1
|
Verma J, Dahiya S. Nanomaterials for diabetes: diagnosis, detection and delivery. NANOTECHNOLOGY 2024; 35:392001. [PMID: 38990067 DOI: 10.1088/1361-6528/ad5db5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
537 million people worldwide suffer from diabetes mellitus, a problem of glucose management that is related to a number of major health risks, including cardiovascular diseases. There is a need for new, efficient formulations of diabetic medications to address this condition and its related consequences because existing treatments have a number of drawbacks and limits. This encouraged the development of treatment plans to get around some of these restrictions, like low therapeutic drug bioavailability or patients' disobedience to existing therapies. Approaches based on nanotechnology have a lot of promise to enhance the treatment of diabetic patients. In order to manage blood glucose, this review article highlights recent developments and explores the potential applications of different materials (polymeric, ceramic, dendrimers, etc.) as nanocarriers for the delivery of insulin and other antidiabetic medications. Using an injectable and acid-degradable polymeric network produced by the electrostatic interaction of oppositely charged dextran nanoparticles loaded with insulin and glucose-specific enzymes, we reviewed a glucose-mediated release approach for the self-regulated delivery of insulin, in which, after a degradable nano-network was subcutaneously injected into type 1 diabetic mice,in vivoexperiments confirmed that these formulations improved glucose management. In addition, a discussion of silica-based nanocarriers, their potential for treating diabetes and controlling blood glucose levels, and an explanation of the role of dendrimers in diabetes treatment have been covered. This is done by utilizing the properties of silica nanoparticles, such as their tuneable particle and pore size, surface chemistry, and biocompatibility. The article summarized the significance of nanomaterials and their uses in the diagnosis and treatment of diabetes overall, illuminating the field's potential and outlining its prospects for the future.
Collapse
Affiliation(s)
- Jaya Verma
- Center for Precision Engineering, Harbin Institute of Technology, Harbin 150001, Heilongjiang, People's Republic of China
| | - Shakti Dahiya
- Department of Surgery, Divison of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15244, United States of America
| |
Collapse
|
2
|
Yu J, Wang H, Zhu M, Xu J. MDI versus CSII in Chinese adults with type 1 diabetes in a real-world situation: based on propensity score matching method. Health Qual Life Outcomes 2024; 22:47. [PMID: 38872219 PMCID: PMC11170850 DOI: 10.1186/s12955-024-02263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Compared with multiple daily insulin injections (MDI), continuous subcutaneous insulin infusion (CSII) is significantly more expensive and has not been widely used in Chinese type 1 diabetes mellitus (T1DM) patients. So there are still significant knowledge gaps regarding clinical and patient-reported outcomes in China. AIMS This study aims to compare the glycated hemoglobin (HbA1C), insulin therapy related quality of life (ITR-QOL), fear of hypoglycemia (FOH) of adult T1DM patients treated with MDI and CSII based on propensity score matching in real-world conditions in China. METHODS Four hundred twenty adult T1DM patients who were treated with MDI or CSII continuously for more than 12 months in a national metabolic center from June 2021 to June 2023 were selected as the study subjects. Their QOL and FOH were evaluated with Insulin Therapy Related Quality of Life Measure Questionnaire-Chinese version (ITR-QOL-CV) and the Chinese Version Hypoglycemia Fear Survey-Worry Scale (CHFSII-WS), and their HbA1C were collected at the same time. Potential confounding variables between the two groups were matched using propensity score matching. RESULTS Of the 420 patients included in the study, 315 were in MDI group and 105 were in CSII group. 102 pairs were successfully matched. After matching, the total score of ITR-QOL-CV scale in CSII group was significantly higher than that in MDI group (87.08 ± 13.53 vs. 80.66 ± 19.25, P = 0.006). Among them, the dimensions of daily life, social life, and psychological state were all statistically different (P < 0.05). The scores of CHFSII-WS (8.33 ± 3.49 vs. 11.77 ± 5.27, P = 0.003) and HbA1C (7.19 ± 1.33% vs. 7.71 ± 1.93%, P = 0.045) in CSII group were lower than those in MDI group. CONCLUSIONS 25.0% of T1DM adults are treated with CSII. Compared with adult T1DM patients treated with MDI, those treated with CSII have higher ITR-QOL, less FoH, and better control of HbA1C in real-world conditions in China. Therefore, regardless of economic factors, CSII is recommended for adult T1DM patients to optimize the therapeutic effect and outcomes.
Collapse
Affiliation(s)
- Jian Yu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China
| | - Hong Wang
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China
| | - Min Zhu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China.
| | - Jingjing Xu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), 300 Guangzhou Road, Nanjing, LA, 210029, China
- Department of Nursing, the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital), Nanjing, China
| |
Collapse
|
3
|
Wu J, Xue W, Yun Z, Liu Q, Sun X. Biomedical applications of stimuli-responsive "smart" interpenetrating polymer network hydrogels. Mater Today Bio 2024; 25:100998. [PMID: 38390342 PMCID: PMC10882133 DOI: 10.1016/j.mtbio.2024.100998] [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: 11/17/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
In recent years, owing to the ongoing advancements in polymer materials, hydrogels have found increasing applications in the biomedical domain, notably in the realm of stimuli-responsive "smart" hydrogels. Nonetheless, conventional single-network stimuli-responsive "smart" hydrogels frequently exhibit deficiencies, including low mechanical strength, limited biocompatibility, and extended response times. In response, researchers have addressed these challenges by introducing a second network to create stimuli-responsive "smart" Interpenetrating Polymer Network (IPN) hydrogels. The mechanical strength of the material can be significantly improved due to the topological entanglement and physical interactions within the interpenetrating structure. Simultaneously, combining different network structures enhances the biocompatibility and stimulus responsiveness of the gel, endowing it with unique properties such as cell adhesion, conductivity, hemostasis/antioxidation, and color-changing capabilities. This article primarily aims to elucidate the stimulus-inducing factors in stimuli-responsive "smart" IPN hydrogels, the impact of the gels on cell behaviors and their biomedical application range. Additionally, we also offer an in-depth exposition of their categorization, mechanisms, performance characteristics, and related aspects. This review furnishes a comprehensive assessment and outlook for the advancement of stimuli-responsive "smart" IPN hydrogels within the biomedical arena. We believe that, as the biomedical field increasingly demands novel materials featuring improved mechanical properties, robust biocompatibility, and heightened stimulus responsiveness, stimuli-responsive "smart" IPN hydrogels will hold substantial promise for wide-ranging applications in this domain.
Collapse
Affiliation(s)
- Jiuping Wu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wu Xue
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Zhihe Yun
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Qinyi Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Xinzhi Sun
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| |
Collapse
|
4
|
Jafar A, Pasqua MR, Olson B, Haidar A. Advanced decision support system for individuals with diabetes on multiple daily injections therapy using reinforcement learning and nearest-neighbors: In-silico and clinical results. Artif Intell Med 2024; 148:102749. [PMID: 38325921 DOI: 10.1016/j.artmed.2023.102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/03/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
Many individuals with diabetes on multiple daily insulin injections therapy use carbohydrate ratios (CRs) and correction factors (CFs) to determine mealtime and correction insulin boluses. The CRs and CFs vary over time due to physiological changes in individuals' response to insulin. Errors in insulin dosing can lead to life-threatening abnormal glucose levels, increasing the risk of retinopathy, neuropathy, and nephropathy. Here, we present a novel learning algorithm that uses Q-learning to track optimal CRs and uses nearest-neighbors based Q-learning to track optimal CFs. The learning algorithm was compared with the run-to-run algorithm A and the run-to-run algorithm B, both proposed in the literature, over an 8-week period using a validated simulator with a realistic scenario created with suboptimal CRs and CFs values, carbohydrate counting errors, and random meals sizes at random ingestion times. From Week 1 to Week 8, the learning algorithm increased the percentage of time spent in target glucose range (4.0 to 10.0 mmol/L) from 51 % to 64 % compared to 61 % and 58 % with the run-to-run algorithm A and the run-to-run algorithm B, respectively. The learning algorithm decreased the percentage of time spent below 4.0 mmol/L from 9 % to 1.9 % compared to 3.4 % and 2.3 % with the run-to-run algorithm A and the run-to-run algorithm B, respectively. The algorithm was also assessed by comparing its recommendations with (i) the endocrinologist's recommendations on two type 1 diabetes individuals over a 16-week period and (ii) real-world individuals' therapy settings changes of 23 individuals (19 type 2 and 4 type 1) over an 8-week period using the commercial Bigfoot Unity Diabetes Management System. The full agreements (i) were 89 % and 76 % for CRs and CFs for the type 1 diabetes individuals and (ii) was 62 % for mealtime doses for the individuals on the commercial Bigfoot system. Therefore, the proposed algorithm has the potential to improve glucose control in individuals with type 1 and type 2 diabetes.
Collapse
Affiliation(s)
- Adnan Jafar
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Melissa-Rosina Pasqua
- Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada; The Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Byron Olson
- Bigfoot Biomedical Inc., Milpitas, CA, United States
| | - Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada; Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada; The Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
5
|
Yang JF, Yang S, Gong X, Bakh NA, Zhang G, Wang AB, Cherrington AD, Weiss MA, Strano MS. In Silico Investigation of the Clinical Translatability of Competitive Clearance Glucose-Responsive Insulins. ACS Pharmacol Transl Sci 2023; 6:1382-1395. [PMID: 37854621 PMCID: PMC10580396 DOI: 10.1021/acsptsci.3c00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Indexed: 10/20/2023]
Abstract
The glucose-responsive insulin (GRI) MK-2640 from Merck was a pioneer in its class to enter the clinical stage, having demonstrated promising responsiveness in in vitro and preclinical studies via a novel competitive clearance mechanism (CCM). The smaller pharmacokinetic response in humans motivates the development of new predictive, computational tools that can improve the design of therapeutics such as GRIs. Herein, we develop and use a new computational model, IM3PACT, based on the intersection of human and animal model glucoregulatory systems, to investigate the clinical translatability of CCM GRIs based on existing preclinical and clinical data of MK-2640 and regular human insulin (RHI). Simulated multi-glycemic clamps not only validated the earlier hypothesis of insufficient glucose-responsive clearance capacity in humans but also uncovered an equally important mismatch between the in vivo competitiveness profile and the physiological glycemic range, which was not observed in animals. Removing the inter-species gap increases the glucose-dependent GRI clearance from 13.0% to beyond 20% for humans and up to 33.3% when both factors were corrected. The intrinsic clearance rate, potency, and distribution volume did not apparently compromise the translation. The analysis also confirms a responsive pharmacokinetics local to the liver. By scanning a large design space for CCM GRIs, we found that the mannose receptor physiology in humans remains limiting even for the most optimally designed candidate. Overall, we show that this computational approach is able to extract quantitative and mechanistic information of value from a posteriori analysis of preclinical and clinical data to assist future therapeutic discovery and development.
