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Prasathkumar M, Becky R, Anisha S, Dhrisya C, Sadhasivam S. Evaluation of hypoglycemic therapeutics and nutritional supplementation for type 2 diabetes mellitus management: An insight on molecular approaches. Biotechnol Lett 2022; 44:203-238. [PMID: 35119572 DOI: 10.1007/s10529-022-03232-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This review aims to summarize the current management of type 2 diabetes principles, including oral hypoglycemic agents, types of insulin administration, diet maintenance, and various molecular approaches. METHODS A literature search was conducted in different databases such as Scopus, ScienceDirect, Google Scholar, and Web of Science by using the following keywords: type-2 diabetes mellitus (T2DM), first-line and second-line treatment, oral hypoglycemic agents, insulin administration, diet/nutritional therapy, gene and stem cell therapy, and diabetic complications. RESULTS The first-line treatment of T2DM includes administering oral hypoglycemic agents (OHAs) and second-line treatment by insulin therapy and some OHAs like Sulfonylurea's (SU). The oral hypoglycemic or oral antidiabetic drugs have the function of lowering glucose in the blood. Insulin therapy is recommended for people with A1C levels > 7.0, and insulin administration is evolved drastically from the syringe, pump, pen, inhalation, insulin jet, and patch. The use of OHAs and insulin therapy during glycemic control has a severe effect on weight gain and other side effects. Hence, diet maintenance (macro and micronutrients) and nutritional therapy guidelines were also reviewed/recommended for safe T2DM management. Besides, the recent progress in molecular approaches that focuses on identifying new targets for T2DM (i.e.) consisting of gene therapy, stem cell therapy, and the modulation of insulin signaling pathways for the regulation of glucose storage and uptake also discussed. CONCLUSION The analysis of all these key factors is necessary to develop a potential agent to cure T2DM and suggest that a combination of therapies will pave the way for advanced management of T2DM.
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Affiliation(s)
- Murugan Prasathkumar
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Robert Becky
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Salim Anisha
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Chenthamara Dhrisya
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India
| | - Subramaniam Sadhasivam
- Bioprocess and Biomaterials Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore, 641046, India.
- Department of Extension and Career Guidance, Bharathiar University, Coimbatore, 641046, India.
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He J, Renard E, Lord P, Cohen D, Gu B, Wang X, Yenduri G, Burgess DJ. Strategies for extended lifetime of implantable intraperitoneal insulin catheters. J Control Release 2021; 341:487-497. [PMID: 34856228 DOI: 10.1016/j.jconrel.2021.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/08/2021] [Accepted: 11/25/2021] [Indexed: 01/01/2023]
Abstract
Implantable insulin infusion systems using the intra-peritoneal route have dramatically changed the management of diabetes paving the way toward the realization of the potential "holy grail" of a fully implantable artificial pancreas. However, the wear duration of delivery catheters is compromised by the foreign body-mediated immune response. Both occlusion material present at the distal catheter tip end and fibrotic encapsulation surrounding the catheters influence the controlled and precise delivery of insulin, which eventually leads to the need for surgical intervention. The novel part of the current work is the investigation of the roles of implant physical properties (catheter size and tip configuration), as well as local inflammation control (through utilization of an anti-inflammatory agent) on the host fibrotic response using a previously developed animal model. The cellular and molecular response, the medication delivery efficacy as well as the ability to flush the catheters were examined and further compared among the different mitigation strategies. Reduction in catheter size as well as tuning the tip configuration from a cone shape to a round shape showed delayed host recognition and delayed propagation of the fibrotic response. However, the round shaped tips had an increased occurrence of lumen occlusion as a result of flow change. It became apparent that changing the physical properties of the catheters was not a long-term solution to catheter obstructions caused by the foreign body reaction. In comparison, control of the local inflammatory response through the use of an anti-inflammatory agent demonstrated a promising strategy for maintenance of catheter functionality without any type of obstructions. These finding will have a large impact toward the development of long-term use catheters for continuous intraperitoneal insulin infusion.
