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Wang W, Men L, Wang Y, Shi C, Yin H, Li H, Zhou H, Du J. Effect of needle-free injection on psychological insulin resistance and insulin dosage in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1379830. [PMID: 38803476 PMCID: PMC11129580 DOI: 10.3389/fendo.2024.1379830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
Background and objective Psychological insulin resistance (PIR), which refers to the reluctance of diabetic patients to use insulin, is a frequently encountered clinical issue. Needle-free injection (NFI) offers advantages in terms of expediting insulin absorption and mitigating adverse reactions related to injection. To evaluate the effects of subcutaneous injection of insulin aspart 30 with NFI on PIR and insulin dosage in patients with type 2 diabetes mellitus (T2DM). Methods Sixty-four patients with T2DM participated in this randomized, prospective, open, crossover study. Insulin aspart 30 was administered subcutaneously to each subject via QS-P NFI and Novo Pen 5 (NP) successively. The effects of NFI on PIR were analyzed. Differences in insulin dosage, glycemic variability, and injection safety were compared at similar levels of glycemic control. Results After the administration of NFI, the insulin treatment attitude scale score decreased (53.7 ± 7.3 vs. 58.9 ± 10.7, p<0.001), the insulin treatment adherence questionnaire score increased (46.3 ± 4.9 vs. 43.8 ± 7.1, p<0.001), and the insulin treatment satisfaction questionnaire score increased (66.6 ± 10.5 vs. 62.4 ± 16.5, p<0.001). At the same blood glucose level, NFI required a smaller dosage of insulin aspart 30 compared with that of NP (30.42 ± 8.70 vs. 33.66 ± 9.13 U/d, p<0.001). There were no differences in glycemic variability indices (standard deviation, mean amplitude of glycemic excursion or coefficient of variation) between the two injection methods. Compared with NP, NFI did not increase the incidence of hypoglycemia (17.2% vs. 14.1%, p=0.774), and it decreased the incidence of induration (4.7% vs. 23.4%, p=0.002) and leakage (6.3% vs. 20.3%, p=0.022) while decreasing the pain visual analog scale score (2.30 ± 1.58 vs. 3.11 ± 1.40, p<0.001). Conclusion NFI can improve PIR in patients with T2DM and be used with a smaller dose of insulin aspart 30 while maintaining the same hypoglycemic effect. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2400083658.
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Affiliation(s)
- Weiping Wang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lili Men
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yongbo Wang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunhong Shi
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huihui Yin
- Nursing Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Han Li
- Nursing Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haicheng Zhou
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Wang Q, Zhu Q, Li N. A Scientometric Analysis and Visualization of Scientific Research and Technology Innovation in Needle-free Insulin Injection From 1974 to 2022. Clin Ther 2023; 45:881-888. [PMID: 37516566 DOI: 10.1016/j.clinthera.2023.06.025] [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: 01/31/2023] [Revised: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Needle-free jet injection has to some extent improved the quality of life of patients with diabetes, but it has not been widely used. Therefore, we analyzed articles, clinical trials, and patents of needle-free insulin injection to (1) perform a systematic and comprehensive analysis of scientific research and technology innovation in needle-free insulin injection during the past 49 years (1974 to 2022) and (2) identify the status of scientific research and technology innovation, their limitations, and future trends. METHODS With a new perspective, we use scientometric tools, including co-word and word frequency analyses, text mining, and cluster network analysis, to provide a scientometric analysis and visualization of articles, clinical trials, and patents related to needle-free insulin injection delivery applications. FINDINGS Patent innovation in this field was more active than clinical research, and clinical research prevailed over basic research. Basic research and clinical trials in this field mainly involved therapy, penetration, tolerability, absorption, and pharmacokinetic properties. Drive mechanisms and needle-free injection devices were the core patent technologies in this field. IMPLICATIONS Although needle-free insulin injection has been under development for decades, its full potential has not yet been reached; needle-free injection technology is still in the growth stage. The field of needleless insulin injection is dominated by patent technology innovation.
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Affiliation(s)
- Qing Wang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qinlei Zhu
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Naishi Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; WHO Family of International Classifications Collaborating Center of China, Beijing, China.