Collapse
Affiliation(s)
- Jing Fan Yang
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Sungyun Yang
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Xun Gong
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Naveed A. Bakh
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Ge Zhang
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Allison B. Wang
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Alan D. Cherrington
- Molecular
Physiology and Biophysics, Vanderbilt University
School of Medicine, Nashville, Tennessee 37232, United States
| | - Michael A. Weiss
- Department
of Biochemistry & Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana 46202, United States
| | - Michael S. Strano
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
6
|
Thorius IH, Husemoen LLN, Nordsborg RB, Alibegovic AC, Gall MA, Petersen J, Mathiesen ER. Congenital malformations among offspring of women with type 1 diabetes who use insulin pumps: a prospective cohort study. Diabetologia 2023; 66:826-836. [PMID: 36640191 DOI: 10.1007/s00125-022-05864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/23/2022] [Indexed: 01/15/2023]
Abstract
AIMS/HYPOTHESIS Continuous subcutaneous insulin infusion by insulin pump is often superior in improving glycaemic control compared with conventional multiple daily insulin injection (MDI). However, whether pump treatment leads to improved pregnancy outcomes in terms of congenital malformations and perinatal death remains unknown. The present aim was to evaluate the risk of malformations and perinatal and neonatal death in pregnant women with type 1 diabetes treated with pump or MDI. METHODS We performed a secondary analysis of a prospective multinational cohort of 2088 pregnant women with type 1 diabetes in a real-world setting who were treated by pump (n=750) or MDI (n=1338). ORs for offspring with congenital malformations or perinatal or neonatal death were calculated using crude data and by logistic regression on propensity score-matched data. RESULTS At enrolment (gestational week 8; 95% CI 4, 14), pump users had a higher educational level (university degree: 37.3% vs 25.1%; p<0.001) and better glycaemic control (mean HbA1c: 51±10 mmol/mol [6.8±0.9%] vs 54±14 mmol/mol [7.1±1.3%], p<0.001) compared with MDI users. Moreover, a greater proportion of pump users had an HbA1c level below 75 mmol/mol (9%) (97.6% vs 91.9%, p<0.001), and more often reported taking folic acid supplementation (86.3% vs 74.8%; p<0.001) compared with MDI users. All clinically important potential confounders were balanced after propensity score matching, and HbA1c remained lower in pump users. The proportion of fetuses with at least one malformation was 13.5% in pump users vs 11.2% in MDI users (crude OR 1.23; 95% CI 0.94, 1.61; p=0.13; propensity score-matched (adjusted) OR 1.11; 95% CI 0.81, 1.52; p=0.52). The proportion of fetuses with at least one major malformation was 2.8% in pump users vs 3.1% in MDI users (crude OR 0.89; 95% CI 0.52, 1.51; p=0.66; adjusted OR 0.78; 95% CI 0.42, 1.45; p=0.43), and the proportions of fetuses carrying one or more minor malformations (but no major malformations) were 10.7% vs 8.1% (crude OR 1.36; 95% CI 1.00, 1.84; p=0.05; adjusted OR 1.23; 95% CI 0.87, 1.75; p=0.25). The proportions of perinatal and neonatal death were 1.6% vs 1.3% (crude OR 1.23; 95% CI 0.57, 2.67; p=0.59; adjusted OR 2.02; 95% CI 0.69, 5.93; p=0.20) and 0.3% vs 0.3% (n=2 vs n=4, p=not applicable), respectively. CONCLUSIONS/INTERPRETATIONS Insulin pump treatment was not associated with a lower risk of congenital malformations, despite better glycaemic control in early pregnancy compared with MDI. Further studies exploring the efficacy and safety of pump treatment during pregnancy are needed.
Collapse
Affiliation(s)
- Ida H Thorius
- Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Novo Nordisk A/S, Søborg, Denmark.
- Copenhagen Phase IV Unit, Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark.
| | | | | | | | | | - Janne Petersen
- Copenhagen Phase IV Unit, Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Biochemical and tissue physiopathological evaluation of the preclinical efficacy of Solanum torvum Swartz leaves for treating oxidative impairment in rats administered a β-cell-toxicant (STZ). Biomed Pharmacother 2022; 154:113605. [PMID: 36030588 DOI: 10.1016/j.biopha.2022.113605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 12/06/2022] Open
Abstract
The current study evaluated the protective role of Solanum torvum Swartz against diabetes-induced oxidative stress and tissue impairment in streptozotocin (STZ)-intoxicated rats. Rats with STZ (40 mg/kg intraperitoneally (i.p.))-induced diabetes were divided into five groups (n = 5) and treated with (i) normal saline, (ii) 150 mg/kg body weight (BW) of the ethanol extract of S. torvum leaf (EESTL), (ii) 300 mg/kg BW EESTL, (iv) 100 mg/kg BW metformin, and (v) 50 m/kg BW metformin + 100 mg/kg BW EESTL orally for 21 days. Our results revealed that the EESTL displayed dose-dependent ferric-reducing antioxidant power (FRAP) activity, scavenged DPPH radicals (IC50) = 13.52 ± 0.45 µg/mL), and inhibited lipid peroxidation in an in vitro models. In addition, the EESTL demonstrated dose-dependent inhibitory activity against α-amylase (IC50 =138.46 ± 3.97 µg/mL) and promoted glucose uptake across plasma membranes of yeast cells in a manner comparable to that of metformin. Interestingly, the extract demonstrated in vivo blood glucose normalization effects with concomitant increased activities of antioxidant parameters (superoxide dismutase (SOD), catalase, and reduced glutathione (GSH)) while decreasing malondialdehyde (MDA) levels when compared to untreated rats. Similarly, serum biochemical alterations, and tissues (liver, kidney, and pancreases) histopathological aberrations in untreated rats with STZ-induced diabetes were attenuated by treatment with the EESTL. Biometabolite characterization of the extract identified gallic acid (45.81 ppm), catechin (1.18 ppm), p-coumaric acid (1.43e-1 ppm), DL-proline 5-oxo-methyl ester (9.16 %, retention time (RT): 8.57 min), salicylic acid (3.26% and 7.61 min), and butylated hydroxytoluene (4.75%, RT: 10.18 min) as the major polyphenolic compounds in the plant extract. In conclusion, our study provides preclinical evidence of the antioxidant properties and oxidative stress-preventing role of S. torvum in STZ-dosed diabetic rats. Taken together, the EESTL represents a reserve of bioactive metabolites for managing diabetes and associated complications.
Collapse
|
9
|
Meneghetti L, Dassau E, Doyle FJ, Del Favero S. Machine Learning-Based Anomaly Detection Algorithms to Alert Patients Using Sensor Augmented Pump of Infusion Site Failures. J Diabetes Sci Technol 2022; 16:641-648. [PMID: 33686873 PMCID: PMC9294564 DOI: 10.1177/1932296821997854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Personal insulin pumps have shown to be effective in improving the quality of therapy for people with type 1 diabetes (T1D). However, the safety of this technology is limited by the possible infusion site failures, which are linked with hyperglycemia and ketoacidosis. Thanks to the large availability of collected data provided by modern therapeutic technologies, machine learning algorithms have the potential to provide new way to identify failures early and avert adverse events. METHODS A clinical dataset (N = 20) is used to evaluate a novel method for detecting real-time infusion site failures using unsupervised anomaly detection algorithms, previously proposed and developed on in-silico data. An adapted feature engineering procedure is introduced to make the method able to operate in the absence of a closed-loop (CL) system and meal announcements. RESULTS In the optimal configuration, we obtained a performance of 0.75 Sensitivity (15 out of 20 total failures detected) and 0.08 FP/day, outperforming previously proposed literature algorithms. The algorithm was able to anticipate the replacement of the malfunctioning infusion sets by ~2 h on average. CONCLUSIONS On the considered dataset, the proposed algorithm showed the potential to improve the safety of patients treated with sensor-augmented pump systems.
Collapse
Affiliation(s)
- Lorenzo Meneghetti
- Department of Information Engineering,
University of Padua, Padua, Italy
| | - Eyal Dassau
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of
Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Simone Del Favero
- Department of Information Engineering,
University of Padua, Padua, Italy
- Simone Del Favero, PhD, Department of
Information Engineering, University of Padova, Via Gradenigo 6/b, Padova (PD)
35131, Italy.
| |
Collapse
|
10
|
Eysenbach G, Hernandez R, Pham LT, Mehdiyeva K, Schneider S, Peters A, Ruelas V, Crandall J, Lee PJ, Jin H, Hoogendoorn CJ, Crespo-Ramos G, Mendez-Rodriguez H, Harmel M, Walker M, Serafin-Dokhan S, Gonzalez JS, Spruijt-Metz D. Function and Emotion in Everyday Life With Type 1 Diabetes (FEEL-T1D): Protocol for a Fully Remote Intensive Longitudinal Study. JMIR Res Protoc 2021; 10:e30901. [PMID: 34463626 PMCID: PMC8544739 DOI: 10.2196/30901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 08/15/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although short-term blood glucose levels and variability are thought to underlie diminished function and emotional well-being in people with type 1 diabetes (T1D), these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among blood glucose levels, functional ability, and emotional well-being in adults with T1D. OBJECTIVE The aim of this study is to present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely. METHODS The FEEL-T1D study will recruit 200 adults with T1D in the age range of 18-75 years. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring, ecological momentary assessments, ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely by mailing the study equipment and by using videoconferencing for study visits. RESULTS The study received institutional review board approval in January 2019 and was funded in April 2019. Data collection began in June 2020 and is projected to end in December 2021. As of June 2021, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Approximately 87.6% (7082/8087) of ecological momentary assessment surveys have been completed with minimal missing data, and 82.0% (82/100) of the participants provided concurrent continuous glucose monitoring data, ecological momentary assessment data, and accelerometer data for at least 10 of the 14 days of data collection. CONCLUSIONS Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships among blood glucose levels, emotional well-being, cognitive function, and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatments to optimize the function and well-being of individuals with T1D. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30901.
Collapse
Affiliation(s)
| | - Raymond Hernandez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Loree T Pham
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Khatira Mehdiyeva
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Stefan Schneider
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA, United States
| | - Anne Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Valerie Ruelas
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jill Crandall
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Haomiao Jin
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA, United States
| | - Claire J Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, CA, United States
| | - Gladys Crespo-Ramos
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Mark Harmel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Martha Walker
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sara Serafin-Dokhan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jeffrey S Gonzalez
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, CA, United States
| | - Donna Spruijt-Metz
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Psychology, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
11
|
Li X, Huang X, Mo J, Wang H, Huang Q, Yang C, Zhang T, Chen H, Hang T, Liu F, Jiang L, Wu Q, Li H, Hu N, Xie X. A Fully Integrated Closed-Loop System Based on Mesoporous Microneedles-Iontophoresis for Diabetes Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2100827. [PMID: 34081407 PMCID: PMC8373098 DOI: 10.1002/advs.202100827] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/07/2021] [Indexed: 05/13/2023]
Abstract
A closed-loop system that can mini-invasively track blood glucose and intelligently treat diabetes is in great demand for modern medicine, yet it remains challenging to realize. Microneedles technologies have recently emerged as powerful tools for transdermal applications with inherent painlessness and biosafety. In this work, for the first time to the authors' knowledge, a fully integrated wearable closed-loop system (IWCS) based on mini-invasive microneedle platform is developed for in situ diabetic sensing and treatment. The IWCS consists of three connected modules: 1) a mesoporous microneedle-reverse iontophoretic glucose sensor; 2) a flexible printed circuit board as integrated and control; and 3) a microneedle-iontophoretic insulin delivery component. As the key component, mesoporous microneedles enable the painless penetration of stratum corneum, implementing subcutaneous substance exchange. The coupling with iontophoresis significantly enhances glucose extraction and insulin delivery and enables electrical control. This IWCS is demonstrated to accurately monitor glucose fluctuations, and responsively deliver insulin to regulate hyperglycemia in diabetic rat model. The painless microneedles and wearable design endows this IWCS as a highly promising platform to improve the therapies of diabetic patients.