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Affiliation(s)
- Jia He
- Department of Pharmaceutical Sciences, University of Connecticut, 69 N Eagleville Road U3092, Storrs, CT 06269, USA
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, Lapeyronie Hospital, Avenue Doyen Giraud, Montpellier 34295, France; Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 141 Rue de la Cardonille, Montpellier 34094, France
| | - Peter Lord
- PhysioLogic Devices, Inc, 2232 Old Stagecoach Trail, Alpine, CA 91901, USA
| | - Don Cohen
- PhysioLogic Devices, Inc, 2232 Old Stagecoach Trail, Alpine, CA 91901, USA
| | - Bing Gu
- Department of Pharmaceutical Sciences, University of Connecticut, 69 N Eagleville Road U3092, Storrs, CT 06269, USA
| | - Xiaoyi Wang
- Department of Pharmaceutical Sciences, University of Connecticut, 69 N Eagleville Road U3092, Storrs, CT 06269, USA
| | - Gowtham Yenduri
- Department of Pharmaceutical Sciences, University of Connecticut, 69 N Eagleville Road U3092, Storrs, CT 06269, USA
| | - Diane J Burgess
- Department of Pharmaceutical Sciences, University of Connecticut, 69 N Eagleville Road U3092, Storrs, CT 06269, USA.
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Fakhroleslam M, Bozorgmehry Boozarjomehry R. A multi‐objective optimal insulin bolus advisor for type 1 diabetes based on personalized model and daily diet. ASIA-PAC J CHEM ENG 2021. [DOI: 10.1002/apj.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mohammad Fakhroleslam
- Process Engineering Department, Faculty of Chemical Engineering Tarbiat Modares University Tehran Iran
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Malone-Povolny MJ, Bradshaw TM, Merricks EP, Long CT, Nichols TC, Schoenfisch MH. Combination of Nitric Oxide Release and Surface Texture for Mitigating the Foreign Body Response. ACS Biomater Sci Eng 2021; 7:2444-2452. [PMID: 33848421 DOI: 10.1021/acsbiomaterials.1c00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The tissue response to polyurethane (PU)-coated implants employing active and/or passive FBR mitigation techniques was evaluated over a 28 day study in a diabetic swine model. Active FBR mitigation was achieved through the sustained release of nitric oxide (NO) from a mesoporous silica nanoparticle-doped PU coating. Passive FBR mitigation was achieved through the application of a foam- or fiber-based topcoat. These topcoats were designed to possess topographical features known to promote tissue integration with foam-coated implants having pore sizes of approximately 50 μm and fiber-coated implants consisting of fiber diameters of less than 1 μm. Nitric oxide-release profiles were minimally impacted by the presence of either topcoat. Inflammatory cell density and collagen density at the implant-tissue interface were assessed at 7, 14, 21, and 28 days following implantation. Nitric oxide-releasing implants had significantly lower inflammatory cell density and collagen density than non-NO-releasing controls. The presence of a topcoat did not significantly impact inflammatory cell density, though top-coated textured implants resulted in significantly lower collagen density, irrespective of NO release. Overall, coatings that combine NO release with surface texture demonstrated the greatest potential for tissue-based biomedical device applications.
