally, times spent in hypoglycaemia were short and not significantly different among the groups. CONCLUSIONS The Diabeloop CL system is superior to OL devices in reducing hyperglycaemic excursions in patients with T1D exposed to gastronomic dinners, or exposed to physical exercise followed by uncontrolled food and carbohydrate intake.
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Affiliation(s)
- Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, University of Toulouse, Toulouse, France
| | - Sylvia Franc
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, and Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabete, Evry, France
| | - Sophie Borot
- Department of Endocrinology, Metabolism, Diabetes and Nutrition, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
| | - Alfred Penfornis
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, and Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabete, Evry, France
- University Paris-Sud, Orsay, France
| | | | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Disorders, Marseille University Hospital, Sainte Marguerite Hospital, Marseille, France
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, and Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Bruno Guerci
- Endocrinology-Diabetes Care Unit, University of Lorraine, Vandoeuvre Lès Nancy, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition, CHU of Strasbourg, Strasbourg, France
| | - Chantal Simon
- Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Lyon Sud, Lyon, France
| | - Patrick Hannaert
- School of Medicine and Pharmacy of Poitiers, IRTOMIT, INSERM UMR 1082, Poitiers, France
| | - Ilham Xhaard
- Centre d'Etudes et de Recherches pour l'Intensification du Traitement du Diabète, Evry, France
| | - Maeva Doron
- University Grenoble Alpes, Grenoble, France
- CEA LETI MlNATEC Campus, Grenoble, France
| | | | - Guillaume Charpentier
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, and Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabete, Evry, France
| | - Yves Reznik
- Department of Endocrinology, University of Caen Côte de Nacre Regional Hospital Centre, Caen, France
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12
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Barasch N, Romig MC, Demko ZO, Dwyer C, Dietz A, Rosen M, Griffiths SM, Ravitz AD, Pronovost PJ, Sapirstein A. Automation and interoperability of a nurse-managed insulin infusion protocol as a model to improve safety and efficiency in the delivery of high-alert medications. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519893228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Noah Barasch
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Mark C Romig
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Zoe O Demko
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Cindy Dwyer
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Aaron Dietz
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Michael Rosen
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Steven M Griffiths
- Applied Physics Laboratory, The Johns Hopkins University, Baltimore, MD, USA
| | - Alan D Ravitz
- Applied Physics Laboratory, The Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Pronovost
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Adam Sapirstein
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
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13
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Abstract
PURPOSE OF REVIEW Pancreas transplantation enables complete patient independence from exogenous insulin administration and increases both patient survival and quality of life. Despite this, there has been a decline in pancreas transplantation for the past 20 years, influenced by changing donor demographics with more high-risk extended criteria (ECD) and donation after cardiac death (DCD) donors. This review discusses whether the advent of machine perfusion (MP), if extended to the pancreas, can increase the pool of suitable donor organs. RECENT FINDINGS Hypothermic and normothermic MP, as forms of preservation deemed superior to cold storage for high-risk kidney and liver donor organs, have opened the avenue for translation of this work into the pancreas. Recent experimental models of porcine and human ex-vivo pancreatic MP are promising. Applications of MP to the pancreas however need refinement-focusing on perfusion protocols and viability assessment tools. Emerging research shows pancreatic MP can potentially offer superior preservation capacity, the ability to both resuscitate and manipulate organs, and assess functional and metabolic organ viability. The future of MP will lie in organ assessment and resuscitation after retrieval, where ultimately organs initially considered high risk and unsuitable for transplantation will be optimised and transformed, making them then available for clinical use, thus increasing the pool of suitably viable pancreata for transplantation.
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Affiliation(s)
- Karim Hamaoui
- 0000 0001 2113 8111grid.7445.2Department of Surgery, Imperial College London, London, UK
| | - Vassilios Papalois
- 0000 0001 2113 8111grid.7445.2Department of Surgery, Imperial College London, London, UK
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14
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Laesser CI, Cumming P, Reber E, Stanga Z, Muka T, Bally L. Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review. J Clin Med 2019; 8:jcm8070935. [PMID: 31261760 PMCID: PMC6678336 DOI: 10.3390/jcm8070935] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/25/2022] Open
Abstract
Hyperglycemia is a common occurrence in hospitalized patients receiving parenteral and/or enteral nutrition. Although there are several approaches to manage hyperglycemia, there is no consensus on the best practice. We systematically searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov to identify records (published or registered between April 1999 and April 2019) investigating strategies to manage glucose control in adults receiving parenteral and/or enteral nutrition whilst hospitalized in noncritical care units. A total of 15 completed studies comprising 1170 patients were identified, of which 11 were clinical trials and four observational studies. Diabetes management strategies entailed adaptations of nutritional regimens in four studies, while the remainder assessed different insulin regimens and administration routes. Diabetes-specific nutritional regimens that reduced glycemic excursions, as well as algorithm-driven insulin delivery approaches that allowed for flexible glucose-responsive insulin dosing, were both effective in improving glycemic control. However, the assessed studies were, in general, of limited quality, and we see a clear need for future rigorous studies to establish standards of care for patients with hyperglycemia receiving nutrition support.