Collapse
Affiliation(s)
- Xiangling Li
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
- School of Biomedical EngineeringSun Yat‐SenUniversityGuangzhouChina
| | - Xinshuo Huang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Jingshan Mo
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Hao Wang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Qiqi Huang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Cheng Yang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Tao Zhang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
- School of Biomedical EngineeringSun Yat‐SenUniversityGuangzhouChina
| | - Hui‐Jiuan Chen
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Tian Hang
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Fanmao Liu
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Lelun Jiang
- School of Biomedical EngineeringSun Yat‐SenUniversityGuangzhouChina
| | - Qianni Wu
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
- Zhongshan Ophthalmic CenterSun Yat‐Sen UniversityGuangzhouChina
| | - Hongbo Li
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Ning Hu
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| | - Xi Xie
- The First Affiliated Hospital of Sun Yat‐Sen UniversityState Key Laboratory of Optoelectronic Materials and TechnologiesSchool of Electronics and Information Technology; Guangdong Province Key Laboratory of Display Material and TechnologySun Yat‐Sen UniversityGuangzhouChina
| |
Collapse
|
12
|
Zhu T, Li K, Herrero P, Georgiou P. Deep Learning for Diabetes: A Systematic Review. IEEE J Biomed Health Inform 2021; 25:2744-2757. [PMID: 33232247 DOI: 10.1109/jbhi.2020.3040225] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diabetes is a chronic metabolic disorder that affects an estimated 463 million people worldwide. Aiming to improve the treatment of people with diabetes, digital health has been widely adopted in recent years and generated a huge amount of data that could be used for further management of this chronic disease. Taking advantage of this, approaches that use artificial intelligence and specifically deep learning, an emerging type of machine learning, have been widely adopted with promising results. In this paper, we present a comprehensive review of the applications of deep learning within the field of diabetes. We conducted a systematic literature search and identified three main areas that use this approach: diagnosis of diabetes, glucose management, and diagnosis of diabetes-related complications. The search resulted in the selection of 40 original research articles, of which we have summarized the key information about the employed learning models, development process, main outcomes, and baseline methods for performance evaluation. Among the analyzed literature, it is to be noted that various deep learning techniques and frameworks have achieved state-of-the-art performance in many diabetes-related tasks by outperforming conventional machine learning approaches. Meanwhile, we identify some limitations in the current literature, such as a lack of data availability and model interpretability. The rapid developments in deep learning and the increase in available data offer the possibility to meet these challenges in the near future and allow the widespread deployment of this technology in clinical settings.
Collapse
|
13
|
Rilstone S, Reddy M, Oliver N. A Pilot Study of Flat and Circadian Insulin Infusion Rates in Continuous Subcutaneous Insulin Infusion (CSII) in Adults with Type 1 Diabetes (FIRST1D). J Diabetes Sci Technol 2021; 15:666-671. [PMID: 32081036 PMCID: PMC8120055 DOI: 10.1177/1932296820906195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Initiation of continuous subcutaneous insulin therapy (CSII) in type 1 diabetes requires conversion of a basal insulin dose into a continuous infusion regimen. There are limited data to guide the optimal insulin profile to rapidly achieve target glucose and minimize healthcare professional input. The aim of this pilot study was to compare circadian and flat insulin infusion rates in CSII naïve adults with type 1 diabetes. METHODS Adults with type 1 diabetes commencing CSII were recruited. Participants were randomized to circadian or flat basal profile calculated from the total daily dose. Basal rate testing was undertaken on days 7, 14 and 28 and basal rates were adjusted. The primary outcome was the between-group difference in absolute change in insulin basal rate over 24 hours following three rounds of basal testing. Secondary outcomes included the number of basal rate changes and the time blocks. RESULTS Seventeen participants (mean age 33.3 (SD 8.6) years) were recruited. There was no significant difference in absolute change in insulin basal rates between groups (P = .85). The circadian group experienced significant variation in the number of changes made with the most changes in the morning and evening (P = .005). The circadian group received a greater reduction in total insulin (-14.1 (interquartile range (IQR) -22.5-12.95) units) than the flat group (-7.48 (IQR -11.90-1.23) units) (P = .021). CONCLUSION The initial insulin profile does not impact on the magnitude of basal rate changes during optimization. The circadian profile requires changes at specific time points. Further development of the circadian profile may be the optimal strategy.
Collapse
Affiliation(s)
- Siân Rilstone
- Department of Nutrition and Dietetics,
Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
- Siân Rilstone, MSc, RD, Department of
Nutrition and Dietetics, Imperial College Healthcare NHS Trust, St Mary’s
Hospital, Praed Street, London W2 1NY, UK.
| | - Monika Reddy
- Diabetes and Endocrinology, Imperial
College Healthcare NHS Trust, St Mary’s Hospital, London, UK
| | - Nick Oliver
- Imperial College London, Hammersmith
Campus, London, UK
| |
Collapse
|
14
|
Zhu T, Li K, Kuang L, Herrero P, Georgiou P. An Insulin Bolus Advisor for Type 1 Diabetes Using Deep Reinforcement Learning. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5058. [PMID: 32899979 PMCID: PMC7570884 DOI: 10.3390/s20185058] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/25/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022]
Abstract
(1) Background: People living with type 1 diabetes (T1D) require self-management to maintain blood glucose (BG) levels in a therapeutic range through the delivery of exogenous insulin. However, due to the various variability, uncertainty and complex glucose dynamics, optimizing the doses of insulin delivery to minimize the risk of hyperglycemia and hypoglycemia is still an open problem. (2) Methods: In this work, we propose a novel insulin bolus advisor which uses deep reinforcement learning (DRL) and continuous glucose monitoring to optimize insulin dosing at mealtime. In particular, an actor-critic model based on deep deterministic policy gradient is designed to compute mealtime insulin doses. The proposed system architecture uses a two-step learning framework, in which a population model is first obtained and then personalized by subject-specific data. Prioritized memory replay is adopted to accelerate the training process in clinical practice. To validate the algorithm, we employ a customized version of the FDA-accepted UVA/Padova T1D simulator to perform in silico trials on 10 adult subjects and 10 adolescent subjects. (3) Results: Compared to a standard bolus calculator as the baseline, the DRL insulin bolus advisor significantly improved the average percentage time in target range (70-180 mg/dL) from 74.1%±8.4% to 80.9%±6.9% (p<0.01) and 54.9%±12.4% to 61.6%±14.1% (p<0.01) in the the adult and adolescent cohorts, respectively, while reducing hypoglycemia. (4) Conclusions: The proposed algorithm has the potential to improve mealtime bolus insulin delivery in people with T1D and is a feasible candidate for future clinical validation.
Collapse
Affiliation(s)
- Taiyu Zhu
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (T.Z.); (L.K.); (P.H.); (P.G.)
| | - Kezhi Li
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (T.Z.); (L.K.); (P.H.); (P.G.)
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Lei Kuang
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (T.Z.); (L.K.); (P.H.); (P.G.)
| | - Pau Herrero
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (T.Z.); (L.K.); (P.H.); (P.G.)
| | - Pantelis Georgiou
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (T.Z.); (L.K.); (P.H.); (P.G.)
| |
Collapse
|
15
|
Osaki A, Yamada E, Nakajima Y, Kasai Y, Shimoda Y, Toki A, Horiguchi K, Yoshino S, Inoue M, Saito T, Kameda T, Okada S, Yamada M. Insulin pump therapy would be favored by pregnant women with diabetes. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1801221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Aya Osaki
- Center of Regional Medical Research and Education, Gunma University Hospital, Maebashi 371-8511, Japan
- Department of Endocrinology and Diabetes, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Eijiro Yamada
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Yasuyo Nakajima
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Yuko Kasai
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Yoko Shimoda
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Akiko Toki
- Department of Endocrinology and Diabetes, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Kazuhiko Horiguchi
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Satoshi Yoshino
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Maki Inoue
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Tsugumichi Saito
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
- Center for Medical Education, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Takashi Kameda
- Center for Medical Education, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Shuichi Okada
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Masanobu Yamada
- Center for Patients Support and Community Service, Gunma University Hospital, Maebashi 371-8511, Japan
| |
Collapse
|
16
|
Yang JF, Gong X, Bakh NA, Carr K, Phillips NFB, Ismail-Beigi F, Weiss MA, Strano MS. Connecting Rodent and Human Pharmacokinetic Models for the Design and Translation of Glucose-Responsive Insulin. Diabetes 2020; 69:1815-1826. [PMID: 32152206 PMCID: PMC8176262 DOI: 10.2337/db19-0879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/08/2020] [Indexed: 12/16/2022]
Abstract
Despite considerable progress, development of glucose-responsive insulins (GRIs) still largely depends on empirical knowledge and tedious experimentation-especially on rodents. To assist the rational design and clinical translation of the therapeutic, we present a Pharmacokinetic Algorithm Mapping GRI Efficacies in Rodents and Humans (PAMERAH) built upon our previous human model. PAMERAH constitutes a framework for predicting the therapeutic efficacy of a GRI candidate from its user-specified mechanism of action, kinetics, and dosage, which we show is accurate when checked against data from experiments and literature. Results from simulated glucose clamps also agree quantitatively with recent GRI publications. We demonstrate that the model can be used to explore the vast number of permutations constituting the GRI parameter space and thereby identify the optimal design ranges that yield desired performance. A design guide aside, PAMERAH more importantly can facilitate GRI's clinical translation by connecting each candidate's efficacies in rats, mice, and humans. The resultant mapping helps to find GRIs that appear promising in rodents but underperform in humans (i.e., false positives). Conversely, it also allows for the discovery of optimal human GRI dynamics not captured by experiments on a rodent population (false negatives). We condense such information onto a "translatability grid" as a straightforward, visual guide for GRI development.
Collapse
Affiliation(s)
- Jing Fan Yang
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA
| | - Xun Gong
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA
| | - Naveed A Bakh
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA
| | - Kelley Carr
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH
| | | | | | - Michael A Weiss
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael S Strano
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA
| |
Collapse
|
17
|
Li C, Liu X, Zhang Y, Lv J, Huang F, Wu G, Liu Y, Ma R, An Y, Shi L. Nanochaperones Mediated Delivery of Insulin. NANO LETTERS 2020; 20:1755-1765. [PMID: 32069419 DOI: 10.1021/acs.nanolett.9b04966] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Insulin would undergo unfolding and fibrillation under stressed conditions, which may cause serious biotechnological and medical problems. Herein, by mimicking the structure and functions of natural chaperones HSP70s, self-assembled polymeric micelles are used as nanochaperones for the delivery of insulin. The confined hydrophobic domains on the surface of nanochaperones adsorb partially unfolded insulin, inhibiting the aggregation and fibrillation and enhancing the stability of insulin. The bioactivity of insulin is well-reserved after incubation with the nanochaperones at 37 °C for 7 d or heating at 70 °C for 1 h. The stealthy poly(ethylene glycol) chains around the confined domains protect the adsorbed insulin from enzymatic degradation and prolong the circulation time. More importantly, the excellent glucose sensitivity of the hydrophobic domains enables the nanochaperones to release and refold insulin in native form in response to hyperglycemia. This kind of nanochaperone may offer a hopeful strategy for the protection and delivery of insulin.
Collapse
Affiliation(s)
| | | | | | | | - Fan Huang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, China
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
The success of diabetes technologies depends on the attitudes and behavior of the individuals who choose to adopt them. Real-time continuous glucose monitoring, continuous subcutaneous insulin infusion, and sensor-augmented pump systems may positively affect diabetes-related quality of life (QOL), although the influence on QOL outcomes seems to be modest and the results from randomized controlled trials are limited and controversial. In contrast, more consistently positive QOL-related responses are apparent from observational data. The newer generations of devices hold the promise for more strongly enhancing diabetes-related QOL. Appropriate training and ongoing support are likely to be the key to successful uptake.