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Affiliation(s)
- Maggie J Malone-Povolny
- Department of Chemistry, University of North Carolina at Chapel Hill, CB3290, Chapel Hill, North Carolina 27599, United States
| | - Taron M Bradshaw
- Department of Chemistry, University of North Carolina at Chapel Hill, CB3290, Chapel Hill, North Carolina 27599, United States
| | - Elizabeth P Merricks
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, CB3290, Chapel Hill, North Carolina 27599, United States
| | - C Tyler Long
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, CB3290, Chapel Hill, North Carolina 27599, United States
| | - Timothy C Nichols
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, CB3290, Chapel Hill, North Carolina 27599, United States
| | - Mark H Schoenfisch
- Department of Chemistry, University of North Carolina at Chapel Hill, CB3290, Chapel Hill, North Carolina 27599, United States
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Gregory JM, Cherrington AD, Moore DJ. The Peripheral Peril: Injected Insulin Induces Insulin Insensitivity in Type 1 Diabetes. Diabetes 2020; 69:837-847. [PMID: 32312900 PMCID: PMC7171956 DOI: 10.2337/dbi19-0026] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/12/2020] [Indexed: 12/13/2022]
Abstract
Insulin resistance is an underappreciated facet of type 1 diabetes that occurs with remarkable consistency and considerable magnitude. Although therapeutic innovations are continuing to normalize dysglycemia, a sizable body of data suggests a second metabolic abnormality-iatrogenic hyperinsulinemia-principally drives insulin resistance and its consequences in this population and has not been addressed. We review this evidence to show that injecting insulin into the peripheral circulation bypasses first-pass hepatic insulin clearance, which leads to the unintended metabolic consequence of whole-body insulin resistance. We propose restructuring insulin therapy to restore the physiological insulin balance between the hepatic portal and peripheral circulations and thereby avoid the complications of life-long insulin resistance. As technology rapidly advances and our ability to ensure euglycemia improves, iatrogenic insulin resistance will become the final barrier to overcome to restore normal physiology, health, and life in type 1 diabetes.
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Affiliation(s)
- Justin M Gregory
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - Alan D Cherrington
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
| | - Daniel J Moore
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
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Magisson J, Sassi A, Kobalyan A, Burcez CT, Bouaoun R, Vix M, Jeandidier N, Sigrist S. A fully implantable device for diffuse insulin delivery at extraperitoneal site for physiological treatment of type 1 diabetes. J Control Release 2020; 320:431-441. [DOI: 10.1016/j.jconrel.2020.01.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 12/22/2022]
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Crinò C, Iavazzo F, Ferri F, Coppola LM, Salesov E, Lutz TA, Reusch CE, Zini E. Diabetic remission in a cat treated with an implantable pump to deliver insulin. Can Vet J 2020; 61:30-34. [PMID: 31892750 PMCID: PMC6909408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A diabetic cat was referred because of poor metabolic control and difficulties the owner experienced injecting insulin. A pump, telemetrically controlled with a smartphone, was implanted subcutaneously to deliver insulin. Before implantation, the pump reservoir was filled with a rapid-acting human recombinant insulin. The insulin was administered through continuous infusion or periodic boluses over 2 weeks while the cat was hospitalized and over another 2 weeks after discharge from the hospital. Adjustments of insulin dosage were performed based on blood glucose concentrations measured with a continuous blood monitoring system (CGMS). The cat achieved diabetic remission that is still lasting after 1 year. The treatment protocol adopted in this cat contributed to achieving remission. The owner's unwillingness to inject insulin into an uncooperative cat was circumvented with the implantable pump. Key clinical message: The implantable subcutaneous pump, telemetrically controlled by a smartphone, easily allowed the clinician to modify the type of administration and the amount of insulin delivered; the concurrent use of a CGMS allowed detection of sudden changes in blood glucose while limiting stress to the cat.
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Affiliation(s)
- Chiara Crinò
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Francesca Iavazzo
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Filippo Ferri
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Luigi M Coppola
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Elena Salesov
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Thomas A Lutz
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Claudia E Reusch
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Eric Zini
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello (NO), Italy (Crinò, Iavazzo, Ferri, Zini); Department of Animal Medicine, Production and Health, viale dell'Università 16, 35020 Legnaro (PD), University of Padova, Italy (Coppola, Zini); Clinic for Small Animal Internal Medicine (Salesov, Reusch, Zini); and Institute of Veterinary Physiology (Lutz), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
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Abstract
In recent years, bariatric surgery, also referred to as metabolic surgery, has become the most successful treatment option in those with Type 2 diabetes and obesity. There are some similarities in the pathological pathways in Type 1 and Type 2 diabetes, but the use of surgery in Type 1 diabetes remains unestablished and controversial. The treatment and management of Type 1 diabetes can be very challenging but recent advances in surgical interventions and technology has the potential to expand and optimize treatment options. This review discusses the current status of some surgical options available to people with Type 1 diabetes. These include implantable continuous glucose monitoring systems, continuous intraperitoneal insulin infusion pumps, closed-loop insulin delivery systems (also known as the artificial pancreas system) utilizing the latter two modalities of glucose monitoring and insulin delivery, and bariatric or metabolic surgery. Whole pancreas and islet transplantation are beyond the scope of this review but are briefly discussed.
