Insulin therapy development beyond 100 years.

The first insulin preparation capable of consistently lowering blood glucose was developed in 1921. But 100 years later, blood glucose control with insulin in people with diabetes is nearly universally suboptimal, with essentially the same molecule still delivered by the same inappropriate subcutaneous injection route. Bypassing this route with oral administration appears to have become technologically feasible, accelerating over the past 50 years, either with packaged insulin peptides or by chemical insulin mimetics. Some of the problems of prospective unregulated absorption of insulin into the circulation from subcutaneous depots might be overcome with glucose-responsive insulins. Approaches to these problems could be modification of the peptide by adducts, or the use of nanoparticles or insulin patches, which deliver insulin according to glucose concentration. Some attention has been paid to targeting insulin preferentially to different organs, either by molecular engineering of insulin, or with adducts. But all these approaches still have problems in even beginning to match the responsiveness of physiological insulin delivery to metabolic requirements, both prandially and basally. As would be expected, for all these technically complex approaches, many examples of abandoned development can be found. Meanwhile, it is becoming possible to change the duration of action of subcutaneous injected insulin analogues to act even more rapidly for meals, and towards weekly insulin for basal administration. The state of the art of all these approaches, and the barriers to success, are reviewed here.

Psychosocial aspects of diabetes technology.

AIM: To identify key psychosocial research in the domain of diabetes technology. RESULTS: Four trajectories of psychosocial diabetes technology research are identified that characterize research over the past 25 years. Key evidence is reviewed on psychosocial outcomes of technology use as well as psychosocial barriers and facilitating conditions of diabetes technology uptake. Psychosocial interventions that address modifiable barriers and psychosocial factors have proven to be effective in improving glycaemic and self-reported outcomes in diabetes technology users. CONCLUSIONS: Psychosocial diabetes technology research is essential for designing interventions and education programmes targeting the person with diabetes to facilitate optimized outcomes associated with technology uptake. Psychosocial aspects of diabetes technology use and related research will be even more important in the future given the advent of systems for automated insulin delivery and the increasingly widespread digitalization of diabetes care.

Diabetes Technology Use in Adults with Type 1 and Type 2 Diabetes.

In the last 2 decades, diabetes technology has emerged as a branch of diabetes management thanks to the advent of continuous glucose monitoring (CGM) and increased availability of continuous subcutaneous insulin infusion systems, or insulin pumps. These tools have progressed from rudimentary instruments to sophisticated therapeutic options for advanced diabetes management. This article discusses the available CGM and insulin pump systems and the clinical benefits of their use in adults with type 1 diabetes, intensively insulin-treated type 2 diabetes, and pregnant patients with preexisting diabetes.

Do-It-Yourself Artificial Pancreas System and the OpenAPS Movement.

People with diabetes have been experimenting with and modifying their own diabetes devices and technologies for many decades in order to achieve the best possible quality of life and improving their long-term outcomes, including do-it-yourself (DIY) closed loop systems. Thousands of individuals use DIY closed loop systems globally, which work similarly to commercial systems by automatically adjusting and controlling insulin dosing, but are different in terms of transparency, access, customization, and usability. Initial outcomes seen by the DIY artificial pancreas system community are positive, and randomized controlled trials are forthcoming on various elements of DIYAPS technology.

Diabetes Technology in the Inpatient Setting for Management of Hyperglycemia.

In past decades, a rapid evolution of diabetes technology led to increased popularity and use of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) in the ambulatory setting for diabetes management, and recently, the artificial pancreas became available. Efforts to translate this technology to the hospital setting have shown accuracy and reliability of CGM, safety of CSII in appropriate populations, improvement of inpatient glycemic control with computerized glycemic management systems, and feasibility of inpatient CGM-CSII closed-loop systems. Several ongoing studies are focusing on continued translation of this technology to improve glycemic control and outcomes in hospitalized patients.

Banting Memorial Lecture 2014* Technology and diabetes care: appropriate and personalized.

Continuous subcutaneous insulin infusion was initially developed as a research procedure in the 1970s but quickly became a routine treatment for selected people with Type 1 diabetes. Continuous subcutaneous insulin infusion and other diabetes technologies, such as continuous glucose monitoring, are now an established and evidence-based part of diabetes care, but there has been some confusion about effectiveness and best use, particularly because of conflicting results from meta-analyses. This is because literature summary meta-analyses (including all trials) are inappropriate for therapeutic and economic decision-making; such meta-analyses should only include trials representative of groups likely to benefit. For example, for continuous subcutaneous insulin infusion, this would be those with continued disabling hypoglycaemia or elevated HbA1c levels. Alternatively, individual patient data meta-analysis allows modelling of covariates that determine effect size, e.g. in the case of continuous glucose monitoring, baseline HbA1c and frequency of sensor usage. Diabetes technology is therefore an example of personalized medicine, where evaluation and use should be both appropriate and targeted. This will also apply to future technologies such as new 'patch' pumps for Type 2 diabetes, closed-loop insulin delivery systems and nanomedicine applications in diabetes that we are currently researching. These include fluorescence lifetime-based non-invasive glucose monitoring and nanoencapsulation of islets for improved post-transplant survival.