Collapse
Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, 5405 Oberlin Drive, Suite 100, San Diego, CA 92121, USA; University of California, San Diego, San Diego, CA, USA.
| |
Collapse
|
19
|
Zuberi Z, Sauli E, Cun L, Deng J, Li WJ, He XL, Li W. Insulin-delivery methods for children and adolescents with type 1 diabetes. Ther Adv Endocrinol Metab 2020; 11:2042018820906016. [PMID: 32944212 PMCID: PMC7466897 DOI: 10.1177/2042018820906016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/17/2020] [Indexed: 11/15/2022] Open
Abstract
Efforts directed toward restoring normal metabolic levels by mimicking the physiological insulin secretion, thereby ensuring safety, efficacy, minimal invasiveness and conveniences, are of great significance in the management of type 1 diabetes among children and adolescents. Regardless of the various technologies being discovered in addressing invasiveness and enhancing medication adherence in the management of type 1 diabetes, yet limited success had been observed among children and adolescents. The multiple daily subcutaneous insulin injections route using vial and syringe, and occasionally insulin pens, remain the most predictable route for insulin administration among children and adolescents. However, this route has been associated with compromised patient compliance, fear of injections and unacceptability, resulting in poor glycemic control, which promote the demand for alternative routes of insulin administration. Alternative routes for delivering insulin are being investigated in children and adolescents with type 1 diabetes; these include the hybrid closed-loop 'artificial pancreas' system, oral, inhalation, intranasal routes, and others. This review article explores the current advances in insulin-delivery methods that address the needs of children and adolescents in the treatment of type 1 diabetes.
Collapse
Affiliation(s)
- Zavuga Zuberi
- Hunan Key Laboratory of Biological Nanomaterials and Devices, Hunan University of Technology, Hunan, PR China
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Elingarami Sauli
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Liu Cun
- Hunan Key Laboratory of Biological Nanomaterials and Devices, Hunan University of Technology, Hunan, PR China
| | - Jing Deng
- Hunan Key Laboratory of Biological Nanomaterials and Devices, Hunan University of Technology, Hunan, PR China
| | - Wen-Jun Li
- Zhuzhou City People’s Hospital, Affiliated Hospital of Changsha Medical College, Hunan, PR China
| | - Xu-Liang He
- Zhuzhou City People’s Hospital, Affiliated Hospital of Changsha Medical College, Hunan, PR China
| | | |
Collapse
|
20
|
Rilstone S, Reddy M, Oliver N. Glycemic Index, Extended Bolusing, and Diabetes Education in Insulin Pump Therapy (GLIDE: A Pilot Study). Diabetes Technol Ther 2019; 21:452-455. [PMID: 31140833 DOI: 10.1089/dia.2019.0079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: There is no published evidence on whether advanced bolus education affects outcomes in insulin pump-treated type 1 diabetes. We assess the feasibility of delivering a clinical education program on rates of digestion and bolusing, and to assess its preliminary impact. Methods: An interactive education session on glycemic index (GI), extended bolusing, and superbolusing was developed and assessed in a nonrandomized single-arm study for 12 weeks. Insulin pump-treated participants with type 1 diabetes were recruited. Glucose outcomes were assessed by blinded continuous glucose monitoring after the consumption of high-fat and high-GI test meal. The primary outcome measure was 8-h glucose area under the curve (AUC) after high-fat meals, before and after intervention. Secondary outcomes included time spent in hypoglycemia, quality of life, treatment satisfaction, HbA1c, frequency of use of extended boluses, and postprandial AUC. Results: Eleven participants completed the study [mean (SD) age 42.3 (12.8) years, baseline HbA1c 57.3 (10.0) mmol/mol, duration of diabetes 19.5 (9.9) years]. AUC for glucose after test meals did not differ significantly after education except for in the first 2 h after the high-GI meal [precourse 83.1 (0.23-88.9), postcourse 5.38 (-16.2 to 50.8)]. Percentage time spent in hypoglycemia (<3.9 and <3.3 mmol/L) fell at week 12 compared with baseline [5.8 (IQR 2.1-8.3) % to 4.3 (IQR 2.1-5.4) %, P = 0.013, and 2.9 (IQR 1.2-3.9) % to 1.6 (IQR 0.7-2.4) %, P = 0.029, respectively]. Conclusion: Delivering an education program to support advanced boluses is feasible and may reduce exposure to hypoglycemia. A further trial is required to confirm the findings.
Collapse
Affiliation(s)
- Siân Rilstone
- 1Department of Nutrition & Dietetics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Monika Reddy
- 2Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nick Oliver
- 3Department of Medicine, Imperial College, London
| |
Collapse
|
21
|
Chen S, Matsumoto H, Moro-oka Y, Tanaka M, Miyahara Y, Suganami T, Matsumoto A. Smart Microneedle Fabricated with Silk Fibroin Combined Semi-interpenetrating Network Hydrogel for Glucose-Responsive Insulin Delivery. ACS Biomater Sci Eng 2019; 5:5781-5789. [DOI: 10.1021/acsbiomaterials.9b00532] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Siyuan Chen
- Kanagawa Institute of Industrial Science and Technology, Kanagawa 213-0012, Japan
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo 101-0062, Japan
| | - Hiroko Matsumoto
- Kanagawa Institute of Industrial Science and Technology, Kanagawa 213-0012, Japan
| | - Yuki Moro-oka
- Kanagawa Institute of Industrial Science and Technology, Kanagawa 213-0012, Japan
| | - Miyako Tanaka
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Yuji Miyahara
- Kanagawa Institute of Industrial Science and Technology, Kanagawa 213-0012, Japan
| | - Takayoshi Suganami
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Akira Matsumoto
- Kanagawa Institute of Industrial Science and Technology, Kanagawa 213-0012, Japan
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo 101-0062, Japan
| |
Collapse
|
22
|
Klonoff DC, Evans ML, Lane W, Kempe H, Renard E, DeVries JH, Graungaard T, Hyseni A, Gondolf T, Battelino T. A randomized, multicentre trial evaluating the efficacy and safety of fast-acting insulin aspart in continuous subcutaneous insulin infusion in adults with type 1 diabetes (onset 5). Diabetes Obes Metab 2019; 21:961-967. [PMID: 30537180 PMCID: PMC6590130 DOI: 10.1111/dom.13610] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the efficacy and safety of fast-acting insulin aspart (faster aspart) vs insulin aspart (IAsp) used in continuous subcutaneous insulin infusion (CSII) in participants with type 1 diabetes (T1D). MATERIALS AND METHODS This was a double-blind, treat-to-target, randomized, 16-week trial investigating CSII treatment with faster aspart (n = 236) or IAsp (n = 236). All available information, regardless of treatment discontinuation, was used for the evaluation of effect. RESULTS Faster aspart was non-inferior to IAsp regarding the change from baseline in glycated haemoglobin (HbA1c; primary endpoint). The mean HbA1c changed from 58.4 mmol/mol (7.5%) at baseline to 57.8 mmol/mol (7.4%) with faster aspart and to 56.8 mmol/mol (7.4%) with IAsp after 16 weeks' treatment, with an estimated treatment difference (ETD) of 1.0 mmol/mol (95% confidence interval [CI] 0.14; 1.87) or 0.09% (95% CI 0.01; 0.17; P < 0.001) for non-inferiority (0.4% margin; P < 0.02 for statistical significance in favour of IAsp). Faster aspart was superior to IAsp in change from baseline in 1-hour postprandial glucose (PPG) increment after a meal test (ETD -0.91 mmol/L [95% CI -1.43; -0.39] or -16.4 mg/dL [95% CI -25.7; -7.0]; P = 0.001), with statistically significant reductions also at 30 minutes and 2 hours. The improvement in PPG was reflected in the change from baseline in 1-hour interstitial glucose increment after all meals (ETD -0.21 mmol/L [95% CI -0.31; -0.11] or -3.77 mg/dL [95% CI -5.53; -2.01]). There was no statistically significant difference in the overall rate of severe or blood glucose-confirmed hypoglycaemia (estimated rate ratio 1.00 [95% CI 0.85; 1.16]). A numerical imbalance in severe hypoglycaemic episodes between faster aspart and IAsp was seen in the treatment (21 vs 7) and 4-week run-in periods (4 vs 0). CONCLUSIONS Faster aspart provides an effective and safe option for CSII treatment in T1D.
Collapse
Affiliation(s)
- David C. Klonoff
- Diabetes Research InstituteMills‐Peninsula Medical CenterSan MateoCalifornia
| | - Mark L. Evans
- Wellcome Trust/MRC Institute of Metabolic Science and Department of MedicineUniversity of CambridgeCambridgeUK
| | - Wendy Lane
- Mountain Diabetes and Endocrine CenterAshevilleNorth Carolina
| | - Hans‐Peter Kempe
- Centre for Diabetes and Nutrition LudwigshafenLudwigshafenGermany
| | - Eric Renard
- Department of Endocrinology, Diabetes, and Nutrition and Clinical Investigation CentreMontpellier University Hospital, Institute of Functional Genomics, CNRS, INSERM, University of MontpellierMontpellierFrance
| | - J. Hans DeVries
- Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
- Profil Institute of Metabolic ResearchNeussGermany
| | | | | | | | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic DiseasesUniversity Children's Hospital Ljubljana, and Faculty of Medicine, University of LjubljanaLjubljanaSlovenia
| |
Collapse
|
23
|
Senn JD, Fischli S, Slahor L, Schelbert S, Henzen C. Long-Term Effects of Initiating Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in People with Type 1 Diabetes and Unsatisfactory Diabetes Control. J Clin Med 2019; 8:jcm8030394. [PMID: 30901914 PMCID: PMC6463068 DOI: 10.3390/jcm8030394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 12/01/2022] Open
Abstract
Background: We aimed to assess the long-term effects of the introduction of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D). Methods: A prospective single-centre cohort study including participants with T1D and HbA1c > 7.5%. After completing a course in flexible intensified insulin treatment (FIT), participants were offered treatment change to CSII/CGM. FIT participants with HbA1c ≤ 7.5% who remained on multiple daily injections (MDI) and without CGM were monitored as a separate cohort to compare the cumulative incidence of diabetic complications. Results: The study cohort included 41 participants with T1D (21 male/20 female). The mean age (±SD) at inclusion was 24.2 ± 10.9 years, the mean follow-up was 8.9 ± 2.8 years, and the mean diabetes duration at the end of the study was 15.9 ± 10.1 years. The mean HbA1c level before the introduction of CSII was 8.8 ± 1.3% (73 ± 8 mmol/mol), and decreased significantly thereafter to 8.0 ± 1.1% (63 ± 7 mmol/mol) (p = 0.0001), and further to 7.6 ± 1.1% (59 ± 11 mmol/mol) after the initiation of CGM (p = 0.051). In the MDI group the HbA1c levels did not change significantly during a mean follow-up of 6.8 ± 3.2 years. The frequency of severe hypoglycaemia after the introduction of CSII/CGM declined significantly (from 9.7 to 2.2 per 100 patient-years, p = 0.03), and the cumulative incidence of newly diagnosed diabetic microvascular complications were comparable between the study group and the observational cohort. Conclusion: In people with T1D and unsatisfactory diabetes control the introduction of CSII and CGM results in a substantial and long-term improvement.