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Affiliation(s)
- K T D Yeung
- Department of Surgery and Cancer, Imperial College, London, UK
- St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
| | - M Reddy
- St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK
| | - S Purkayastha
- Department of Surgery and Cancer, Imperial College, London, UK
- St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
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Abstract
Novel drug delivery systems based on microtechnology have advanced tremendously, but yet face some technological and societal hurdles to fully achieve their potential. The novel drug delivery systems aim to deliver drugs in a spatiotemporal- and dosage-controlled manner with a goal to address the unmet medical needs from oral delivery and hypodermic injection. The unmet needs include effective delivery of new types of drug candidates that are otherwise insoluble and unstable, targeted delivery to areas protected by barriers (e.g. brain and posterior eye segment), localized delivery of potent drugs, and improved patient compliance. After scrutinizing the design considerations and challenges associated with delivery to areas that cannot be efficiently targeted through standard drug delivery (e.g. brain, posterior eye segment, and gastrointestinal tract), this review provides a summary of recent advances that addressed these challenges and summarizes yet unresolved problems in each target area. The opportunities for innovation in devising the novel drug delivery systems are still high; with integration of advanced microtechnology, advanced fabrication of biomaterials, and biotechnology, the novel drug delivery is poised to be a promising alternative to the oral administration and hypodermic injection for a large spectrum of drug candidates.
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Affiliation(s)
- Hyunjoo J Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Nakwon Choi
- Center for BioMicrosystems, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea; Division of Bio-Medical Science & Technology (Biomedical Engineering), KIST School, Korea University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - Eui-Sung Yoon
- Center for BioMicrosystems, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea
| | - Il-Joo Cho
- Center for BioMicrosystems, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea; Division of Bio-Medical Science & Technology (Biomedical Engineering), KIST School, Korea University of Science and Technology (UST), Daejeon 34113, Republic of Korea.
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Giménez M, Purkayajtha S, Moscardó V, Conget I, Oliver N. Intraperitoneal insulin therapy in patients with type 1 diabetes. Does it fit into the current therapeutic arsenal? ACTA ACUST UNITED AC 2018; 65:182-184. [PMID: 29429951 DOI: 10.1016/j.endinu.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Marga Giménez
- Diabetes Unit, Endocrinology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain; Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom.
| | - Sanjay Purkayajtha
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Vanessa Moscardó
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain; Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom
| | - Ignacio Conget
- Diabetes Unit, Endocrinology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Nick Oliver
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom
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Abstract
In recent years, continuous intraperitoneal insulin infusion (CIPII) has become a favored treatment alternative for patients with subcutaneous insulin resistance, mainly due to its ability of mimicking physiological conditions of insulin absorption. CIPII has been shown to improve glycemic control as well as to reduce hypoglycemic events and to lead to increased patient satisfaction and quality of life (QoL). Among CIPII delivery systems, Diaport stands out due to its low side effects, its demonstrated clinical efficacy and the potential for integration into closed-loop systems.
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Affiliation(s)
| | | | - Oliver Schnell
- Sciarc Institute, Baierbrunn, Germany
- Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany
- Oliver Schnell, MD, Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764 Munich-Neuherberg, Germany.
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12
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Zini E, Padrutt I, Macha K, Riederer A, Pesaresi M, Lutz T, Reusch C. Use of an implantable pump for controlled subcutaneous insulin delivery in healthy cats. Vet J 2017; 219:60-4. [DOI: 10.1016/j.tvjl.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 11/19/2022]
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Abstract
INTRODUCTION Implantable pump therapy adopting the intraperitoneal route of insulin delivery has been available for the past three decades. The key rationale for implantable pump therapy is the restoration of the portal-peripheral insulin gradient of the normal physiology. Uptake in clinical practice is limited to specialized centers and selected patient populations. Areas covered: Implantable pump therapy is discussed, including technical aspects, rationale for its use, and glycemic and non-glycemic effects. Target populations, summaries of clinical studies and issues related to implantable pump therapy are highlighted. Limitations of implantable pump therapy and its future outlook in clinical practice are presented. Expert opinion: Although intraperitoneal insulin delivery appears closer to the normal physiology, technical, pharmacological, and costs barriers prevent a wider adoption. Evidence from clinical studies remains scarce and inconclusive. As a consequence, the use of implantable pump therapy will be confined to a small population unless considerable technological progress is made and well-conducted studies can demonstrate glycemic and/or non-glycemic benefits justifying wider application.