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Zeng D, Tang Z, Wang W, Wang Z, Li J. Experimental investigation of the optimal driving pressure for a larger-volume controllable jet injection system. Med Eng Phys 2023; 119:104033. [PMID: 37634910 DOI: 10.1016/j.medengphy.2023.104033] [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: 01/17/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023]
Abstract
Jet injection technology has become the alternative drug delivery method of conventional needle-based injection due to its obvious advantages. In order to meet the demand for larger volume injection, the pneumatic jet injection systems have efficiently administrated vaccine up to 1 mL in human. Our recent study has also demonstrated that controlling the driving pressure enabled the pneumatic jet injection system to deliver larger volumes of drugs to target sites at desired rates and times. This work continues to explore the optimal two-phase driving pressure combination with better injection efficiency for typical larger-volume (1.0 mL) jet injection with controllable pneumatic jet injection system. Under the combination of a first phase driving pressure of 1.00 MPa and a second phase driving pressure ranging from 0.25 to 0.90 MPa, dynamic characteristics, dispersion characteristics and pharmacokinetic characteristics of this controllable jet injection system were quantitatively analyzed. In all experiments, it was confirmed that the optimal driving pressure combination of 1.0 mL ejection volume was close to (1.00-0.50) MPa. That is, the injection velocities of 151.85 m/s and 102.01 m/s for the first and second phase respectively facilitated better injection performance with a controlled release of 1.0 mL ejection volume. This strategy is practical for facilitating the clinical application of large-volume controllable jet injection systems.
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Affiliation(s)
- Dongping Zeng
- School of Energy and Power Engineering, Changsha University of Science and Technology, Changsha, 410114, China.
| | - Zheng Tang
- School of Energy and Power Engineering, Changsha University of Science and Technology, Changsha, 410114, China
| | - Wei Wang
- School of Energy and Power Engineering, Changsha University of Science and Technology, Changsha, 410114, China
| | - Zefeng Wang
- School of Urban Construction, Wuhan University of Science and Technology, Wuhan 430081, China
| | - Jiamin Li
- Hubei Key Laboratory of Waterjet Theory and New Technology, Wuhan University, Wuhan 430072, China
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Wu Q, Deng M, Wang W, Yu S, Wang M, Sun C, Pan Q, Guo L. A self-controlled, cross-over study of intensive insulin treatment with needle-based injection versus needle-free injection in hospitalized patients with type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1162176. [PMID: 37501783 PMCID: PMC10369336 DOI: 10.3389/fendo.2023.1162176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/15/2023] [Indexed: 07/29/2023] Open
Abstract
Background and Aims Needle injection and needle-free injection were proven effective in improving glycated hemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) patients. However, it is unclear if needle-free and needle injections of insulin during intensive insulin therapy in hospitalized patients provide similar efficacy and safety benefits. Methods A self-controlled cross-over study was conducted on 62 patients with T2DM who received intensive long-acting and short-acting insulin injections with or without needles. The 7-point blood glucose test was performed on the 6th day after insulin administration and the injection method switched on the 7th day of hospitalization. The difference was compared in 7-point blood glucose levels. Results The blood glucose levels at fasting (mean difference=-1.09 ± 2.38mmol/L, 95% CI, -1.69 to -0.48, p=0.0007) and post-breakfast (-1.14 ± 3.02mmol/L, 95%CI, -1.91 to -0.37, p=0.004) were better when patients were receiving needle-free injections compared to when receiving a needle injection. Indeed, daily blood glucose fluctuation, which presented as the area under the curve of glycemia, was decreased in needle-free injection periods (-0.3.48 ± 9.64, 95%CI, -5.95 to -1.01, p=0.0065). There was no significant difference in the dose of long-acting insulin between the two injection methods (-0.32 ± 2.69, 95%CI, -0.99 to 0.37, p>0.05). The dose of fast-acting insulin during the needle-free period was lower than that of when patients received needle injections (-1.66 ± 6.45, 95%CI, -3.29 to -0.025, p<0.05). There was no significant difference in satisfaction between the two regimens (-0.59 ± 1.55,95%CI, -0.938 to 0.509, p=0.557), but there was a significant difference in pain experience, favoring needle-free injections (p < 0.001). Conclusion Glycemia was better controlled by needle-free insulin injections in hospitalized T2DM patients subjected to intensive glycemic control. These patients also experienced less pain than when insulin was injected with a needle.
