Medical devices, smart drug delivery, wearables and technology for the treatment of Diabetes Mellitus

Domingo‐Lopez, Daniel A.; Lattanzi, Giulia; Schreiber, Lucien H. J.; Wallace, Eimear; Wylie, Robert B.; O’Sullivan, Janice; Dolan, Eimear; Duffy, Garry P.

doi:10.1016/j.addr.2022.114280

Cited by 48 publications

(30 citation statements)

References 229 publications

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“…However, the clinical safety and efficacy, especially in post-prandial control, of ultra-rapid acting insulins is now supported by many studies [15, 16, 52, 53]. The factitious “too rapid” assertion also deflects the many advances in continuous glucose monitoring (CGM) devices, insulin dosage-predicting algorithms, precision-dosing insulin pumps, open and closed loop systems, and the “artificial pancreas” (AP) [6]. To this point, a recent, comprehensive review of multiple input AP systems [54], identified two persistent challenges: lag times in acquiring blood glucose concentration data, and delays in absorption of insulin from SC depots.…”

Section: Discussionmentioning

confidence: 99%

“…insulin pumps, open-or closed-loop systems, and the "artificial pancreas" [4,6]. Efforts to accelerate absorption of insulin have pursued two general approaches: novel formulations of pharmacologic insulins and altered routes of administration.…”

Section: Introductionmentioning

confidence: 99%

“…foreshortened by the development of "ultra-rapid acting insulins" [Faster aspart (Fiasp), 63 min, URLj (Lyumjev), 57 min [15]], the subcutaneous route is beleaguered by a second confounding problem: intra-patient variability of absorption of the specified dose [26][27][28] resulting in unanticipated blood glucose effects. This variance between anticipated and actual effect upon blood glucose concentration contributes to the incidence of both diabetic ketoacidosis (DKA) and importantly, hypoglycemic episodes [6], especially in those individuals who are constitutively "hypoglycemia unaware" [29,30]. Unpredictable discrepancies between the intended and evinced biochemical effects of a particular SC dose are multifactorial.…”

Section: Introductionmentioning

confidence: 99%

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Accelerated absorption of regular insulin administered via a vascularizing permeable microchamber implanted subcutaneously in diabeticRattus norvegicus

Steyn

Drew

Vlachos

et al. 2022

Preprint

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In Type 1 diabetes patients, even ultra-rapid acting insulins injected subcutaneously reach peak concentrations in 45 minutes or longer. The lag time between dosing and peak concentration, as well as intra- and inter-subject variability, render prandial glucose control and dose consistency difficult. We postulated that insulin absorption from subcutaneously implantable vascularizing microchambers would be significantly faster than conventional subcutaneous injection. Male athymic nude R. norvegicus rendered diabetic with streptozotocin were implanted with vascularizing microchambers (single chamber; 1.5 cm2 surface area per side; nominal volume, 22.5 µL). Plasma insulin was assayed after a single dose (1.5 U/kg) of diluted insulin human (Humulin®R U-100), injected subcutaneously or via microchamber. Microchambers were also implanted in additional animals and retrieved at intervals for histologic assessment of vascularity. Following conventional subcutaneous injection, the mean peak insulin concentration was 22.7 (SD 14.2) minutes. By contrast, when identical doses of insulin were injected via subcutaneous microchamber 28 days after implantation, the mean peak insulin time was shortened to 7.50 (SD 4.52) minutes. Peak insulin concentrations were similar by either route; however, inter-subject variability was reduced when insulin was administered via microchamber. Histologic examination of tissue surrounding microchambers showed mature vascularization on days 21 and 40 post-implantation. Implantable vascularizing microchambers of similar design may prove clinically useful for insulin dosing, either intermittently by needle, or continuously by pump including in “closed loop” systems, such as the artificial pancreas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Accelerated absorption of regular insulin administered via a vascularizing permeable microchamber implanted subcutaneously in diabeticRattus norvegicus