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Affiliation(s)
- Lia Bally
- 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.,c Department of Diabetes, Endocrinology, Clinical Nutrition & Metabolism, Inselspital , Bern University Hospital, University of Bern , Bern , Switzerland
| | - 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.,d Department of Paediatrics , University of Cambridge , Cambridge , UK
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Abstract
The formation of insulin amyloid can dramatically impact glycemic control in patients with diabetes, making it an important therapeutic consideration. In addition, the cost associated with the excess insulin required by patients with amyloid is estimated to be $3K per patient per year, which adds to the growing financial burden of this disease. Insulin amyloid has been observed with every mode of therapeutic insulin administration (infusion, injection and inhalation), and the number of reported cases has increased significantly since 2002. The new cases represent a much broader demographic, and include many patients who have used exclusively human insulin and human insulin analogs. The reason for the increase in case reports is unknown, but this review explores the possibility that changes in patient care, improved differential diagnosis and/or changes in insulin type and insulin delivery systems may be important factors. The goal of this review is to raise key questions that will inspire proactive measures to prevent, identify and treat insulin amyloid. Furthermore, this comprehensive examination of insulin amyloid can provide insight into important considerations for other injectable drugs that are prone to form amyloid deposits.
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Affiliation(s)
- Melanie R Nilsson
- a Department of Chemistry , McDaniel College , Westminster , MD , USA
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van Dijk PR, Logtenberg SJJ, Gans ROB, Bilo HJG, Kleefstra N. Intraperitoneal insulin infusion: treatment option for type 1 diabetes resulting in beneficial endocrine effects beyond glycaemia. Clin Endocrinol (Oxf) 2014; 81:488-97. [PMID: 25041605 DOI: 10.1111/cen.12546] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/11/2014] [Accepted: 07/03/2014] [Indexed: 11/28/2022]
Abstract
Continuous intraperitoneal insulin infusion (CIPII) is a treatment option for patients with type 1 diabetes mellitus who fail to reach adequate glycaemic control despite intensive subcutaneous (SC) insulin therapy. CIPII has clear advantages over SC insulin administration in terms of pharmacokinetic and pharmacodynamic properties and has been shown to improve glycaemic regulation. Due to the delivery of insulin predominantly in the portal vein, as opposed to systemically, CIPII offers a unique research model to investigate the effects of insulin on endocrine and metabolic parameters in vivo. The aim of the present article is to provide an overview of the literature with respect to the effects of CIPII on glucose management, quality of life, complications and costs, with additional focus on metabolic and endocrine aspects. Finally, future use and research objectives are discussed.
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Lee SI, Narendran P. Intraperitoneal insulin therapy for a patient with type 1 diabetes with insulin injection site inflammation. BMJ Case Rep 2014; 2014:bcr-2014-205278. [PMID: 25188930 DOI: 10.1136/bcr-2014-205278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old man with type 1 diabetes developed skin inflammation at the site of subcutaneous insulin injection after 10 years of basal bolus subcutaneous insulin therapy. This inflammation led to poor insulin absorption, poorly controlled blood glucose and subsequently to ketoacidosis. The problem persisted despite a trial of continuous subcutaneous insulin infusion. The patient went on to be treated with continuous intraperitoneal insulin infusion. Three months after the procedure, he was achieving good glucose control and was able to resume his normal life, with the only complication being an episode of cellulitis surrounding the port site.
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Affiliation(s)
| | - Parth Narendran
- Clinical and Experimental Medicine, The Medical School, University of Birmingham, UK Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, UK
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