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Affiliation(s)
- Quanying Wu
- Nursing Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingqun Deng
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyi Yu
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Miao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Sun
- Nursing Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Mao S, Li S, Zhang Y, Long L, Peng J, Cao Y, Mao JZ, Qi X, Xin Q, San G, Ding J, Jiang J, Bai X, Wang Q, Xu P, Xia H, Lu L, Xie L, Kong D, Zhu S, Xu W. A highly efficient needle-free-injection delivery system for mRNA-LNP vaccination against SARS-CoV-2. NANO TODAY 2023; 48:101730. [PMID: 36570700 PMCID: PMC9767897 DOI: 10.1016/j.nantod.2022.101730] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 05/14/2023]
Abstract
Despite the various vaccines that have been developed to combat the coronavirus disease 2019 (COVID-19) pandemic, the persistent and unpredictable mutations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) require innovative and unremitting solutions to cope with the resultant immune evasion and establish a sustainable immune barrier. Here we introduce a vaccine-delivery system with a combination of a needle-free injection (NFI) device and a SARS-CoV-2-Spike-specific mRNA-Lipid Nanoparticle (LNP) vaccine. The benefits are duller pain and a significant increase of immunogenicity compared to the canonical needle injection (NI). From physicochemical and bioactivity analyses, the structure of the mRNA-LNP maintains stability upon NFI, contradictory to the belief that LNPs are inclined towards destruction under the high-pressure conditions of NFI. Moreover, mRNA-LNP vaccine delivered by NFI induces significantly more binding and neutralizing antibodies against SARS-CoV-2 variants than the same vaccine delivered by NI. Heterogeneous vaccination of BA.5-LNP vaccine with NFI enhanced the generation of neutralizing antibodies against Omicron BA.5 variants in rabbits previously vaccinated with non-BA.5-specific mRNA-LNP or other COVID-19 vaccines. NFI parameters can be adjusted to deliver mRNA-LNP subcutaneously or intramuscularly. Taken together, our results suggest that NFI-based mRNA-LNP vaccination is an effective substitute for the traditional NI-based mRNA-LNP vaccination.
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Affiliation(s)
- Shanhong Mao
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China
- School of Light Industry, Beijing Technology and Business University, Beijing 100048, China
| | - Shiyou Li
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Yuxin Zhang
- Beijing QS Medical Technology Co.,Ltd., Beijing 100176, China
| | - Luoxin Long
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China
| | - Junfeng Peng
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Yuanyan Cao
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China
| | - Jessica Z Mao
- School of Veterinary Medicine & Biomedical Sciences, Texas A&M, College Station, TX 77843, USA
| | - Xin Qi
- Beijing QS Medical Technology Co.,Ltd., Beijing 100176, China
| | - Qi Xin
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Guoliang San
- Beijing QS Medical Technology Co.,Ltd., Beijing 100176, China
| | - Jing Ding
- Beijing QS Medical Technology Co.,Ltd., Beijing 100176, China
| | - Jun Jiang
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Xuejiao Bai
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Qianting Wang
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Pengfei Xu
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Huan Xia
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Lijun Lu
- Tricision Biotherapeutic Inc, Beijing 100176, Zhuhai 519040, China
| | - Liangzhi Xie
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Desheng Kong
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Shuangli Zhu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Wenbo Xu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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6
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Jin X, Sun Q, Yue C, Han J, Zhou X, Guan Q, Zhang X. A clinical observation study on the effect of needle-free insulin syringe on blood glucose control and well-being index in patients with early-onset type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1137179. [PMID: 36864833 PMCID: PMC9973436 DOI: 10.3389/fendo.2023.1137179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To explore the effect of using needle-free insulin syringe on blood sugar control and well-being index in patients with early-onset type 2 diabetes mellitus. METHODS A total of 42 patients with early-onset type 2 diabetes mellitus treated with insulin aspart 30 injection in a stable condition in the Endocrinology Department of a tertiary hospital from January 2020 to July 2021 were randomly divided into two groups, one group received insulin pen injections followed by needle-free injections, and the other group received needle-free injections followed by insulin pen injections. Transient scanning glucose monitoring was performed during the last two weeks of each injection modality phase. Comparison of the two injection methods in terms of test indicators and differences in injection site pain scores, the number of red spots on the skin at the injection site and the number of bleeding spots on the skin at the injection site. RESULTS The FBG of the needle-free injection group was lower than that of the Novo Pen group (p<0.05); the 2-hour postprandial blood glucose of the needle-free injection group was lower than that of the Novo Pen group, but there was no statistical significant difference. The amount of Insulin in the needle-free injector group was lower than that in the Novo pen group, but there was no statistical significant difference between the two groups. The WHO-5 score of the needle-free injector group was higher than that of the Novo Pen group(p<0.05); the pain score at the injection site was lower than that of the Novo Pen group (p<0.05). The number of skin red spots using the needle-free syringe was more than that of the Novo pen group(p<0.05); the number of skin bleeding at the site of injection was similar between the two injection methods. CONCLUSION Compared to traditional insulin pens, subcutaneous injection of premixed insulin using a needle-free syringe is effective in controlling fasting blood glucose in patients with early onset type 2 diabetes and is less painful at the injection site. In addition, blood glucose monitoring should be strengthened and insulin dosage should be adjusted in a timely manner.
