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Insulin Pump Therapy

Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou
Diabetes mellitus is defined by chronic elevation of blood glucose linked to insulin resistance and/or insulinopaenia. Its diagnosis is based on a fasting blood-glucose level of ≥1.26g/L or, in some countries, a blood glycated haemoglobin (HbA1c) level of >6.5%. Of the several forms of diabetes, type-2 diabetes (T2D) is the most common and is found in patients with other risk factors. In contrast, type-1 diabetes (T1D) is linked to the auto-immune destruction of β-pancreatic cells, leading to insulinopaenia...
March 17, 2018: Anaesthesia, Critical Care & Pain Medicine
Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou
In diabetic patients undergoing surgery, we recommend assessing glycaemic control preoperatively by assessing glycated haemoglobin (HbA1c) levels and recent capillary blood sugar (glucose) levels, and to adjust any treatments accordingly before surgery, paying particular attention to specific complications of diabetes. Gastroparesis creates a risk of stasis and aspiration of gastric content at induction of anaesthesia requiring the use of a rapid sequence induction technique. Cardiac involvement can be divided into several types...
March 17, 2018: Anaesthesia, Critical Care & Pain Medicine
Cheisson Gaëlle, Jacqueminet Sophie, Cosson Emmanuel, Ichai Carole, Leguerrier Anne-Marie, Nicolescu-Catargi Bogdan, Ouattara Alexandre, Tauveron Igor, Valensi Paul, Benhamou Dan
Perioperative hyperglycaemia (>1.80g/L or 10 mmol/L) increases morbidity (particularly due to infection) and mortality. Hypoglycaemia can be managed in the perioperative period by decreasing blood sugar levels with insulin between 0.90 and 1.80g/l but it may occur more frequently when the goal is strict normoglycaemia. We propose continuous administration of insulin therapy via an electronic syringe (IVES) in type-1 diabetes (T1D) and type-2 diabetes (T2D) patients if required or in cases of stress hyperglycaemia...
March 16, 2018: Anaesthesia, Critical Care & Pain Medicine
George Grunberger, Yehuda Handelsman, Zachary T Bloomgarden, Vivian A Fonseca, Alan J Garber, Richard A Haas, Victor L Roberts, Guillermo E Umpierrez
This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there are no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician...
March 2018: Endocrine Practice
Frank L Schwartz, Cynthia R Marling, Razvan C Bunescu
Development of truly useful wearable physiologic monitoring devices for use in diabetes management is still in its infancy. From wearable activity monitors such as fitness trackers and smart watches to contact lenses measuring glucose levels in tears, we are just at the threshold of their coming use in medicine. Ultimately, such devices could help to improve the performance of sense-and-respond insulin pumps, illuminate the impact of physical activity on blood glucose levels, and improve patient safety. This is a summary of our experience attempting to use such devices to enhance continuous glucose monitoring-augmented insulin pump therapy...
March 1, 2018: Journal of Diabetes Science and Technology
Özlem Korkmaz, Günay Demir, Hafize Çetin, İlkin Mecidov, Yasemin Atik Altınok, Samim Özen, Şükran Darcan, Damla Gökşen
AIM: To compare continuous subcutaneous insulin infusion therapy (CSII) with multiple daily insulin therapy (MDI) on metabolic control in children and adolescents with type 1 diabetes mellitus (T1DM) over the long term. METHOD: 52 T1DM patients treated with CSII and monitored for at least 1 year prior to and at least five years following CSII were included. 38 age and sex-matched MDI controls with a 5-year follow up were recruited. RESULTS: Mean age of the subjects, duration of diabetes and CSII therapy were 17...
February 28, 2018: Journal of Clinical Research in Pediatric Endocrinology
Zoe A Stewart, Malgorzata E Wilinska, Sara Hartnell, Leanne K O'Neil, Gerry Rayman, Eleanor M Scott, Katharine Barnard, Conor Farrington, Roman Hovorka, Helen R Murphy
OBJECTIVE: Despite advances in technology, optimal glucose control remains elusive and neonatal complications ubiquitous in type 1 diabetes (T1D) pregnancy. Our aim was to examine the safety, efficacy, and longer-term feasibility of day-and-night closed-loop insulin delivery. RESEARCH DESIGN AND METHODS: We recruited 16 pregnant women (mean [SD]: age 32.8 [5.0] years, T1D duration 19.4 [10.2] years, HbA1c 8.0% [1.1%], BMI 26.6 [4.4] kg/m2 ) to an open-label, randomized, crossover trial...