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Affiliation(s)
- Céline Isabelle Laesser
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Paul Cumming
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- School of Psychology and Counselling and IHBI, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
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15
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Artificial Pancreas: Current Progress and Future Outlook in the Treatment of Type 1 Diabetes. Drugs 2019; 79:1089-1101. [DOI: 10.1007/s40265-019-01149-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Christensen MO, Berg AK, Rytter K, Hommel E, Thyssen JP, Svensson J, Nørgaard K. Skin Problems Due to Treatment with Technology Are Associated with Increased Disease Burden Among Adults with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:215-221. [PMID: 30943072 DOI: 10.1089/dia.2019.0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In a 4-month follow-up survey, we examined whether treatment with continuous subcutaneous insulin infusion (CSII) and/or continuous glucose monitoring (CGM) in adults with type 1 diabetes was associated with sustained skin problems and whether skin problems were associated with diabetes-related emotional distress. RESEARCH DESIGN AND METHODS A total of 111 adult patients completed a follow-up questionnaire concerning skin problems as a result of CSII and/or CGM use. The questionnaire included a patient-reported outcome measure, the Problem Areas in Diabetes (PAID) scale. RESULTS Current visible skin problems caused by CSII or CGM use were reported by 51 (46.0%) participants, in 34 (66.7%) of whom skin problems had been reported more than 4 months earlier. Seventy-two (64.9%) participants reported skin problems as a result of CSII use, whereas 38 (74.5%) reported skin problems owing to CGM use at some time. Itching was the most prevalent complaint. CSII-related itching was associated with a mean PAID score >20 (P = 0.01), and patients with more than one skin problem had an increased PAID score compared with those with one or no skin problems (P = 0.006). CONCLUSIONS More than half patients treated with CSII, CGM, or both had experienced skin problems during 4 months of follow-up that were associated with increased diabetes burden. Skin problems represent a persistent health issue affecting diabetes-specific emotional distress.
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Affiliation(s)
- Maria O Christensen
- 1 University of Copenhagen, Copenhagen, Denmark
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Anna K Berg
- 1 University of Copenhagen, Copenhagen, Denmark
- 3 Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Karen Rytter
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Eva Hommel
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Jacob P Thyssen
- 4 Department of Dermatology and Allergy, Copenhagen University Hospital, Hellerup, Denmark
| | - Jannet Svensson
- 1 University of Copenhagen, Copenhagen, Denmark
- 3 Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Kirsten Nørgaard
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
- 5 Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
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17
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Huang Q, Liu C, Li JR, Zhang L, Huang FC, Wang D, Luo YJ. Incremental effect of liraglutide on traditional insulin injections in rats with type 2 diabetes mellitus by maintaining glycolipid metabolism and cardiovascular function. Exp Ther Med 2019; 17:1863-1869. [PMID: 30783461 DOI: 10.3892/etm.2019.7148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/26/2018] [Indexed: 11/06/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia, damaged insulin secretion and insulin resistance with high morbidity and mortality. Liraglutide (liragl) and insulin are effective hypoglycemic agents used in T2DM treatment. The potential effect of liragl in combination with insulin on T2DM remains unclear. The aim of the current study was to explore effects of liragl combined with insulin on glycolipid metabolism and cardiovascular function in rats with diabetes. A diabetes model was established in Sprague Dawley rats exposed to a high calorie and high sugar diet in conjunction with intraperitoneal injections of streptozotocin. Results indicated that liragl or insulin used alone decreased glucose and elevated insulin and c-peptide levels. However, their combination revealed greater effects. A significant increase in high-density lipoprotein cholesterol levels along with a decrease in total cholesterol, triglycerides and low-density lipoprotein cholesterol were observed in liragl- and insulin-treated rats compared with STZ-induced diabetes rats. Furthermore, co-administration of liragl and insulin significantly decreased sterol regulatory element-binding protein 1 levels and increased adenosine 5'-monophosphate kinase-α1 and carnitine palmitoyltransferase 1 expression. Combining liragl with insulin reduced myocardial hypertrophy level and gaps between cardiomyocytes compared with liragl or insulin treatment alone. Caspase-3 expression was significantly decreased by combination treatment of liragl and insulin. Oxidative damage was significantly decreased by co-administration of liragl and insulin through enhancing superoxide dismutase expression and reducing malondialdehyde. Furthermore, combination of liragl and insulin significantly reduced myocardial enzyme expression, including myoglobin, creatine kinase-muscle/brain and cardiac troponin I. In summary, the current study demonstrated synergistic effects of liragl and insulin injections on a T2DM rat model by maintaining glycolipid metabolism and cardiovascular function.