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Affiliation(s)
- Xiaolong Jin
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qiuying Sun
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chenying Yue
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Junming Han
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xinli Zhou
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qingbo Guan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- *Correspondence: Xu Zhang, ; Qingbo Guan,
| | - Xu Zhang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- *Correspondence: Xu Zhang, ; Qingbo Guan,
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7
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McHugh AD, Chase JG, Knopp JL, Zhou T, Holder-Pearson L. Determining Losses in Jet Injection Subcutaneous Insulin Delivery: A Model-Based Approach. J Diabetes Sci Technol 2022:19322968221085032. [PMID: 35343255 DOI: 10.1177/19322968221085032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Accurate, safe glycemic management requires reliable delivery of insulin doses. Insulin can be delivered subcutaneously for action over a longer period of time. Needle-free jet injectors provide subcutaneous (SC) delivery without requiring needle use, but the volume of insulin absorbed varies due to losses associated with the delivery method. This study employs model-based methods to determine the expected proportion of active insulin present from a needle-free SC dose. METHODS Insulin, C-peptide, and glucose assay data from a frequently sampled insulin-modified oral glucose tolerance test trial with 2U SC insulin delivery, paired with a well-validated metabolic model, predict metabolic outcomes for N = 7 healthy adults. Subject-specific nonlinear hepatic clearance profiles are modeled over time using third-order basis splines with knots located at assay times. Hepatic clearance profiles are constrained within a physiological rate of change, and relative to plasma glucose profiles. Insulin loss proportions yielding optimal insulin predictions are then identified, quantifying delivery losses. RESULTS Optimal parameter identification suggests losses of up to 22% of the nominal 2U SC dose. The degree of loss varies between subjects and between trials on the same subject. Insulin fit accuracy improves where loss greater than 5% is identified, relative to where delivery loss is not modeled. CONCLUSIONS Modeling shows needle-free SC jet injection of a nominal dose of insulin does not necessarily provide metabolic action equivalent to total dose, and this availability significantly varies between trials. By quantifying and accounting for variability of jet injection insulin doses, better glycemic management outcomes using SC jet injection may be achieved.
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Affiliation(s)
- Alexander D McHugh
- Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - J Geoffrey Chase
- Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Jennifer L Knopp
- Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Tony Zhou
- Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Lui Holder-Pearson
- Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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8
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Kong X, Luo M, Cai L, Zhang P, Yan R, Hu Y, Li H, Ma J. Needle-free jet injection of insulin glargine improves glycemic control in patients with type 2 diabetes mellitus: a study based on the flash glucose monitoring system. Expert Opin Drug Deliv 2021; 18:635-641. [PMID: 33317342 DOI: 10.1080/17425247.2021.1863945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: To investigate the effects of insulin glargine injection given with a QS-P jet injector on the glucose profile using a professional mode flash glucose monitoring (FGM) system in patients with type 2 diabetes mellitus (T2DM).Research design and methods: In this randomized, controlled, cross-sectional study, 66 patients with T2DM who received insulin glargine (12-18 IU/day) injection were enrolled. The patients were randomly divided into group A (jet injector before insulin pen) and group B (insulin pen before jet injector). Each subject injected insulin daily before breakfast. We analyzed the changes in the glucose profile using a professional mode FGM system.Results: Treatment with a jet injector led to significantly lower 24-h mean glucose, maximum blood glucose, area under the curve (AUC) > 10.0 mmol/L, time above range and increased AUC < 3.9 mmol/L and time below range than those when using an insulin pen. There was no difference in glycemic variability between the two groups. We observed that patients using a jet injector had significantly lower mean glucose between 12:00 to 22:00.Conclusions: Needle-free jet injection of insulin glargine was more effective than use of an insulin pen for good glycemic control in patients with T2DM.Clinical trial registration: www.clinicaltrials.gov identifier is NCT04093284.