March 13, 2018: Diabetes Care
Anthony Pease, Clement Lo, Arul Earnest, Danny Liew, Sophia Zoungas
BACKGROUND: Technology has been implemented since the 1970s with the hope of improving glycaemic control and reducing the burden of complications for those living with type 1 diabetes. A clinical and cost-effectiveness comparison of all available technologies including continuous subcutaneous insulin infusion (CSII), continuous glucose monitors (CGMs), sensor-augmented pump therapy (including either low-glucose suspend or predictive low-glucose suspend), hybrid closed-loop systems, closed-loop (single-hormone or dual-hormone) systems, flash glucose monitoring (FGM), insulin bolus calculators, and 'smart-device' applications is currently lacking...
March 12, 2018: Systematic Reviews
Johannes M Werzowa, Marcus D Säemann, Alexander Mohl, Michael Bergmann, Christopher C Kaltenecker, Wolfgang Brozek, Andreas Thomas, Michael Haidinger, Marlies Antlanger, Johannes J Kovarik, Chantal Kopecky, Peter X K Song, Klemens Budde, Julio Pascual, Manfred Hecking
Treating hyperglycemia in previously non-diabetic individuals with exogenous insulin immediately after kidney transplantation reduced the odds of developing Posttransplantation Diabetes Mellitus (PTDM) in our previous proof-of-concept clinical trial. We hypothesized that insulin-pump therapy with maximal insulin dosage during the afternoon would improve glycemic control compared to basal insulin and standard-of-care. In a multi-center, randomized, controlled trial testing insulin isophane for PTDM prevention, we added a third study arm applying continuous subcutaneous insulin lispro infusion (CSII) treatment...
2018: PloS One
Pau Herrero, Jorge Bondia, Marga Giménez, Nick Oliver, Pantelis Georgiou
BACKGROUND: People with insulin-dependent diabetes rely on an intensified insulin regimen. Despite several guidelines, they are usually impractical and fall short in achieving optimal glycemic outcomes. In this work, a novel technique for automatic adaptation of the basal insulin profile of people with diabetes on sensor-augmented pump therapy is presented. METHODS: The presented technique is based on a run-to-run control law that overcomes some of the limitations of previously proposed methods...
March 2018: Journal of Diabetes Science and Technology
Giacomo Cappon, Martina Vettoretti, Francesca Marturano, Andrea Facchinetti, Giovanni Sparacino
BACKGROUND: In type 1 diabetes (T1D) therapy, the calculation of the meal insulin bolus is performed according to a standard formula (SF) exploiting carbohydrate intake, carbohydrate-to-insulin ratio, correction factor, insulin on board, and target glucose. Recently, some approaches were proposed to account for preprandial glucose rate of change (ROC) in the SF, including those by Scheiner and by Pettus and Edelman. Here, the aim is to develop a new approach, based on neural networks (NN), to optimize and personalize the bolus calculation using continuous glucose monitoring information and some easily accessible patient parameters...
March 2018: Journal of Diabetes Science and Technology
James Pavela, Rahul Suresh, Rebecca S Blue, Charles H Mathers, L Maria Belalcazar
OBJECTIVE: Individuals with diabetes are increasingly seeking pretravel advice, but updated professional recommendations remain scant. We performed a systematic review on diabetes management during air travel to summarize current recommendations, assess supporting evidence, and identify areas of future research. METHODS: A systematic review of the English literature on diabetes management during air travel was undertaken utilizing PubMed and MEDLINE. Publications regarding general travel advice; adjustment of insulin and noninsulin therapies; and the use of insulin pumps, glucometers and subcutaneous glucose sensors at altitude were included...
February 2018: Endocrine Practice
Thomas Danne, Anke Schwandt, Torben Biester, Bettina Heidtmann, Birgit Rami-Merhar, Holger Haberland, Silvia Müther, Semik Khodaverdi, Thomas Haak, Reinhard W Holl
OBJECTIVE: To examine glycemic control in youth with type 1 diabetes (T1D) who switched from multiple daily injections (MDI) to a tubeless insulin pump (Omnipod ® Insulin Management System, Insulet Corp., Billerica, MA) compared to patients who continued MDI therapy over a 3-year time period. RESEARCH DESIGN AND METHODS: This retrospective analysis of the German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registry included data from 263 centers and 2529 patients <20 years (n=660 tubeless insulin pump; n=1869 MDI) who initiated treatment on a tubeless insulin pump as of January 1, 2013 and had 1 year of data pre-switch from MDI and 3 years of data post-switch to a tubeless pump...
