Advances in Insulin Infusion Set in the New Era of Automated Insulin Delivery: A Systematic Review

Abstract

Introduction: Automated insulin delivery (AID) has become a well-known research topic devoted to achieving better glycemic outcomes. AID systems consist primarily of three components: the continuous glucose monitoring system, the insulin delivery system, either tethered or patch pump, and the control system (algorithm). A key component in the tethered pump AID system is the insulin infusion set (IIS). This Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) study was conducted to evaluate the IIS evolution in the era of AID and to provide future perspectives of IIS clinical use. Methods: Literature searches for articles published from January 2016 to July 2022 were performed in Embase/Medline and PubMed. Data were extracted following PRISMA guidelines. Primary meta-analysis outcomes were IIS wear duration, total daily dose of insulin, and IIS failure reasons/modes. Results: We identified 387 publications, of which 15 eligible studies compared various IISs comprising over 1400 participants and >53 000 wears. Half of the studies published in 2022 were focused on extended IISs designed for wear durations of seven days or more. Three clinical trials have demonstrated the safe use of extended IISs to seven days of wear in individuals with type 1 diabetes, and two also demonstrated good glycemic control throughout the seven-day use. Conclusions: Research in insulin infusion technology has increased in the last six years, and extended IISs have demonstrated improved overall performance, particularly in duration of wear. Paths for future products are discussed with an emphasis on understanding the existing barriers related to both technical and nontechnical issues.

Skin Problems due to Treatment with Diabetes Technology: A Narrative Review

“…Therefore, it is intensely encouraged that future trials of diabetes devices with other more skin friendly medical adhesives based on hydrocolloid or silicone will be included, at least to be used in a subgroup of the population 33 . When it comes to the insulin being used in diabetes devices, studies are also needed after approval of new insulin comparing the tendency of resulting in both lipohypertrophy and lipoatrophy, and this may also be a perspective of the insulin designing process or using filters in infusions set to prevent precipitation products 62 .…”

Lipohypertrophy and Insulin: An Update From the Diabetes Technology Society

“…Novel seven-day infusion sets may lead to fewer cases of LH, but studies are underway to quantify this hypothesis. 26,27 Additives in different types of insulin may also have some influence because of the introduction of foreign bodies that can activate the immune system. Insulin delivery via jet injectors has been speculated to decrease LH risk.…”