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Affiliation(s)
- Xiaocen Kong
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Menghui Luo
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Ling Cai
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Peng Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Rengna Yan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Huiqin Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
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Long LY, Zhang J, Yang Z, Guo Y, Hu X, Wang Y. Transdermal delivery of peptide and protein drugs: Strategies, advantages and disadvantages. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.102007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Ji L, Gao L, Chen L, Wang Y, Ma Z, Ran X, Sun Z, Xu X, Wang G, Guo L, Shan Z. Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study). EClinicalMedicine 2020; 23:100368. [PMID: 32529176 PMCID: PMC7283138 DOI: 10.1016/j.eclinm.2020.100368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Insulin therapy is poorly accepted by patients with type 2 diabetes mellitus (T2DM). A needle-free insulin injector has been developed for patients who fear injections or are reluctant to initiate insulin therapy when it is clearly indicated. The objective of this trial was to evaluate the glucose-lowering effect, tolerability, patient satisfaction and compliance with insulin treatment via a needle-free insulin injector (NFII) compared with insulin treatment via a conventional insulin pen (CIP) in patients with T2DM. METHODS A total of 427 patients with T2DM were enrolled in a prospective, multicenter, randomized, open-label study, and were randomly assigned 1:1 to receive 16 weeks' treatment with basal insulin or premixed insulin administered either by a NFII or CIP. TRIAL REGISTRATION ClinicalTrials.gov (NCT03243903). FINDINGS In the 412 patients who completed the study, the adjusted mean reduction of HbA1c from baseline at week 16 in the NFII group was 0.55% (95% CI -0.71, -0.39), which was non-inferior and statistically superior to the HbA1c reduction in the CIP group (0.26%, 95% CI -0.42, -0.11). Patients in the NFII group showed significantly higher treatment satisfaction scores than those in the CIP group (mean scores, 8.17 ± 1.78 vs. 7.21 ± 2.22, respectively; p<0.0001). The occurrence of hypoglycemia was similar in the two groups, and the NFII group showed reduced incidences of skin scratches, indurations and lower VAS pain scores. INTERPRETATION Insulin therapy through needle-free injector showed a non-inferior glycemic-lowering effect and a significantly enhanced level of patient satisfaction with insulin treatment compared with conventional insulin therapy through needle injections. In addition, the needle-free injector also had a better safety profile. FUNDING This study were funded by Beijing QS Medical Technology Co., Ltd, as well as The Major Chronic Non-communicable Disease Prevention and Control Research.
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Affiliation(s)
- Linong Ji
- Department of Endocrinology and Metabolism, Peking University Peoples Hospital, Beijing, China
- Corresponding author.
| | - Leili Gao
- Department of Endocrinology and Metabolism, Peking University Peoples Hospital, Beijing, China
| | - Liming Chen
- Metabolic Disease Hospital, Tianjin Medical University, Heping District, Tianjin, China
| | - Yangang Wang
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongshu Ma
- Department of Endocrinology and Metabolism, General Hospital of Tianjin Medical University, Tianjin, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Xiangjin Xu
- Department of Endocrinology, Fuzhou General Hospital of Nanjing Command, Fujian Province, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Zhongyan Shan
- Department of Endocrinology, the First Affiliated Hospital of China Medical University, Shenyang, China
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Kesavadev J, Saboo B, Krishna MB, Krishnan G. Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. Diabetes Ther 2020; 11:1251-1269. [PMID: 32410184 PMCID: PMC7261311 DOI: 10.1007/s13300-020-00831-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 12/24/2022] Open
Abstract
The year 2021 will mark 100 years since the discovery of insulin. Insulin, the first medication to be discovered for diabetes, is still the safest and most potent glucose-lowering therapy. The major challenge of insulin despite its efficacy has been the occurrence of hypoglycemia, which has resulted in sub-optimal dosages being prescribed in the vast majority of patients. Popular devices used for insulin administration are syringes, pens, and pumps. An artificial pancreas (AP) with a closed-loop delivery system with > 95% time in range is believed to soon become a reality. The development of closed-loop delivery systems has gained momentum with recent advances in continuous glucose monitoring (CGM) and computer algorithms. This review discusses the evolution of syringes, disposable, durable pens and connected pens, needles, tethered and patch insulin pumps, bionic pancreas, alternate controller-enabled infusion (ACE) pumps, and do-it-yourself artificial pancreas systems (DIY-APS).