Collapse
Affiliation(s)
- Jon-Duri Senn
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Stefan Fischli
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Lea Slahor
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Susanne Schelbert
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Christoph Henzen
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| |
Collapse
|
24
|
Hu C, Jia W. Therapeutic medications against diabetes: What we have and what we expect. Adv Drug Deliv Rev 2019; 139:3-15. [PMID: 30529309 DOI: 10.1016/j.addr.2018.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/01/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
Diabetes has become one of the largest global health and economic burdens, with its increased prevalence and high complication ratio. Stable and satisfactory blood glucose control are vital to reduce diabetes-related complications. Therefore, continuous attempts have been made in antidiabetic drugs, treatment routes, and traditional Chinese medicine to achieve better disease control. New antidiabetic drugs and appropriate combinations of these drugs have increased diabetes control significantly. Besides, novel treatment routes including oral antidiabetic peptide delivery, nanocarrier delivery system, implantable drug delivery system are also pivotal for diabetes control, with its greater efficiency, increased bioavailability, decreased toxicity and reduced dosing frequency. Among these new routes, nanotechnology, artificial pancreas and islet cell implantation have shown great potential in diabetes therapy. Traditional Chinese medicine also offer new options for diabetes treatment. Our paper aim to overview these therapeutic methods for diabetes therapy. Proper combinations of these existing anti-diabetic medications and searching for novel routes are both necessary for better diabetes control.
Collapse
Affiliation(s)
- Cheng Hu
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China; Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, 6600 Nanfeng Road, Shanghai 200433, People's Republic of China
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China.
| |
Collapse
|
25
|
Zuo M, Qian W, Xu Z, Shao W, Hu XY, Zhang D, Jiang J, Sun X, Wang L. Multiresponsive Supramolecular Theranostic Nanoplatform Based on Pillar[5]arene and Diphenylboronic Acid Derivatives for Integrated Glucose Sensing and Insulin Delivery. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2018; 14:e1801942. [PMID: 30073791 DOI: 10.1002/smll.201801942] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/12/2018] [Indexed: 05/20/2023]
Abstract
A closed-loop "smart" insulin delivery system with the capability to mimic pancreatic cells will be highly desirable for diabetes treatment. This study reports a multiple stimuli-responsive insulin delivery platform based on an explicit supramolecular strategy. Self-assembled from a well-designed amphiphilic host-guest complex formed by pillar[5]arene and a diphenylboronic acid derivative and loaded with insulin and glucose oxidase, the obtained insulin-GOx-loaded supramolecular vesicles can selectively recognize glucose, accompanied by the structure disruption and efficient release of the entrapped insulin triggered by the high glucose concentration as well as the in situ generated H2 O2 and acid microenvironment during the GOx-promoted specific oxidation of glucose into gluconic acid. Moreover, such a "smart" supramolecular theranostic nanoplatform is able to function as both a glucose sensor and a controlled insulin delivery actuator. In vivo experiments further demonstrate that this smart supramolecular nanocarrier shows fast response to hyperglycemic circumstances and can effectively regulate the glucose levels in a mouse model of type I diabetes.
Collapse
Affiliation(s)
- Minzan Zuo
- Key Laboratory of Mesoscopic Chemistry of MOE and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Weirui Qian
- Key Laboratory of Mesoscopic Chemistry of MOE and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Zuqiang Xu
- Key Laboratory of Mesoscopic Chemistry of MOE and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Wei Shao
- Key Laboratory of Mesoscopic Chemistry of MOE and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Xiao-Yu Hu
- Key Laboratory of Mesoscopic Chemistry of MOE and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
- Applied Chemistry Department, School of Material Science & Engineering, Nanjing University of Aeronautics & Astronautics, Nanjing, 210016, China
| | - Dongmei Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, 210023, China
| | - Juli Jiang
- Key Laboratory of Mesoscopic Chemistry of MOE and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Xiaoqiang Sun
- School of Petrochemical Engineering, Changzhou University, Changzhou, 213164, China
| | - Leyong Wang
- Key Laboratory of Mesoscopic Chemistry of MOE and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
- School of Petrochemical Engineering, Changzhou University, Changzhou, 213164, China
| |
Collapse
|
26
|
Reidy C, Bracher M, Foster C, Vassilev I, Rogers A. The process of incorporating insulin pumps into the everyday lives of people with Type 1 diabetes: A critical interpretive synthesis. Health Expect 2018; 21:714-729. [PMID: 29418050 PMCID: PMC6117487 DOI: 10.1111/hex.12666] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insulin pump therapy (IPT) is a technological advancement that has been developed to help people manage Type 1 diabetes (T1D). However, ways of managing diabetes requiring the implementation of health technologies bring new complexities and a need to understand the factors which enable people with T1D to incorporate a novel device. This new comprehension could provide an exemplar for people with long-term conditions to incorporate new technologies more generally. OBJECTIVE To determine what influences the incorporation, adaptation and use of IPT into the everyday lives of people living with diabetes. DESIGN Critical interpretive synthesis (CIS) using systematic searches undertaken in 7 electronic databases of literature, published 2008 onwards. RESULTS A total of 4998 titles were identified, 274 abstracts reviewed, 39 full articles retrieved and 22 papers selected for analysis. Three themes emerged which were of relevance to the introduction and use of IPT; Tensions between expectations and experiences in adoption and early adaptation; Negotiation of responsibility and accessing support; Reflexivity, active experimentation and feedback. CONCLUSIONS This CIS builds on earlier reviews on lived experiences of IPT. Novel insights are offered through examination of the experiences of pump users from children through to adults, their families and health-care professionals. Expectations of what the device can do to improve self-management impacts on the early stages of adoption as the reality of the technology requires substantial thought and action. Areas for intervention to improve IPT incorporation include establishing who is responsible for management tasks of the device and enabling navigation to further means of support and resources.
Collapse
Affiliation(s)
- Claire Reidy
- Faculty of Health SciencesNIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexUniversity of SouthamptonSouthamptonHampshireUK
| | - Mike Bracher
- School of Health and Social CareHealth SciencesBournemouth UniversityBournemouthDorsetUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonHampshireUK
| | - Claire Foster
- Faculty of Health SciencesMacmillan Survivorship Research GroupUniversity of SouthamptonSouthamptonHampshireUK
| | - Ivaylo Vassilev
- Faculty of Health SciencesNIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexUniversity of SouthamptonSouthamptonHampshireUK
| | - Anne Rogers
- Faculty of Health SciencesNIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexUniversity of SouthamptonSouthamptonHampshireUK
| |
Collapse
|
27
|
Oliver N. Continuous Glucose Monitoring Adoption in the United Kingdom - An Economic and Policy Perspective. EUROPEAN ENDOCRINOLOGY 2018; 13:73-75. [PMID: 29632611 PMCID: PMC5813468 DOI: 10.17925/ee.2017.13.02.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/22/2017] [Indexed: 11/24/2022]
Abstract
Continuous glucose monitoring (CGM) technology provides real-time glucose concentration data to people with diabetes. The data enable timely treatment decisions that can lead to avoidance or mitigation of hypoglycaemia, with potential cost savings. This commentary discusses CGM implementation and funding policies in the UK, and regional disparities that confront many people with diabetes who could benefit from the technology.
Collapse
Affiliation(s)
- Nick Oliver
- Section of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK
| |
Collapse
|
28
|
Herrero P, Bondia J, Giménez M, Oliver N, Georgiou P. Automatic Adaptation of Basal Insulin Using Sensor-Augmented Pump Therapy. J Diabetes Sci Technol 2018; 12:282-294. [PMID: 29493359 PMCID: PMC5851242 DOI: 10.1177/1932296818761752] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with insulin-dependent diabetes rely on an intensified insulin regimen. Despite several guidelines, they are usually impractical and fall short in achieving optimal glycemic outcomes. In this work, a novel technique for automatic adaptation of the basal insulin profile of people with diabetes on sensor-augmented pump therapy is presented. METHODS The presented technique is based on a run-to-run control law that overcomes some of the limitations of previously proposed methods. To prove its validity, an in silico validation was performed. Finally, the artificial intelligence technique of case-based reasoning is proposed as a potential solution to deal with variability in basal insulin requirements. RESULTS Over a period of 4 months, the proposed run-to-run control law successfully adapts the basal insulin profile of a virtual population (10 adults, 10 adolescents, and 10 children). In particular, average percentage time in target [70, 180] mg/dl was significantly improved over the evaluated period (first week versus last week): 70.9 ± 11.8 versus 91.1 ± 4.4 (adults), 46.5 ± 11.9 versus 80.1 ± 10.9 (adolescents), 49.4 ± 12.9 versus 73.7 ± 4.1 (children). Average percentage time in hypoglycemia (<70 mg/dl) was also significantly reduced: 9.7 ± 6.6 versus 0.9 ± 1.2 (adults), 10.5 ± 8.3 versus 0.83 ± 1.0 (adolescents), 10.9 ± 6.1 versus 3.2 ± 3.5 (children). When compared against an existing technique over the whole evaluated period, the presented approach achieved superior results on percentage of time in hypoglycemia: 3.9 ± 2.6 versus 2.6 ± 2.2 (adults), 2.9 ± 1.9 versus 2.0 ± 1.5 (adolescents), 4.6 ± 2.8 versus 3.5 ± 2.0 (children), without increasing the percentage time in hyperglycemia. CONCLUSION The present study shows the potential of a novel technique to effectively adjust the basal insulin profile of a type 1 diabetes population on sensor-augmented insulin pump therapy.
Collapse
Affiliation(s)
- Pau Herrero
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
- Pau Herrero, PhD, Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
| | - Jorge Bondia
- Institut Universitari d’Automàtica i Informàtica Industrial, Universitat Politècnica de València, València, Spain
| | - Marga Giménez
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Imperial College, London, UK
| | - Nick Oliver
- Diabetes Unit, Endocrinology Department, ICMDiM Hospital Clínic, Barcelona, Spain
| | - Pantelis Georgiou
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| |
Collapse
|
29
|
Bally L, Thabit H, Hovorka R. Glucose-responsive insulin delivery for type 1 diabetes: The artificial pancreas story. Int J Pharm 2017; 544:309-318. [PMID: 29258910 DOI: 10.1016/j.ijpharm.2017.12.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/04/2017] [Accepted: 12/10/2017] [Indexed: 12/20/2022]
Abstract
Insulin replacement therapy is integral to the management of type 1 diabetes, which is characterised by absolute insulin deficiency. Optimal glycaemic control, as assessed by glycated haemoglobin, and avoidance of hyper- and hypoglycaemic excursions have been shown to prevent diabetes-related complications. Insulin pump use has increased considerably over the past decade with beneficial effects on glycaemic control, quality of life and treatment satisfaction. The advent and progress of ambulatory glucose sensor technology has enabled continuous glucose monitoring based on real-time glucose levels to be integrated with insulin therapy. Low glucose and predictive low glucose suspend systems are currently used in clinical practice to mitigate against hypoglycaemia, and provide the first step towards feedback glucose control. The more advanced technology approach, an artificial pancreas or a closed-loop system, gradually increases and decreases insulin delivery in a glucose-responsive fashion to mitigate against hyper- and hypoglycaemia. Randomised outpatient clinical trials over the past 5 years have demonstrated the feasibility, safety and efficacy of the approach, and the recent FDA approval of the first single hormone closed-loop system establishes a new standard of care for people with type 1 diabetes.
Collapse
Affiliation(s)
- Lia Bally
- Department of Diabetes, Endocrinology Clinical Nutrition & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Hood Thabit
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom; Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
30
|
Bakh NA, Bisker G, Lee MA, Gong X, Strano MS. Rational Design of Glucose-Responsive Insulin Using Pharmacokinetic Modeling. Adv Healthc Mater 2017; 6. [PMID: 28841775 DOI: 10.1002/adhm.201700601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/30/2017] [Indexed: 11/08/2022]
Abstract
A glucose responsive insulin (GRI) is a therapeutic that modulates its potency, concentration, or dosing of insulin in relation to a patient's dynamic glucose concentration, thereby approximating aspects of a normally functioning pancreas. Current GRI design lacks a theoretical basis on which to base fundamental design parameters such as glucose reactivity, dissociation constant or potency, and in vivo efficacy. In this work, an approach to mathematically model the relevant parameter space for effective GRIs is induced, and design rules for linking GRI performance to therapeutic benefit are developed. Well-developed pharmacokinetic models of human glucose and insulin metabolism coupled to a kinetic model representation of a freely circulating GRI are used to determine the desired kinetic parameters and dosing for optimal glycemic control. The model examines a subcutaneous dose of GRI with kinetic parameters in an optimal range that results in successful glycemic control within prescribed constraints over a 24 h period. Additionally, it is demonstrated that the modeling approach can find GRI parameters that enable stable glucose levels that persist through a skipped meal. The results provide a framework for exploring the parameter space of GRIs, potentially without extensive, iterative in vivo animal testing.