Managing type 1 diabetes ­ a journey from starvation to insulin pump.

With the discovery of insulin in 1921, hopes were high that type 1 diabetes mellitus would soon be cured. However, this goal has remained elusive. Nevertheless, technological advances have improved the management of diabetes and the quality of life of patients with diabetes. One of these advances has been the development of the insulin pump. This article reviews the development of insulin pumps and outlines the advantages and disadvantages of insulin pumps currently available.

Insulin delivery device technology 2012: where are we after 90 years?

Since the first successful use of insulin in 1921 to treat diabetes at Toronto General Hospital, the major advances in development of the medication itself have taken place in parallel with equally significant developments in the means of delivery. Administration of insulin remains parenteral. This article reviews the main variants in prescription-available delivery technology: vial and syringe, pen injector, needle-free injection, and continuous subcutaneous insulin infusion pumps. For each of these, the background and major milestones are covered briefly and followed by a discussion of the latest product innovations, technologies, and implementations, which are all considered in the context of the interaction with users. The article concludes by reflecting upon how the progress in the technology of diabetes management can best serve the patient. The spectacular technological advances in medication, monitoring, and delivery since 1922 have transformed the lives of millions. However, the fact that we can add sophisticated technology to delivery devices and accessories does not mean it is always the best thing for the patient. Electronic sophistication may be welcomed by a young, eager type 1 diabetes patient, while a senior citizen who discovers he has type 2 diabetes may yearn for simplicity. Technology continues to provide great solutions, but the type of solution delivered must be matched to the user if the maximum benefit is to be achieved for all.

Continuous insulin infusion systems in type 2 diabetes.

There are various delivery devices available for insulin like syringes, pens, and insulin pumps. Syringes have drawbacks like dosage errors and pain. Insulin pumps can be useful to mimic the physiological insulin secretion. Though the insulin pumps are launched in India a decade ago, they are not popular due to high price and thus there is limited experience and queries with its use. Use of insulin pumps can improve the quality of life for diabetic patients. Available evidence from recent studies is a compelling indication and not to deny the never before discovered benefits of continuous subcutaneous insulin infusion (CSII) in selective patients with type 2 diabetes mellitus. Pumps with continuous glucose monitoring (CGM) system helps as a therapeutic option enabling diabetic patients to restructure lifestyles based on glycemic patterns.

Terapia com bomba de insulina no tratamento do diabetes tipo 1 / Insulin pump therapy in type 1 diabetes treatment

A evolução tecnológica proporciona o surgimento de novas formas de aplicação da insulina, na busca de maior conforto e comodidade para os pacientes, permitindo o controle adequado da glicemia e a redução das complicações em curto e longo prazo. A terapia com bomba de insulina está cada vez mais disseminada em todo o mundo, trazendo maior conforto e comodidade aos pacientes. Está associada à melhora do controle metabólico, maior aceitação da doença, menor risco de crises hipoglicêmicas, maior segurança de dose, maior facilidade de uso e à melhora da qualidade de vida dessa população. Os autores revisam a literatura médica quanto aos impactos do uso da bomba de insulina em relação à terapia convencional com seringas, no tratamento do diabetes mellitus tipo 1, entre 1992 e 2002. As bases de dados utilizadas foram MEDLINE e LILACS. Objetiva-se contribuir para o maior conhecimento dos aspectos farmacológicos, clínicos, indicações, vantagens e desvantagens da terapia com bomba de insulina em relação à terapia convencional com seringas no tratamento do diabetes mellitus tipo 1.

The new technology bring to us different kinds of insulin administration trying to improve the diabetics patients lives and reduce the risks of short and long term complications, such insulin pump therapy. The use of insulin pump therapy is desseminated all over the world. The most studies showed that this method is related to more comfort and commodity. It is associated to better glycemic control, it is more acceptable and it is related to reduce of hypoglycemic crisis. The use of insulin pump proportionate a better quality of live in this group of patients. This study results from a publication review about insulin pump therapy in type 1 diabetes from 1992 to 2002. This review is based on MEDLINE and LILLACS sites. The aim of this study is to promote the diffusion of the knowledge of the pharmalological, clinical, indications, advantages and disadvantages of insulin pump therapy versus insulin syringes in treatment of children and adolescents with type 1 diabetes.