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Affiliation(s)
- Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India.
| | | | - Meera B Krishna
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
| | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
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12
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Sun Y, Wang J, Li H, Sun X, Su X, Ma J. Comparison of glucose variability in patients with type 2 diabetes administrated glargine with needle-free jet injector and conventional insulin pen. Expert Opin Drug Deliv 2020; 17:713-717. [PMID: 32141347 DOI: 10.1080/17425247.2020.1738381] [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: 10/24/2022]
Abstract
Background: The effects of insulin delivered by needle-free jet injector on glycemic variations (GV) in patients with type 2 diabetes (T2D) which remains largely unknown.Research design and methods: We aimed to compare the glucose variability in Chinese T2D patients administrated glargine 100 U/mL (Gla-100) with a needle-free jet injector and conventional insulin pen. This was a self-comparative, observational study of 26 patients who were subjected to a flash glucose monitoring system (FGM) for 14 consecutive days. During the study period, all subjects received Gla-100 daily before breakfast using a conventional insulin pen, with the exception of day 3 and day 7, when insulin was delivered by needle-free jet injection. We analyzed FGM data of day 3, day 5, day 7, and day 9 at the endpoint.Results: There were no differences in the glycemic variability between the jet injector group and the conventional pen group. However, patients with needle-free jet injection had a lower 24 hr mean glucose (MG) and lower incremental area under the curve (AUC) of 1 hr, 12 hr, and 24 hr, compared to the conventional pen group (p = 0.001).Conclusions: Gla-100 delivered by needle-free jet injection potentially lowered MG in patients with T2D in the Chinese population.
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Affiliation(s)
- Yixuan Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian Wang
- Department of Intensive Care Unit, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Huiqin Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaojuan Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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14
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Xing Y, Xie X, Xu J, Liu J, He Q, Yang W, Zhang N, Li X, Wang L, Fu J, Zhou J, Gao B, Ming J, Liu X, Lai J, Liu T, Shi M, Ji Q. Efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin: a multicentre, prospective, randomised, crossover study. Expert Opin Drug Deliv 2019; 16:995-1002. [PMID: 31359813 DOI: 10.1080/17425247.2019.1649251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: To evaluate the efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin. Methods: 62 patients with type 2 diabetes were enrolled in a multicenter, randomised, prospective, open-label, crossover study. All patients received subcutaneous insulin glargine administered by a needle-free injector or a glargine pen for 7 ~ 14 days, and were then crossed over after wash out. Results: Patients in the insulin needle-free injector (NFI) and glargine pen (GP) groups achieved similar fasting blood glucose control . However, the dosage of insulin required to achieve the target FBG level in the NFI group was lower than in the GP group (16.14 ± 5.13 U/day vs 19.25 ± 6.20 U/day, respectively; p = 0.0046). This difference was more significant in patients who received higher insulin dosages compared with those receiving lower dosages. Use of the needle-free injector was also associated with significantly less pain (p < 0.001) and less fear of injection (p < 0.001) than glargine pens. Conclusion: The use of a needle-free injector can significantly lower the dosage of insulin required to achieve good glycemic control and reduce topical adverse reactions and the fear of injections as well, which help to improve patient compliance. Clinical Trial Registration Number KY20172077-1; NCT03420040.
