Closed loop insulin delivery in diabetes

Battelino, Tadej; Omladic, Jasna Suput; Phillip, Moshe

doi:10.1016/j.beem.2015.03.001

Cited by 35 publications

(25 citation statements)

References 73 publications

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“…Ultra-long acting and high-strength formulations of new basal analogs have the potential for less glycemic variability and less (nocturnal) hypoglycemia [27]. Furthermore, closed loop insulin delivery, which links subcutaneous CGM with an external insulin pump through computerized control algorithms, has been shown to reduce glucose variability in both type 1 diabetes children and adults as compared with SAP [28].…”

Section: Discussionmentioning

confidence: 99%

Reducing glucose variability with continuous subcutaneous insulin infusion increases endothelial progenitor cells in type 1 diabetes: an observational study

et al. 2015

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Circulating endothelial progenitor cells (EPCs) are involved in the repairing mechanisms of vascular damage. Glucose variability may contribute to the development of chronic vascular complications of diabetes. We evaluated whether reducing glucose variability with continuous subcutaneous insulin infusion (CSII) would increase circulating levels of EPCs in type 1 diabetes. The study population consisted of 106 type 1 diabetic patients: 41 subjects considered eligible for CSII completed a 6-month follow-up. Sixty-five patients on intensified insulin therapy with multiple daily injections served as control group. Seven EPCs phenotypes were assessed by flow cytometry, and glucose variability by mean amplitude of glycemic excursions (MAGE). Both CD34+KDR+ [difference between groups 32.0, 95 % CI (19.6-44.4) number/10(6) cells, P < 0.001] and CD34+KDR+CD133+ [12.5 (5.5-19.5), P < 0.001)] cell count increased at endpoint in the CSII group, associated with a reduction of MAGE [-1.1 (-2.1 to -0.1), P = 0.026]. No changes occurred in the control group. In multivariate analyses, changes in MAGE were independently associated with changes in both CD34+KDR+ (P = 0.019) and CD34+KDR+CD133+ (P = 0.022) cell count. Reducing glucose variability with CSII in type 1 diabetes increases circulating EPCs levels, suggesting a novel mechanism of vascular damage by oscillating glucose.

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Section: Discussionmentioning

confidence: 99%

Reducing glucose variability with continuous subcutaneous insulin infusion increases endothelial progenitor cells in type 1 diabetes: an observational study

et al. 2015

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“…An adequate reaction to dynamic glycaemic changes induced by meals and physical activity poses a real challenge to the artificial pancreas. A slightly easier role of the artificial pancreas seems to be at night, which is confirmed in the case of pumps that automatically suspend insulin delivery and are already available on the market [26,27].…”

Section: Prace Poglądowementioning

confidence: 92%

“…However, due to the bulky size of these devices, they could be used only at the bedside. In the 1980s the first portable devices appeared on the market [26]. Despite the fact that currently the size of the pumps is relatively small, the key problem that limits their broad clinical usage is still the need for improvement in glucose sensors due to the delay period concerning the information and the delay in insulin delivery and in the onset of its action.…”

Section: Prace Poglądowementioning

confidence: 99%

“…W latach 70 ubiegłego wieku stworzono systemy wykorzystujące mikrokomputery obliczające zapotrzebowanie na insulinę za pomocą prostego algorytmu, ale ze względu na duże rozmiary, urządzenia te mogły być stosowane tylko przy łóżku chorego. W latach 80. ubiegłego wieku pojawiły się pierwsze przenośne urządzenia [26] i chociaż w chwili obecnej pompy mają niewielkie rozmiary, to ciągle jednak kluczowym problemem ograniczającym szerokie kliniczne zastosowanie jest niedoskonałość sensorów glukozowych w zakresie opóźnienia przekazywanej informacji oraz opóźnienie czasu podaży i początku działania podanej insuliny.…”

Section: Prace Poglądoweunclassified

“…Nieco łatwiejsze wydaje się jej zadanie w czasie odpoczynku nocnego, co sprawdza się w obecnych już na rynku pompach z funkcją hipoblokady [26,27].…”

Section: Prace Poglądoweunclassified

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Insulin therapy is the most effective method of lowering blood glucose. Over 100 years have passed the studies for the optimisation of insulin action. To date, subcutaneous insulin administration has been the basic route of insulin delivery. The search for insulin therapy is simultaneously conducted in the following directions: the optimisation of insulin action, automatisation, and the decrease in the invasiveness of insulin delivery methods. The optimisation of insulin action has led to the discovery of ultra-rapid-acting human insulin analogues, ultra-long-acting human insulin analogues, and biosimilar insulin. Automatisation referred to the "artificial pancreas" and closing the loop system in insulin pump therapy. The decrease in the invasiveness of insulin delivery methods is focused on alternative routes of insulin administration. StreszczenieInsulina to najskuteczniejszy lek obniżający glikemię. Od blisko 100 lat trwają badania nad optymalizacją insulinoterapii. Na chwilę obecną, nadal podstawową drogą podawania insuliny jest podaż podskórna. Badania w zakresie insulinoterapii wiodą w kilku kierunkach równocześnie: optymalizacji, automatyzacji i zmniejszenia inwazyjności podawania insuliny. Optymalizacja parametrów działania insuliny prowadzi do wprowadzenia ultraszybkodziałających analogów insuliny, nowych insulin bazowych oraz insulin biopodobnych. Automatyzacja terapii pompowej wiedzie do zamknięcia pętli i stworzenia "sztucznej trzustki". Zmniejszenie inwazyjności to wykorzystanie alternatywnych, innych niż podskórna, dróg podawania insuliny.

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Foreign‐body response caused by implanted biomaterials seriously impedes the function of implants and is a major obstacle to the development of implantable biomaterials and medical devices. Recent advances in implantable biomaterials and medical devices have provided strategies to resist the foreign‐body response. In this review, the mechanism of the foreign‐body response and conventional strategies to mitigate foreign‐body response is briefly introduced. Then, three types of promising foreign‐body response resisting materials are focused and the advantages, characteristics, and applications of each material are discussed. Finally, prospects are put forward for future development of foreign‐body response resisting materials and current challenges that require in‐depth study.

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Closed loop insulin delivery in diabetes

Cited by 35 publications

References 73 publications

Reducing glucose variability with continuous subcutaneous insulin infusion increases endothelial progenitor cells in type 1 diabetes: an observational study

Reducing glucose variability with continuous subcutaneous insulin infusion increases endothelial progenitor cells in type 1 diabetes: an observational study

Insulinoterapia — nowe kierunki poszukiwań

Dealing with the Foreign‐Body Response to Implanted Biomaterials: Strategies and Applications of New Materials

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