Novel simple insulin delivery device reduces barriers to insulin therapy in type 2 diabetes: results from a pilot study

Addressing the Burden of Multiple Daily Insulin Injections in Type 2 Diabetes with Insulin Pump Technology: A Narrative Review

The growing prevalence of type 2 diabetes (T2D) remains a leading health concern in the US. Despite new medications and technologies, glycemic control in this population remains suboptimal, which increases the risk of poor outcomes, increased healthcare resource utilization, and associated costs. This article reviews the clinical and economic impacts of suboptimal glycemic control in patients on basal-bolus insulin or multiple daily injections (MDI) and discusses how new technologies, such as tubeless insulin delivery devices, referred to as "patch pumps", have the potential to improve outcomes in patients with T2D.

Opportunities to overcome underutilization of enhanced insulin delivery technologies in people with type 2 diabetes: a narrative review

Use of innovative technologies such as continuous glucose monitoring (CGM) and insulin delivery systems have been shown to be safe and effective in helping patients with diabetes achieve significantly improved glycemic outcomes compared to their previous therapies. However, these technologies are underutilized in many primary care practices. This narrative review discusses some of the clinical and economic benefits of tubeless insulin delivery devices and discusses how this technology can overcome the main obstacles inherent to use of conventional insulin delivery devices.

Transparent Conducting Films Based on Carbon Nanotubes: Rational Design toward the Theoretical Limit

Electrically conductive thin-film materials possessing high transparency are essential components for many optoelectronic devices. The advancement in the transparent conductor applications requires a replacement of indium tin oxide (ITO), one of the key materials in electronics. ITO and other transparent conductive metal oxides have several drawbacks, including poor flexibility, high refractive index and haze, limited chemical stability, and depleted raw material supply. Single-walled carbon nanotubes (SWCNTs) are a promising alternative for transparent conducting films (TCFs) because of their unique and excellent chemical and physical properties. Here, the latest achievements in the optoelectronic performance of TCFs based on SWCNTs are analyzed. Various approaches to evaluate the performance of transparent electrodes are briefly reviewed. A roadmap for further research and development of the transparent conductors using "rational design," which breaks the deadlock for obtaining the TCFs with a performance close to the theoretical limit, is also described.

Patch Pumps: What are the advantages for people with diabetes?

AIM

Patch pumps, i.e. insulin pumps without tubing, are an attractive alternative to conventional insulin pumps for people with type 1 diabetes and type 2 diabetes on insulin therapy. In this review, potential patient-relevant advantages and disadvantages of patch pumps are summarized and respective studies on patient-reported outcomes (PROs) are assessed.

METHODS

Relevant studies were identified through a systematic PubMed search. Reference lists in respective articles and Google Scholar were also checked for additional references. Articles in English published before June 30, 2021, were included; no other criteria on publication dates were set.

RESULTS

A total of 12 studies were included. The results of this analysis provide evidence that patch pumps improve quality of life, reduce diabetes-related distress, increase patient satisfaction, and are preferred by patients compared to conventional insulin pumps and multiple daily injection therapy (MDI). However, several methodological limitations of the studies identified constrain the significance of this analysis.

CONCLUSIONS

Despite the limited number of studies evaluating the benefits of patch pumps on PROs, there is increasing evidence that people with diabetes prefer patch pumps. Although there are numerous PROs for patch pumps, it is surprising that this aspect has been relatively understudied. More systematic evaluation studies of the benefits of patch pumps on PROs are needed.

Insulin Pump Therapy for Patients With Type 2 Diabetes Mellitus: Evidence, Current Barriers, and New Technologies

An increasing number of patients with type 2 diabetes mellitus (T2DM) use insulin pumps. The first insulin pumps especially designed for patients with T2DM have recently become available. However, national guidelines do not primarily recommend the use of continuous subcutaneous insulin infusion (CSII) for this patient group. The effectiveness of CSII in T2DM has not yet been convincingly demonstrated, despite some positive evidence. An overview and an assessment of various studies to date will be given. T2DM is a heterogeneous disease with a substantial phenotypic variability; therefore, it is difficult to provide general conclusions about the effectiveness of CSII in T2DM therapy. The pump types, characteristics, and associated barriers may play a relevant role for therapy outcome. Most advanced functions like various bolus dosages offered by conventional insulin pumps are not needed for T2DM treatment and complicate the device handling for this subject group. Additionally, new technologies like increased connectivity, advanced software features, and interoperability are currently becoming available representing further barriers. The implementation of this technological progress might be a benefit for pumps for T2DM as well. However, these have not been sufficiently examined either and increased security challenges due to integrated peripheral components should not be neglected in terms of a sound cybersecurity. Pump features and handling for patients with T2DM should be as easy as possible, indicating a need for insulin pumps specially designed for patients with T2DM. However, it has to be investigated if pumps designed for T2DM are more effective than other intensified insulin regimens.