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Affiliation(s)
- Qian Huang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Chan Liu
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Jia-Rui Li
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Ling Zhang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Fu-Chang Huang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Dan Wang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Ya-Jing Luo
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
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18
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Jones SJ, Taylor AF, Beales PA. Towards feedback-controlled nanomedicines for smart, adaptive delivery. Exp Biol Med (Maywood) 2019; 244:283-293. [PMID: 30205721 PMCID: PMC6435888 DOI: 10.1177/1535370218800456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPACT STATEMENT The timing and rate of release of pharmaceuticals from advanced drug delivery systems is an important property that has received considerable attention in the scientific literature. Broadly, these mostly fall into two classes: controlled release with a prolonged release rate or triggered release where the drug is rapidly released in response to an environmental stimulus. This review aims to highlight the potential for developing adaptive release systems that more subtlety modulate the drug release profile through continuous communication with its environment facilitated through feedback control. By reviewing the key elements of this approach in one place (fundamental principles of nanomedicine, enzymatic nanoreactors for medical therapies and feedback-controlled chemical systems) and providing additional motivating case studies in the context of chronobiology, we hope to inspire innovative development of novel "chrononanomedicines."
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Affiliation(s)
- Stephen J. Jones
- School of Chemistry and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds LS2 9JT, UK
| | - Annette F. Taylor
- Department of Chemical and Biological Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Paul A Beales
- School of Chemistry and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds LS2 9JT, UK
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19
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A steady decline in pancreas transplantation rates. Pancreatology 2019; 19:31-38. [PMID: 30448085 DOI: 10.1016/j.pan.2018.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/27/2018] [Accepted: 11/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES After years of growth in many pancreas transplant programs, UNOS has reported declining transplant numbers in the USA. This precipitating trend urges for an evaluation of the transplant numbers and scientific productivity in the Eurotransplant region and the UK. METHODS We performed a trend analysis of pancreas transplantation rates, between 1997 and 2016, adjusting for changes in population size, and an analysis of scientific publications in this field. We used information from the UNOS, Eurotransplant, and UK transplant registry and bibliometric information from the Web of Science database. RESULTS Between 2004 and 2016 there was an average annual decline in pancreas transplantation rates per million inhabitants of 3.3% in the USA and 2.5% in the Eurotransplant region. In the UK, transplant numbers showed an average annual decline of 1.0% from 2009 to 2016. Publications in Q1 journals showed an annual change of -2.1% and +20.1%, before 2004, and a change of -3.8% and -5.5%, between 2004 and 2016, for USA and Eurotransplant publications, respectively. CONCLUSIONS Adjusting pancreas transplantation rates for changes in population size showed a clear decline in transplant numbers in both the USA and Eurotransplant region, with first signs of decline in the UK. Following this trend, the number of scientific publications in this field have declined worldwide.