Collapse
Affiliation(s)
- Naveed A. Bakh
- Department of Chemical Engineering; Massachusetts Institute of Technology; 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Gili Bisker
- Department of Chemical Engineering; Massachusetts Institute of Technology; 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Michael A. Lee
- Department of Chemical Engineering; Massachusetts Institute of Technology; 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Xun Gong
- Department of Chemical Engineering; Massachusetts Institute of Technology; 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Michael S. Strano
- Department of Chemical Engineering; Massachusetts Institute of Technology; 77 Massachusetts Avenue Cambridge MA 02139 USA
| |
Collapse
|
31
|
Rabbone I, Barbetti F, Gentilella R, Mossetto G, Bonfanti R, Maffeis C, Iafusco D, Piccinno E. Insulin therapy in neonatal diabetes mellitus: a review of the literature. Diabetes Res Clin Pract 2017; 129:126-135. [PMID: 28527303 DOI: 10.1016/j.diabres.2017.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
AIMS Neonatal diabetes mellitus (NDM) is a rare disorder, and guidance is limited regarding its optimal management. We reviewed insulin usage in NDM, with a focus on continuous subcutaneous insulin infusion (CSII). METHODS A PubMed search identified 40 reports of patients with NDM treated with insulin published between 1994 and 2016. RESULTS Data concerning treatment of NDM are limited. CSII resolves some of the issues associated with insulin therapy in neonates. No clinical trials of CSII in NDM have been reported. Case reports suggest that CSII is a safe and effective means of treating NDM. CSII was initiated to improve glycaemic control, for practicality and convenience, and to overcome difficulties associated with the maintenance of long-term intravenous catheters. CSII can provide better glycaemic control than multiple daily injections, with few hypoglycaemic events. Continuous glucose monitoring integrated with the pump helps provide more precise control of blood glucose levels. CSII generally uses short-acting insulin or rapid-acting insulin analogues, and those that are approved for use in neonates appear to be appropriate for the treatment of NDM using an insulin pump. CONCLUSIONS Information from case reports indicates that CSII is safe and effective for the management of NDM.
Collapse
Affiliation(s)
- Ivana Rabbone
- Department of Paediatrics, University of Turin, 10126 Turin, Italy.
| | - Fabrizio Barbetti
- Department of Experimental Medicine and Surgery, University of Tor Vergata, 00133 Rome, Italy; Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | | | | | - Riccardo Bonfanti
- Pediatric Department and Diabetes Research Institute (OSR-DRI), San Raffaele Scientific Hospital, 20132 Milan, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, 37126 Verona, Italy
| | - Dario Iafusco
- Regional Center of Pediatric Diabetology "G.Stoppoloni", Department of Women, Child and General Surgery, Second University of Naples, 80138 Naples, Italy
| | - Elvira Piccinno
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, 70126 Bari, Italy
| |
Collapse
|
32
|
Scott EA, Karabin NB, Augsornworawat P. Overcoming Immune Dysregulation with Immunoengineered Nanobiomaterials. Annu Rev Biomed Eng 2017; 19:57-84. [PMID: 28226216 DOI: 10.1146/annurev-bioeng-071516-044603] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The immune system is governed by an immensely complex network of cells and both intracellular and extracellular molecular factors. It must respond to an ever-growing number of biochemical and biophysical inputs by eliciting appropriate and specific responses in order to maintain homeostasis. But as with any complex system, a plethora of false positives and false negatives can occur to generate dysregulated responses. Dysregulated immune responses are essential components of diverse inflammation-driven pathologies, including cancer, heart disease, and autoimmune disorders. Nanoscale biomaterials (i.e., nanobiomaterials) have emerged as highly customizable platforms that can be engineered to interact with and direct immune responses, holding potential for the design of novel and targeted approaches to redirect or inhibit inflammation. Here, we present recent developments of nanobiomaterials that were rationally designed to target and modulate inflammatory cells and biochemical pathways for the treatment of immune dysregulation.
Collapse
Affiliation(s)
- Evan A Scott
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208
| | - Nicholas B Karabin
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208
| | - Punn Augsornworawat
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208
| |
Collapse
|
33
|
Yu J, Zhang Y, Bomba H, Gu Z. Stimuli-Responsive Delivery of Therapeutics for Diabetes Treatment. Bioeng Transl Med 2016; 1:323-337. [PMID: 29147685 PMCID: PMC5685194 DOI: 10.1002/btm2.10036] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 12/12/2022] Open
Abstract
Diabetic therapeutics, including insulin and glucagon-like peptide 1 (GLP-1), are essential for diabetic patients to regulate blood glucose levels. However, conventional treatments that are based on subcutaneous injections are often associated with poor glucose control and a lack of patient compliance. In this review, we focus on the different stimuli-responsive systems to deliver therapeutics for diabetes treatment to improve patient comfort and prevent complications. Specifically, the pH-responsive systems for oral drug delivery are introduced first. Then, the closed-loop glucose-responsive systems are summarized based on different glucose-responsive moieties, including glucose oxidase (GOx), glucose binding protein (GBP), and phenylboronic acid (PBA). Finally, the on-demand delivery systems activated by external remote triggers are also discussed. We conclude by discussing advantages and limitations of current strategies, as well as future opportunities and challenges in this area.
Collapse
Affiliation(s)
- Jicheng Yu
- Joint Dept. of Biomedical EngineeringUniversity of North Carolina at Chapel Hill and North Carolina State UniversityRaleighNC27695
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNC27599
| | - Yuqi Zhang
- Joint Dept. of Biomedical EngineeringUniversity of North Carolina at Chapel Hill and North Carolina State UniversityRaleighNC27695
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNC27599
| | - Hunter Bomba
- Joint Dept. of Biomedical EngineeringUniversity of North Carolina at Chapel Hill and North Carolina State UniversityRaleighNC27695
| | - Zhen Gu
- Joint Dept. of Biomedical EngineeringUniversity of North Carolina at Chapel Hill and North Carolina State UniversityRaleighNC27695
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics, UNC Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNC27599
- Dept. of MedicineUniversity of North Carolina at Chapel HillChapel HillNC27599
| |
Collapse
|
34
|
Abstract
The artificial pancreas (closed-loop system) addresses the unmet clinical need for improved glucose control whilst reducing the burden of diabetes self-care in type 1 diabetes. Glucose-responsive insulin delivery above and below a preset insulin amount informed by sensor glucose readings differentiates closed-loop systems from conventional, threshold-suspend and predictive-suspend insulin pump therapy. Insulin requirements in type 1 diabetes can vary between one-third-threefold on a daily basis. Closed-loop systems accommodate these variations and mitigate the risk of hypoglycaemia associated with tight glucose control. In this review we focus on the progress being made in the development and evaluation of closed-loop systems in outpatient settings. Randomised transitional studies have shown feasibility and efficacy of closed-loop systems under supervision or remote monitoring. Closed-loop application during free-living, unsupervised conditions by children, adolescents and adults compared with sensor-augmented pumps have shown improved glucose outcomes, reduced hypoglycaemia and positive user acceptance. Innovative approaches to enhance closed-loop performance are discussed and we also present the outlook and strategies used to ease clinical adoption of closed-loop systems.
Collapse
Affiliation(s)
- Hood Thabit
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Level 4, Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
- Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Level 4, Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK.
- Department of Paediatrics, University of Cambridge, Cambridge, UK.
| |
Collapse
|
35
|
Narayanaswamy S, Jayasena CN, Ng N, Ratnasabapathy R, Prague JK, Papadopoulou D, Abbara A, Comninos AN, Bassett P, Bloom SR, Veldhuis JD, Dhillo WS. Subcutaneous infusion of kisspeptin-54 stimulates gonadotrophin release in women and the response correlates with basal oestradiol levels. Clin Endocrinol (Oxf) 2016; 84:939-45. [PMID: 26572695 PMCID: PMC4914955 DOI: 10.1111/cen.12977] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/17/2015] [Accepted: 11/06/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Kisspeptin stimulates hypothalamic GnRH secretion resulting in gonadotrophin release and has potential as a future therapeutic. Chronic subcutaneous infusion of kisspeptin via a pump (similar to an insulin pump) may provide an alternative route of administration in the future. We investigated for the first time in humans, the gonadotrophin response to subcutaneous (SC) infusions of kisspeptin-54 in healthy women. Women are markedly more responsive to exogenous kisspeptin in the late follicular phase preovulation when oestradiol levels are naturally high. Therefore, we further investigated whether there was a correlation between baseline oestradiol levels and LH response to kisspeptin. DESIGN AND PATIENTS A prospective, single-blinded placebo-controlled study. Healthy women (n = 4) received an 8-h SC infusion of kisspeptin-54 0·1, 0·3 or 1·0 nmol/kg/h or saline in the early follicular phase of 4 separate menstrual cycles. Gonadotrophins and oestradiol were measured every 10 min during the infusions. RESULTS SC infusion of kisspeptin-54 increased LH and FSH. The LH response to SC infusion of kisspeptin-54 (0·3 and 1·0 nmol/kg/h) positively correlated with baseline oestradiol levels (P < 0·001). Further statistical analyses showed that in the 1·0 nmol/kg/h group, a 100pmol/l rise in baseline oestradiol was associated with a 1·0 IU/l increase in LH. CONCLUSIONS Kisspeptin administered via a SC infusion could be a viable future therapeutic route of administration for patients with infertility. Baseline oestradiol levels may be an important determinant of the gonadotrophin response to kisspeptin treatment in women and should be taken into consideration when evaluating gonadotrophin response.
Collapse
Affiliation(s)
| | - Channa N. Jayasena
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| | - Noel Ng
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| | | | - Julia K. Prague
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| | - Deborah Papadopoulou
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| | - Ali Abbara
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| | - Alexander N. Comninos
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| | | | - Stephen R. Bloom
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| | - Johannes D. Veldhuis
- Endocrine Research UnitCenter for Translational Science ActivitiesMayo ClinicRochesterMinnesotaUSA
| | - Waljit S. Dhillo
- Section of Investigative Medicine Imperial College LondonHammersmith HospitalLondonUK
| |
Collapse
|
36
|
[Insulin therapy of diabetes]. Wien Klin Wochenschr 2016; 128 Suppl 2:S54-61. [PMID: 27052221 DOI: 10.1007/s00508-015-0925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hyperglycemia contributes to morbidity and mortality in patients with diabetes. Thus, reaching treatment targets with regard to control of glycemia is a central goal in the therapy of diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the practical use of insulin according to current scientific evidence and clinical studies.