Key Features of Insulin Delivery Devices for Type 2 Diabetes: Type 2.0 Booth Survey

This article reports on a survey conducted at four diabetes-related annual conferences in 2017 and 2018 to obtain input from the medical community regarding the most important features of insulin delivery devices to address the unmet needs of people with type 2 diabetes who require basal/bolus insulin therapy. The overall patterns of responses compiled from 742 participating health care providers, each voting for three of eight proposed features of insulin delivery devices, were mostly similar numerically at each conference. The features garnering the top three percentages of votes (n = 2,226) averaged for all four conferences were tube-free patch (14.7%), reduced number of insulin injections (14.7%), and dose capture report (14.2%). Four other features received almost as many votes: flexible dosing (14.0%), patient lifestyle app (13.3%), wireless controller (12.7%), and interconnected glucose monitoring (12.6%). This survey provided valuable information that can aid the development of future insulin delivery devices.

A Clinical Overview of Insulin Pump Therapy for the Management of Diabetes: Past, Present, and Future of Intensive Therapy

IN BRIEF Insulin pump therapy is advancing rapidly. This article summarizes the variety of insulin pump technologies available to date and discusses important clinical considerations for each type of technology.

Developing a Simple 3-Day Insulin Delivery Device to Meet the Needs of People With Type 2 Diabetes

AIM

We sought to design an insulin delivery method that would overcome barriers to insulin therapy and meet the needs of the users, adults with diabetes, and their health care providers (HCPs).

METHODS

We conducted focus groups and human factors studies with users to learn about their needs and requirements. We then designed an insulin delivery device, PAQ, with features that met the user's requirements. Iterative design and human factors testing (HFT) was performed with adults with diabetes on ⩾2 injections/day and HCPs. In parallel, studies were conducted to identify an adhesive that stayed adhered for 3 days and caused minimal, if any, dermal irritation. Pilot clinical studies were then initiated.

RESULTS

Users want a way to administer insulin that is simple, discreet, safe, and effective. A summative HFT found the device was easy to learn and use. All participants (30/30, 100%) successfully completed the key performance measures tested. An adhesive validation study in 30 adults with diabetes found 90% of the devices remained adhered to the participant's application site at the end of 3 days with minimal skin irritation. Data from 3 clinical studies revealed 74-75% transitioned from injectable insulin to the device with the first fixed basal rate selected, improved glycemic control, and participants' satisfaction with the device.

CONCLUSION

The collective data from the HFT, adhesive, and clinical studies demonstrated that the device provides a method of insulin delivery that overcomes barriers to injectable insulin, meets the needs of the user, and achieves glycemic control.

Translation and validation of the Insulin Treatment Appraisal Scale in Hong Kong primary care patients

AIMS/INTRODUCTION

Patients with type 2 diabetes mellitus often delay the initiation or titration of insulin treatment due to psychological factors. This phenomenon is referred to as psychological insulin resistance (PIR). The Insulin Treatment Appraisal Scale (ITAS) is a 20-item instrument for assessing PIR. A previous Chinese version of the ITAS (C-ITAS) was found to be subject to problems arising from its translation. The present study aimed to translate and validate this instrument, which will facilitate research and aid in counseling in a clinical setting.

MATERIALS AND METHODS

The C-ITAS was modified to develop the Hong Kong version of the C-ITAS (C-ITAS-HK) according to published guidelines for the translation of transcultural research. A total of 328 diabetes mellitus patients who were followed-up in 10 different publically funded primary care outpatient clinics were recruited for self-administration of the C-ITAS-HK. Demographic data were recorded, and clinical data (e.g., presence of diabetes mellitus complications) were obtained from case records. The C-ITAS-HK results were subjected to psychometric analysis, including the assessment of Cronbach's alpha, factor analysis and test-retest reliability.

RESULTS

Factor analysis supported a two-factor structure with good internal consistency (whole scale 0.846, negative subscale 0.882, positive subscale 0.619). The test-retest reliability correlation coefficients for all items were positive, at 0.871, 0.782, and 0.692 for the whole scale, negative subscale and positive subscale, respectively. The ITAS scores differed significantly between participants with PIR and those without in the expected direction, suggesting good discriminant validity.

CONCLUSIONS

The C-ITAS-HK is a valid tool for measuring and assessing PIR in the Hong Kong primary care diabetes mellitus population.

Assessing Psychological Insulin Resistance in Type 2 Diabetes: a Critical Comparison of Measures

PURPOSE OF REVIEW

This study aims to examine the operationalisation of 'psychological insulin resistance' (PIR) among people with type 2 diabetes and to identify and critique relevant measures.

RECENT FINDINGS

PIR has been operationalised as (1) the assessment of attitudes or beliefs about insulin therapy and (2) hypothetical or actual resistance, or unwillingness, to use to insulin. Five validated PIR questionnaires were identified. None was fully comprehensive of all aspects of PIR, and the rigour and reporting of questionnaire development and psychometric validation varied considerably between measures. Assessment of PIR should focus on the identification of negative and positive attitudes towards insulin use. Actual or hypothetical insulin refusal may be better conceptualised as a potential consequence of PIR, as its assessment overlooks the attitudes that may prevent insulin use. This paper provides guidance on the selection of questionnaires for clinical or research purpose and the development of new, or improvement of existing, questionnaires.