Steyn

Drew

Vlachos

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…In subcutaneous continuous insulin infusion, a single subcutaneous site is used by insulin pumps to infuse insulin continuously; this site is changed, on average, every three days. The only type of insulin utilized is rapid-acting, and analog insulins have become more widespread than conventional insulin for this application [14]. Compared to MDIs or traditional continuous subcutaneous infusion of insulin, sensoraugmented pump (SAP) therapy, which integrates insulin pump therapy and real-time continuous glycaemic monitoring, has enhanced metabolic control and has lowered the incidence of hypoglycemia in patients having type I diabetes mellitus [15].…”

Section: Insulin Delivery Methodsmentioning

confidence: 99%

A Look Into the Next Century After 100 Years of Insulin

Gupta¹,

Acharya²,

Shukla³

2022

Cureus

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Being diagnosed with diabetes can be challenging, particularly if we do not know a similar individual with the same disease. A person's life may suddenly change and he/she may not be aware of the possibilities or treatment options available or the questions that need to be asked; hence, instead of looking for assistance, many people hide their diabetic condition from others. But due to innovative devices, individuals no longer need to be concerned. Various gadgets today help provision insulin via a subcutaneous route, for example, an insulin pen, pump, vial, or syringe. Despite being the most familiar way to provide insulin, subcutaneous insulin delivery is linked to needle pain, injection anxiety, lipodystrophy, compliance issues, and peripheral hyperinsulinemia; thus, there is a need for an insulin delivery system that is both less invasive and more biological. The discovery of insulin and its uses are linked to the beginning of diabetes treatment. Initially, the delivery of insulin was accomplished using giant, heavy, reusable syringes equipped with plungers, barrels, and wide-bore needles. To prepare these syringes and needles for reuse, these were boiled. The development of insulin syringes, which are presently in use and have revolutionized healthcare, resulted from manufacturers' continued efforts and technological innovations. Injections of insulin may become obsolete if research from the University of Alberta is successful. Researchers from the University of Alberta claim that insulin-producing cells developed from stem cells are secure for transplantation to wean diabetes patients from injectable insulin permanently. In a significant mice experiment, experts demonstrated the role of the inceptor (insulin inhibitory receptor), which protects the beta cells from insulin pathway activation. Insulin resistance in diabetes may be exacerbated by the inceptor's ability to block insulin signaling. Technologies known as "smart insulin" (glucose-responsive insulin) deliver insulin according to the patient's glycemic condition without needing additional monitoring by the patient or the physician in charge. The review of insulin administration devices and several cutting-edge insulin-related ideas are the main topics of this article.

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“…With rapid urbanization and significant changes in lifestyles, diabetes mellitus (DM) rapidly become a global health burden, which impacts approximately 9% of the population worldwide ( Domingo-Lopez et al, 2022 ). The disease is characterized by chronic hyperglycemia due to inadequate insulin secretion or reduced insulin sensitivity ( American Diabetes Association Professional Practice, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Cellular phenotypic transitions in diabetic nephropathy: An update

Cao

Lin²,

Hammes³

et al. 2022

Front. Pharmacol.

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Diabetic nephropathy (DN) is a major cause of morbidity and mortality in diabetes and is the most common cause of end stage renal disease (ESRD). Renal fibrosis is the final pathological change in DN. It is widely believed that cellular phenotypic switching is the cause of renal fibrosis in diabetic nephropathy. Several types of kidney cells undergo activation and differentiation and become reprogrammed to express markers of mesenchymal cells or podocyte-like cells. However, the development of targeted therapy for DN has not yet been identified. Here, we discussed the pathophysiologic changes of DN and delineated the possible origins that contribute to myofibroblasts and podocytes through phenotypic transitions. We also highlight the molecular signaling pathways involved in the phenotypic transition, which would provide valuable information for the activation of phenotypic switching and designing effective therapies for DN.

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Medical devices, smart drug delivery, wearables and technology for the treatment of Diabetes Mellitus

Cited by 48 publications

References 229 publications

Accelerated absorption of regular insulin administered via a vascularizing permeable microchamber implanted subcutaneously in diabeticRattus norvegicus

Accelerated absorption of regular insulin administered via a vascularizing permeable microchamber implanted subcutaneously in diabeticRattus norvegicus

A Look Into the Next Century After 100 Years of Insulin

Cellular phenotypic transitions in diabetic nephropathy: An update

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