Collapse
|
37
|
Zou Z, He D, Cai L, He X, Wang K, Yang X, Li L, Li S, Su X. Alizarin Complexone Functionalized Mesoporous Silica Nanoparticles: A Smart System Integrating Glucose-Responsive Double-Drugs Release and Real-Time Monitoring Capabilities. ACS APPLIED MATERIALS & INTERFACES 2016; 8:8358-8366. [PMID: 26998551 DOI: 10.1021/acsami.5b12576] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The outstanding progress of nanoparticles-based delivery systems capable of releasing hypoglycemic drugs in response to glucose has dramatically changed the outlook of diabetes management. However, the developed glucose-responsive systems have not offered real-time monitoring capabilities for accurate quantifying hypoglycemic drugs released. In this study, we present a multifunctional delivery system that integrates both delivery and monitoring issues using glucose-triggered competitive binding scheme on alizarin complexone (ALC) functionalized mesoporous silica nanoparticles (MSN). In this system, ALC is modified on the surface of MSN as the signal reporter. Gluconated insulin (G-Ins) is then introduced onto MSN-ALC via benzene-1,4-diboronic acid (BA) mediated esterification reaction, where G-Ins not only blocks drugs inside the mesopores but also works as a hypoglycemic drug. In the absence of glucose, the sandwich-type boronate ester structure formed by BA binding to the diols of ALC and G-Ins remains intact, resulting in an fluorescence emission peak at 570 nm and blockage of pores. Following a competitive binding, the presence of glucose cause the dissociation of boronate ester between ALC and BA, which lead to the pores opening and disappearance of fluorescence. As proof of concept, rosiglitazone maleate (RSM), an insulin-sensitizing agent, was doped into the MSN to form a multifunctional MSN (RSM@MSN-ALC-BA-Ins), integrating with double-drugs loading, glucose-responsive performance, and real-time monitoring capability. It has been demonstrated that the glucose-responsive release behaviors of insulin and RSM in buffer or in human serum can be quantified in real-time through evaluating the changes of fluorescence signal. We believe that this developed multifunctional system can shed light on the invention of a new generation of smart nanoformulations for optical diagnosis, individualized treatment, and noninvasive monitoring of diabetes management.
Collapse
Affiliation(s)
- Zhen Zou
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Dinggeng He
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Linli Cai
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Xiaoxiao He
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Kemin Wang
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Xue Yang
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Liling Li
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Siqi Li
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| | - Xiaoya Su
- College of Biology, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Key Laboratory for Bio-Nanotechnology and Molecular Engineering of Hunan Province, Hunan University , Changsha 410082, China
| |
Collapse
|
38
|
Thabit H, Hovorka R. Continuous subcutaneous insulin infusion therapy and multiple daily insulin injections in type 1 diabetes mellitus: a comparative overview and future horizons. Expert Opin Drug Deliv 2015; 13:389-400. [PMID: 26618219 DOI: 10.1517/17425247.2016.1115013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Continuous subcutaneous insulin infusion (CSII) therapy is currently accepted as a treatment strategy for type 1 diabetes. Transition from multiple daily injection therapy (MDI; including basal-bolus regimens) to CSII is based on expectations of better metabolic control and fewer hypoglycaemic events. Evidence to date has not been always conclusive. AREAS COVERED Evidence for CSII and MDI in terms of glycaemic control, hypoglycaemia and psychosocial outcomes is reviewed in the adult and paediatric population with type 1 diabetes. Findings from studies on threshold-based insulin pump suspension and predictive low glucose management (PLGM) are outlined. Limitations of current CSII application and future technological developments are discussed. EXPERT OPINION Glycaemic control and quality of life (QOL) may be improved by CSII compared to MDI depending on baseline HbA1c and hypoglycaemia rates. Future studies are expected to provide evidence on clinical and cost effectiveness in those who will benefit the most. Training, structured education and support are important to benefit from CSII. Novel technological approaches linking continuous glucose monitoring (CGM) and CSII may help mitigate against frequent hypoglycaemia in those at risk. Development of glucose-responsive automated closed-loop insulin delivery systems may reduce the burden of disease management and improve outcomes in type 1 diabetes.
Collapse
Affiliation(s)
- Hood Thabit
- a Wellcome Trust-MRC Institute of Metabolic Science , University of Cambridge , Cambridge , UK.,b Department of Diabetes & Endocrinology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Roman Hovorka
- a Wellcome Trust-MRC Institute of Metabolic Science , University of Cambridge , Cambridge , UK.,c Department of Paediatrics , University of Cambridge , Cambridge , UK
| |
Collapse
|
39
|
Abstract
Scientific and technological advancements have led to the increasing availability and use of sophisticated devices for diabetes management, with corresponding improvements in public health. These devices are often capable of sharing data with a few other specific devices but are generally not broadly interoperable; they cannot work together with a wide variety of other devices. As a result of limited interoperability, benefits of modern diabetes devices and potential for development of innovative new diabetes technologies are not being fully realized. Here we discuss diabetes device interoperability in general, then focus on 4 examples that show how diabetes management could benefit from enhanced interoperability: remote monitoring and data sharing, integrating data from multiple devices to better inform diabetes management strategies, device consolidation, and artificial pancreas development.
Collapse
Affiliation(s)
- Alain D Silk
- US Food and Drug Administration, Silver Spring, MD, USA
| |
Collapse
|
40
|
Kwai N, Arnold R, Poynten AM, Lin CSY, Kiernan MC, Krishnan AV. Continuous subcutaneous insulin infusion preserves axonal function in type 1 diabetes mellitus. Diabetes Metab Res Rev 2015; 31:175-82. [PMID: 25066412 DOI: 10.1002/dmrr.2583] [Citation(s) in RCA: 14] [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: 04/04/2014] [Revised: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetic peripheral neuropathy is a common and debilitating complication of diabetes mellitus. Although strict glycaemic control may reduce the risk of developing diabetic peripheral neuropathy, the neurological benefits of different insulin regimens remain relatively unknown. METHODS In the present study, 55 consecutive patients with type 1 diabetes mellitus underwent clinical neurological assessment. Subsequently, 41 non-neuropathic patients, 24 of whom were receiving multiple daily insulin injections (MDII) and 17 receiving continuous subcutaneous insulin infusion (CSII), underwent nerve excitability testing, a technique that assesses axonal ion channel function and membrane potential in human nerves. Treatment groups were matched for glycaemic control, body mass index, disease duration and gender. Neurophysiological parameters were compared between treatment groups and those taken from age and sex-matched normal controls. RESULTS Prominent differences in axonal function were noted between MDII-treated and CSII-treated patients. Specifically, MDII patients manifested prominent abnormalities when compared with normal controls in threshold electrotonus (TE) parameters including depolarizing TE(10-20ms), undershoot and hyperpolarizing TE (90-100 ms) (P < 0.05). Additionally, recovery cycle parameters superexcitability and subexcitability were also abnormal (P < 0.05). In contrast, axonal function in CSII-treated patients was within normal limits when compared with age-matched controls. The differences between the groups were noted in cross-sectional analysis and remained at longitudinal follow-up. CONCLUSIONS Axonal function in type 1 diabetes is maintained within normal limits in patients treated with continuous subcutaneous insulin infusion and not with multiple daily insulin injections. This raises the possibility that CSII therapy may have neuroprotective potential in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Natalie Kwai
- Translational Neuroscience Facility, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | | | | | | | | | | |
Collapse
|
41
|
Veiseh O, Tang BC, Whitehead KA, Anderson DG, Langer R. Managing diabetes with nanomedicine: challenges and opportunities. Nat Rev Drug Discov 2015; 14:45-57. [PMID: 25430866 PMCID: PMC4751590 DOI: 10.1038/nrd4477] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nanotechnology-based approaches hold substantial potential for improving the care of patients with diabetes. Nanoparticles are being developed as imaging contrast agents to assist in the early diagnosis of type 1 diabetes. Glucose nanosensors are being incorporated in implantable devices that enable more accurate and patient-friendly real-time tracking of blood glucose levels, and are also providing the basis for glucose-responsive nanoparticles that better mimic the body's physiological needs for insulin. Finally, nanotechnology is being used in non-invasive approaches to insulin delivery and to engineer more effective vaccine, cell and gene therapies for type 1 diabetes. Here, we analyse the current state of these approaches and discuss key issues for their translation to clinical practice.
Collapse
Affiliation(s)
- Omid Veiseh
- 1] Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, Massachusetts 02139, USA. [2] David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, Massachusetts 02139, USA. [3] Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, Massachusetts 02115, USA. [4]
| | - Benjamin C Tang
- 1] David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, Massachusetts 02139, USA. [2] Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, Massachusetts 02115, USA. [3]
| | - Kathryn A Whitehead
- Department of Chemical Engineering, Carnegie Mellon University, 5000 Forbes Ave., Pittsburgh, Pennsylvania 15213, USA
| | - Daniel G Anderson
- 1] Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, Massachusetts 02139, USA. [2] David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, Massachusetts 02139, USA. [3] Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, Massachusetts 02115, USA. [4] Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA. [5] Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Robert Langer
- 1] Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, Massachusetts 02139, USA. [2] David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, Massachusetts 02139, USA. [3] Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, Massachusetts 02115, USA. [4] Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA. [5] Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| |
Collapse
|
42
|
Pickup JC. Banting Memorial Lecture 2014* Technology and diabetes care: appropriate and personalized. Diabet Med 2015; 32:3-13. [PMID: 25345658 DOI: 10.1111/dme.12613] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 12/11/2022]
Abstract
Continuous subcutaneous insulin infusion was initially developed as a research procedure in the 1970s but quickly became a routine treatment for selected people with Type 1 diabetes. Continuous subcutaneous insulin infusion and other diabetes technologies, such as continuous glucose monitoring, are now an established and evidence-based part of diabetes care, but there has been some confusion about effectiveness and best use, particularly because of conflicting results from meta-analyses. This is because literature summary meta-analyses (including all trials) are inappropriate for therapeutic and economic decision-making; such meta-analyses should only include trials representative of groups likely to benefit. For example, for continuous subcutaneous insulin infusion, this would be those with continued disabling hypoglycaemia or elevated HbA1c levels. Alternatively, individual patient data meta-analysis allows modelling of covariates that determine effect size, e.g. in the case of continuous glucose monitoring, baseline HbA1c and frequency of sensor usage. Diabetes technology is therefore an example of personalized medicine, where evaluation and use should be both appropriate and targeted. This will also apply to future technologies such as new 'patch' pumps for Type 2 diabetes, closed-loop insulin delivery systems and nanomedicine applications in diabetes that we are currently researching. These include fluorescence lifetime-based non-invasive glucose monitoring and nanoencapsulation of islets for improved post-transplant survival.
Collapse
Affiliation(s)
- J C Pickup
- Diabetes Research Group, King's College London School of Medicine, Guy's Hospital, London, UK
| |
Collapse
|
43
|
Borot S, Franc S, Cristante J, Penfornis A, Benhamou PY, Guerci B, Hanaire H, Renard E, Reznik Y, Simon C, Charpentier G. Accuracy of a new patch pump based on a microelectromechanical system (MEMS) compared to other commercially available insulin pumps: results of the first in vitro and in vivo studies. J Diabetes Sci Technol 2014; 8:1133-41. [PMID: 25079676 PMCID: PMC4455475 DOI: 10.1177/1932296814543946] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The JewelPUMP™ (JP) is a new patch pump based on a microelectromechanical system that operates without any plunger. The study aimed to evaluate the infusion accuracy of the JP in vitro and in vivo. For the in vitro studies, commercially available pumps meeting the ISO standard were compared to the JP: the MiniMed® Paradigm® 712 (MP), Accu-Chek® Combo (AC), OmniPod® (OP), Animas® Vibe™ (AN). Pump accuracy was measured over 24 hours using a continuous microweighing method, at 0.1 and 1 IU/h basal rates. The occlusion alarm threshold was measured after a catheter occlusion. The JP, filled with physiological serum, was then tested in 13 patients with type 1 diabetes simultaneously with their own pump for 2 days. The weight difference was used to calculate the infused insulin volume. The JP showed reduced absolute median error rate in vitro over a 15-minute observation window compared to other pumps (1 IU/h): ±1.02% (JP) vs ±1.60% (AN), ±1.66% (AC), ±2.22% (MP), and ±4.63% (OP), P < .0001. But there was no difference over 24 hours. At 0.5 IU/h, the JP was able to detect an occlusion earlier than other pumps: 21 (19; 25) minutes vs 90 (85; 95), 58 (42; 74), and 143 (132; 218) minutes (AN, AC, MP), P < .05 vs AN and MP. In patients, the 24-hour flow error was not significantly different between the JP and usual pumps (-2.2 ± 5.6% vs -0.37 ± 4.0%, P = .25). The JP was found to be easier to wear than conventional pumps. The JP is more precise over a short time period, more sensitive to catheter occlusion, well accepted by patients, and consequently, of potential interest for a closed-loop insulin delivery system.