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20
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Wysocki T, Pierce J, Caldwell C, Aroian K, Miller L, Farless R, Hafezzadeh I, McAninch T, Lee JM. A Web-Based Coping Intervention by and for Parents of Very Young Children With Type 1 Diabetes: User-Centered Design. JMIR Diabetes 2018; 3:e16. [PMID: 30559089 PMCID: PMC6307695 DOI: 10.2196/diabetes.9926] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/08/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Management of type 1 diabetes (T1D) among children aged <6 years is exceptionally challenging for parents and caregivers. Metabolic and psychosocial outcomes among very young children with T1D (YC-T1D) are tightly associated with their parents’ ability to meet these challenges. There is scant research testing interventions targeting these issues and few resources to equip health care providers with feasible and effective coping strategies for these parents. User-centered design (UCD) of a continuously accessible Web-based resource could be a mechanism for helping parents of YC-T1D cope more effectively with the complex challenges they face by providing them with information, solutions, and emotional support. Objective The objectives of this paper are to (1) describe the application of UCD principles to the development of a Web-based coping intervention designed by and for parents of very young children (<6 years old) with T1D; (2) illustrate the use of crowdsourcing methods in obtaining the perspectives of parents, health care providers, and Web development professionals in designing and creating this resource; and (3) summarize the design of an ongoing randomized controlled trial (RCT) that is evaluating the effects of parental access to this resource on pertinent child and parent outcomes. Methods This paper illustrates the application of UCD principles to create a Web-based coping resource designed by and for parents of YC-T1D. A Web-based Parent Crowd, a Health Care Provider Crowd, and a Focus Group of minority parents provided input throughout the design process. A formal usability testing session and design webinars yielded additional stakeholder input to further refine the end product. Results This paper describes the completed website and the ongoing RCT to evaluate the effects of using this Web-based resource on pertinent parent and child outcomes. Conclusions UCD principles and the targeted application of crowdsourcing methods provided the foundation for the development, construction, and evaluation of a continuously accessible, archived, user-responsive coping resource designed by and for parents of YC-T1D. The process described here could be a template for the development of similar resources for other special populations that are enduring specific medical or psychosocial distress. The ongoing RCT is the final step in the UCD process and is designed to validate its merits.
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Affiliation(s)
- Tim Wysocki
- Nemours Children's Specialty Care, Center for Health Care Delivery Science, Nemours Children's Health System, Jacksonville, FL, United States
| | - Jessica Pierce
- Nemours Children's Hospital, Center for Health Care Delivery Science, Nemours Children's Health System, Orlando, FL, United States
| | - Cindy Caldwell
- Nemours Children's Specialty Care, Center for Health Care Delivery Science, Nemours Children's Health System, Jacksonville, FL, United States
| | - Karen Aroian
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Louis Miller
- eCity Interactive, Inc, Philadelphia, PA, United States
| | | | | | - Terri McAninch
- Nemours Foundation, Department of Marketing and Communication, Nemours Children's Health System, Jacksonville, FL, United States
| | - Joyce M Lee
- Child Health Evaluation Research, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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21
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Lin CE, Ito Y, Deng A, Johns J, Matloff D, Cook CB, Sode K, La Belle JT. A Disposable Tear Glucose Biosensor-Part 5: Improvements in Reagents and Tear Sampling Component. J Diabetes Sci Technol 2018; 12:842-846. [PMID: 29667855 PMCID: PMC6134317 DOI: 10.1177/1932296818769944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A tear glucose (TG) sensor with an integrated tear sampler can provide a noninvasive method for calibrating the continuous TG contact lens and monitoring glucose. Expanding from previous work, an improved TG sensor that implements dried reagents, genetically modified glucose dehydrogenase (GDH), and a tear sampler was developed and compared against the TG sensor prepared with commercial GDH. It was found that neither sensor was affected by the tear interferents: ascorbic acid, acetaminophen, and uric acid. The sensor prepared with commercial GDH generated higher current. This suggests that using enzymes with lower Km may be advantageous when operating in low glucose environments like tears. The improved TG sensor also demonstrated the potential of integrating Schirmer's test strip as a tear sampler for self-monitoring of TG.
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Affiliation(s)
- Chi En Lin
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Yuka Ito
- Department of Biotechnology and Life
Science, Graduate School of Engineering, Tokyo University of Agriculture and
Technology, Koganei, Tokyo, Japan
| | - Anna Deng
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Jared Johns
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Daniel Matloff
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
| | - Curtiss B. Cook
- School of Medicine, Mayo Clinic Arizona,
Scottsdale, AZ, USA
| | - Koji Sode
- Department of Biotechnology and Life
Science, Graduate School of Engineering, Tokyo University of Agriculture and
Technology, Koganei, Tokyo, Japan
- Joint Department of Biomedical
Engineering, University of North Carolina at Chapel Hill, North Carolina State
University, Chapel Hill, NC, USA
| | - Jeffrey T. La Belle
- School of Biological and Health Systems
Engineering, Arizona State University, Tempe, AZ, USA
- School of Medicine, Mayo Clinic Arizona,
Scottsdale, AZ, USA
- Jeffrey T. La Belle, PhD, Arizona State
University, 550 E Orange St, Tempe, AZ 85287, USA.
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