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Affiliation(s)
- Ying Xing
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Xiaomin Xie
- Department of Endocrinology, The first People's Hospital , YinChuan , China
| | - Jing Xu
- Department of Endocrinology, The Second affiliated hospital of Xi'an Jiaotong University , Xi'an , China
| | - Jianrong Liu
- Department of Endocrinology, Changan Hospital , Xi'an , China
| | - Qingzhen He
- Department of Endocrinology, Xi'an Gaoxin Hospital , Xi'an , China
| | - Wenjuan Yang
- Department of Endocrinology, Shaanxi Aerospace Hospital , Xi'an , China
| | - Nana Zhang
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Xiaomiao Li
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Li Wang
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Jianfang Fu
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Jie Zhou
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Bin Gao
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Jie Ming
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Xiangyang Liu
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Jingbo Lai
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Tao Liu
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Min Shi
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Qiuhe Ji
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China
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Study Protocol for a Prospective, Multicenter, Randomized, Open-Label, Parallel-Group Clinical Trial Comparing the Efficacy and Safety of a Needle-Free Insulin Injector and a Conventional Insulin Pen in Controlling Blood Glucose Concentrations in Chinese Patients with Type 2 Diabetes Mellitus (The FREE Study). Adv Ther 2019; 36:1485-1496. [PMID: 31004325 DOI: 10.1007/s12325-019-00951-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION China has the largest number of diabetic patients in the world. In the past 2 decades, the prevalence of diabetes in China has increased dramatically, and the current status of diabetes control in the diabetic population is not satisfactory. Although insulin is currently recognized in diabetes treatment guidelines as the therapeutic option for patients not adequately controlled by diet/exercise and oral agents, the proportion of patients with type 2 diabetes using insulin is still very low, and the time when insulin therapy is initiated is relatively late. In using insulin injections, concerns about the complexity of the treatment regimen, a fear of needles, and other psychological barriers can affect insulin treatment, impacting on patient compliance and potentially resulting in a poor treatment response. Another type of insulin injection device that has become available recently, the needle-free injector, is now being used in clinical practice because of its unique features and patients' injection experiences. The aims of this study are to investigate the efficacy and safety of the needle-free injector-based insulin treatment in blood glucose control in patients with type 2 diabetes, as compared with a conventional needle-based insulin treatment, and to evaluate patient satisfaction with the different insulin delivery methods. METHODS AND PLANNED OUTCOMES A prospective, multicenter, randomized, open-label, parallel-group clinical trial was designed and implemented in China. A total of 420 patients with type 2 diabetes from ten research centers will be enrolled in the study. The primary efficacy endpoint is the change in the glycosylated hemoglobin (HbA1c) level from baseline to after 16 weeks of treatment after randomization. Secondary efficacy endpoints include measurements of blood glucose concentrations, the rate of achieving the target HbA1c level of less than 7%, patients' quality-of-life (as determined by the SF-36 questionnaire), the insulin dose administered, compliance with insulin therapy, and patients' satisfaction with their injection device. ETHICS AND DISSEMINATION The study was approved by the Independent Ethics Committee (IEC) of Peking University Peoples Hospital and was conducted in accordance with the moral, ethical, and scientific principles of the declaration of Helsinki and the provisions of good clinical practice (GCP) in China. Written informed consent will be obtained from all participants before any study-related procedures are implemented. It is hoped that the study will provide evidence for the clinical application of the needle-free injector by providing data on its efficacy and safety, as compared with a conventional insulin pen, in the Chinese type 2 diabetes population. When available, the results will be published in an international peer-reviewed journal. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT03243903. Registration date, August 9, 2017. FUNDING Beijing QS Medical Technology Co., Ltd.
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16
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Zhang Y, Yu J, Kahkoska AR, Wang J, Buse JB, Gu Z. Advances in transdermal insulin delivery. Adv Drug Deliv Rev 2019; 139:51-70. [PMID: 30528729 PMCID: PMC6556146 DOI: 10.1016/j.addr.2018.12.006] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/06/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
Insulin therapy is necessary to regulate blood glucose levels for people with type 1 diabetes and commonly used in advanced type 2 diabetes. Although subcutaneous insulin administration via hypodermic injection or pump-mediated infusion is the standard route of insulin delivery, it may be associated with pain, needle phobia, and decreased adherence, as well as the risk of infection. Therefore, transdermal insulin delivery has been widely investigated as an attractive alternative to subcutaneous approaches for diabetes management in recent years. Transdermal systems designed to prevent insulin degradation and offer controlled, sustained release of insulin may be desirable for patients and lead to increased adherence and glycemic outcomes. A challenge for transdermal insulin delivery is the inefficient passive insulin absorption through the skin due to the large molecular weight of the protein drug. In this review, we focus on the different transdermal insulin delivery techniques and their respective advantages and limitations, including chemical enhancers-promoted, electrically enhanced, mechanical force-triggered, and microneedle-assisted methods.
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Affiliation(s)
- Yuqi Zhang
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Jicheng Yu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Anna R Kahkoska
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Jinqiang Wang
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Zhen Gu
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA; California NanoSystems Institute, Jonsson Comprehensive Cancer Center, Center for Minimally Invasive Therapeutics, University of California, Los Angeles, CA 90095, USA.
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