Collapse
Affiliation(s)
- Sophie Borot
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, University Hospital of Besançon and University of Franche-Comte, Besançon, France
| | - Sylvia Franc
- Centre Hospitalier Sud-Francilien, Department of Diabetes and Endocrinology, Corbeil-Essonne, France Centre d'Etudes et de Recherche pour l'Intensification du Traitement du Diabète, Corbeil-Essonnes, France
| | - Justine Cristante
- Department of Endocrinology, Pôle DigiDune, Grenoble University Hospital, Joseph-Fourier University, Grenoble, France
| | - Alfred Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, University Hospital of Besançon and University of Franche-Comte, Besançon, France
| | - Pierre-Yves Benhamou
- Department of Endocrinology, Pôle DigiDune, Grenoble University Hospital, Joseph-Fourier University, Grenoble, France
| | - Bruno Guerci
- University of Lorraine and the Department of Diabetology, Metabolic Diseases and Nutrition, Brabois Adult Hospital, Vandoeuvre les Nancy, France
| | - Hélène Hanaire
- Cardiovascular and Metabolic Unit, Department of Diabetology, University Hospital of Toulouse, Toulouse, France
| | - Eric Renard
- Department of Endocrinology, Diabetes, and Nutrition and Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France
| | - Yves Reznik
- Endocrinology and Diabetes Department, Côte de Nacre, Caen, France
| | - Chantal Simon
- Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Guillaume Charpentier
- Centre Hospitalier Sud-Francilien, Department of Diabetes and Endocrinology, Corbeil-Essonne, France Centre d'Etudes et de Recherche pour l'Intensification du Traitement du Diabète, Corbeil-Essonnes, France
| |
Collapse
|
44
|
Abstract
Insulin has classically been considered a treatment of last resort for individuals with type 2 diabetes, delayed until all other efforts by the patient and healthcare provider have failed. Recent treatment guidelines recommend the use of insulin, in particular basal insulin, as part of a treatment regimen earlier in the disease process. Many patients are reticent about initiating insulin, so therapies that allow insulin treatment to be more tailored to individual needs are likely to result in greater acceptance and patient adherence with therapy. To meet this need, a range of insulin products are in development that aim to increase absorption rate or prolong the duration of action, reduce peak variability and weight gain associated with insulin treatment, and offer alternative delivery methods. This review describes insulin products in clinical development, new combination therapies, and new devices for insulin delivery.
Collapse
Affiliation(s)
- Christopher Sorli
- Department of Diabetes, Endocrinology and Metabolism, Billings Clinic, Billings, Mont.
| |
Collapse
|
45
|
A Synthetic Multifunctional Mammalian pH Sensor and CO2 Transgene-Control Device. Mol Cell 2014; 55:397-408. [DOI: 10.1016/j.molcel.2014.06.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/07/2014] [Accepted: 05/15/2014] [Indexed: 11/16/2022]
|
46
|
Jayasena CN, Abbara A, Veldhuis JD, Comninos AN, Ratnasabapathy R, De Silva A, Nijher GMK, Ganiyu-Dada Z, Mehta A, Todd C, Ghatei MA, Bloom SR, Dhillo WS. Increasing LH pulsatility in women with hypothalamic amenorrhoea using intravenous infusion of Kisspeptin-54. J Clin Endocrinol Metab 2014; 99:E953-61. [PMID: 24517142 PMCID: PMC4207927 DOI: 10.1210/jc.2013-1569] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypothalamic amenorrhea (HA) is the one of the most common causes of period loss in women of reproductive age and is associated with deficient LH pulsatility. High-dose kisspeptin-54 acutely stimulates LH secretion in women with HA, but chronic administration causes desensitization. GnRH has paradoxical effects on reproductive activity; we therefore hypothesized that a dose-dependent therapeutic window exists within which kisspeptin treatment restores the GnRH/LH pulsatility in women with HA. AIM The aim of the study was to determine whether constant iv infusion of kisspeptin-54 temporarily increases pulsatile LH secretion in women with HA. METHODS Five patients with HA each underwent six assessments of LH pulsatility. Single-blinded continuous iv infusion of vehicle or kisspeptin-54 (0.01, 0.03, 0.10, 0.30, or 1.00 nmol/kg/h) was administered. The LH pulses were detected using blinded deconvolution. RESULTS Kisspeptin increased LH pulsatility in all patients with HA, with peak responses observed at different doses in each patient. The mean peak number of pulses during infusion of kisspeptin-54 was 3-fold higher when compared with vehicle (number of LH pulses per 8 h: 1.6 ± 0.4, vehicle; 5.0 ± 0.5, kisspeptin-54, P < .01 vs vehicle). The mean peak LH pulse secretory mass during kisspeptin-54 was 6-fold higher when compared with vehicle (LH pulse secretory mass in international units per liter: 3.92 ± 2.31, vehicle; 23.44 ± 12.59, kisspeptin-54; P < .05 vs vehicle). CONCLUSIONS Kisspeptin-54 infusion temporarily increases LH pulsatility in women with HA. Furthermore, we have determined the dose range within which kisspeptin-54 treatment increases basal and pulsatile LH secretion in women with HA. This work provides a basis for studying the potential of kisspeptin-based therapies to treat women with HA.
Collapse
Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine (C.N.J., A.A., A.N.C., R.R., A.D.S., G.M.K.N., Z.G.-D., M.A.G., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London W12 ONN, United Kingdom; and Endocrine Research Unit (J.D.V.), Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905; and Department of Imaging (A.M., C.T.), Imperial College Healthcare National Health Service Trust, Charing Cross Hospital, London W6 8RF, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Aye MM, Atkin SL. Patient safety and minimizing risk with insulin administration - role of insulin degludec. DRUG HEALTHCARE AND PATIENT SAFETY 2014; 6:55-67. [PMID: 24812526 PMCID: PMC4010638 DOI: 10.2147/dhps.s59566] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetes is a lifelong condition requiring ongoing medical care and patient self-management. Exogenous insulin therapy is essential in type 1 diabetes and becomes a necessity in patients with longstanding type 2 diabetes who fail to achieve optimal control with lifestyle modification, oral agents, and glucagon-like peptide 1-based therapy. One of the risks that hinders insulin use is hypoglycemia. Optimal insulin therapy should therefore minimize the risk of hypoglycemia while improving glycemic control. Insulin degludec (IDeg) is a novel basal insulin that, following subcutaneous injection, assembles into a depot of soluble multihexamer chains. These subsequently release IDeg monomers that are absorbed at a slow and steady rate into the circulation, with the terminal half-life of IDeg being ~25 hours. Thus, it requires only once-daily dosing unlike other basal insulin preparations that often require twice-daily dosing. Despite its long half-life, once-daily IDeg does not cause accumulation of insulin in the circulation after reaching steady state. IDeg once a day will produce a steady-state profile with a lower peak:trough ratio than other basal insulins. In clinical trials, this profile translates into a lower frequency of nocturnal hypoglycemia compared with insulin glargine, as well as an ability to allow some flexibility in dose timing without compromising efficacy and safety. Indeed, a study that tested the extremes of dosing intervals of 8 and 40 hours showed no detriment in either glycemic control or hypoglycemic frequency versus insulin glargine given at the same time each day. While extreme flexibility in dose timing is not recommended, these findings are reassuring. This may be particularly beneficial to elderly patients, patients with learning difficulties, or others who have to rely on health-care professionals for their daily insulin injections. Further studies are required to confirm whether this might benefit adherence to treatment, reduce long-term hypoglycemia or reduce diabetes-related complications.
Collapse
Affiliation(s)
- Myint M Aye
- Hull Royal Infirmary, Michael White Diabetes Centre, Hull, UK
| | - Stephen L Atkin
- Weill Cornell Medical College Qatar, Qatar Foundation, Doha, Qatar
| |
Collapse
|
48
|
Tauschmann M, Hovorka R. Insulin pump therapy in youth with type 1 diabetes: toward closed-loop systems. Expert Opin Drug Deliv 2014; 11:943-55. [PMID: 24749563 DOI: 10.1517/17425247.2014.910192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Insulin pump technology has advanced considerably over the past three decades, leading to more favorable metabolic control and less hypoglycemic events when compared with multiple daily injection therapy. The use of insulin pumps is increasing, particularly in children and adolescents with type 1 diabetes. AREAS COVERED This review outlines recent developments in insulin pump therapy from a pediatric perspective. 'Smart' pumps, sensor-augmented pump therapy and threshold-suspend feature of insulin pumps are reviewed in terms of efficacy, safety and psychosocial impact. The current status of closed-loop systems focusing on clinical outcomes is highlighted. EXPERT OPINION Closed-loop insulin delivery is gradually progressing from bench to the clinical practice. Longer and larger studies in home settings are needed to expand on short- to medium-term outpatient evaluations. Predictive low glucose management and overnight closed-loop delivery may be the next applications to be implemented in daily routine. Further challenges include improvements of control algorithms, sensor accuracy, duration of insulin action, integration and size of devices and connectivity and usability. Gradual improvements and increasing sophistication of closed-loop components lie on the path toward unsupervised hands-off fully closed-loop system.
Collapse
Affiliation(s)
- Martin Tauschmann
- University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science , Cambridge , UK
| | | |
Collapse
|
49
|
Abstract
When we are interested in making decisions about best use, comparative therapeutic efficacy, or cost-effectiveness of diabetes technologies such as insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] or continuous glucose monitoring, meta-analysis for the purpose of literature summary is inappropriate and may be misleading. Instead, "decision-making meta-analysis" is more appropriate and should involve either preselection of trials based on intended use [e.g., elevated baseline hemoglobin A1c or hypoglycemia rate for trials of multiple daily injections (MDI) versus CSII] or metaregression of summary effect sizes in different trials against potential effect-modifying covariates such as baseline risk, or models of the covariates that determine effect size using individual patient data. Appropriate meta-analysis should also only include trials that are of sufficient duration to accurately measure outcomes such as severe hypoglycemia, and they should not use obsolete technology that is of proven inferiority to current technology. The use of appropriate decision-making meta-analysis is illustrated by the change in the rate ratio for severe hypoglycemia in randomized controlled trials of MDI versus CSII in type 1 diabetes from 1.56 (95% confidence interval 0.96-2.55; p = .074) for literature-summary meta-analysis to 2.0 (1.08-3.69; p = .027) for decision-making meta-analysis of all patients and 3.91 (1.35-11.36; p = .01) for trials in children.
Collapse
Affiliation(s)
- John C Pickup
- Diabetes Research Group, King's College London School of Medicine, Guy's Hospital, London SE1 1UL, United Kingdom.
| |
Collapse
|
50
|
Abstract
Hyperglycemia contributes to morbidity and mortality in patients with diabetes. Thus, reaching treatment targets with regard to control of glycemia is a central goal in the therapy of diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the practical use of insulin according to current scientific evidence and clinical studies.
Collapse
|