February 15, 2018: Pediatric Diabetes
Xing-Guang Zhang, Yan-Qi Zhang, Qian-Peng Cheng, Yi Cao, Jian-Min Sun, Xiao-Feng Lv
BACKGROUND: The oxidative stress resulting from increased production of ROS plays a crucial role in the development of diabetic complications. We aim to explore the relationships between oxidative stress, diabetic nephropathy (DN) and short-term insulin pump intensive therapy (insulin therapy). METHODS: Levels of 8-hydroxy-deoxyguanosine (8-OHdG), 3-nitrotyrosine (3-NT), glutathione (GSH), superoxide dismutase (SOD) and Interleukin-6 (IL-6) were estimated before and after 2 weeks of insulin therapy in normal group (NC) and type 2 diabetic (DM) with normal albuminuria (NA), microalbuminuria (MA) and clinical albuminuria (CA)...
February 12, 2018: European Journal of Medical Research
Isabella Walter-Höliner, Daniela Seick Barbarini, Jürg Lütschg, Anya Blassnig-Ezeh, Ulrike Zanier, Christoph H Saely, Burkhard Simma
BACKGROUND: In this prospective cohort study, we investigated the prevalence of diabetic peripheral neuropathy at baseline and after five years of follow-up in children and adolescents with type 1 diabetes mellitus using both measurements of nerve conduction velocity and clinical neurological examination. METHODS: A total of 38 patients who underwent insulin pump or intensive insulin therapy were included. The subjects averaged 12.6 ± 2.4 years of age and their diabetes duration averaged 5...
December 13, 2017: Pediatric Neurology
Mark Peyrot, Timothy S Bailey, Belinda P Childs, Gérard Reach
INTRODUCTION: Type 2 diabetes mellitus (T2D) is a growing global epidemic. Due to the progressive nature of the disease, many people with T2D require insulin at some point, most commonly a long-acting (basal) insulin to assist with 24-hour control of glucose levels. OBJECTIVE: This opinion paper provides an overview of considerations for primary care providers (PCPs) in intensifying the treatment regimen when basal insulin therapy is inadequate. RESULTS: Control of mealtime hyperglycemia, in addition to fasting hyperglycemia, has been shown to be crucial in reaching A1c goals of <7...
February 12, 2018: Current Medical Research and Opinion
Rebecka Enander, Peter Adolfsson, Torun Bergdahl, Gun Forsander, Johnny Ludvigsson, Ragnar Hanas
BACKGROUND: Our aim was to see if IV insulin therapy at diagnosis preserves beta-cell function better than multiple subcutaneous injections (SC). METHODS: 54 children 9.9±3.5 years (range 2.8-14.9) without ketoacidosis were included in a 2 year, randomized multicenter study with insulin SC or 48-72 hours IV initially. 33 (61%) were boys, 22 (41%) were pubertal. 48 subjects completed 12 months follow-up and 43 completed 24 months. At 1, 6, 12 and 24 months, HbA1c, C-peptide and insulin/kg/24h were measured...
February 8, 2018: Pediatric Diabetes
Claire Reidy, Mike Bracher, Claire Foster, Ivaylo Vassilev, Anne Rogers
BACKGROUND: Insulin pump therapy (IPT) is a technological advancement that has been developed to help people manage Type 1 diabetes (T1D). However, ways of managing diabetes requiring the implementation of health technologies bring new complexities and a need to understand the factors which enable people with T1D to incorporate a novel device. This new comprehension could provide an exemplar for people with long-term conditions to incorporate new technologies more generally. OBJECTIVE: To determine what influences the incorporation, adaptation and use of IPT into the everyday lives of people living with diabetes...
February 8, 2018: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Snijezana Hasanbegovic, Emina Obarcanin, Edo Hasanbegovic, Nedim Begic
Introduction: Insulin therapy of pediatric patients with type 1 diabetes mellitus (T1DM) is highly demanding due to their dynamic growth, development and different daily life activities. Goal: To determine the optimal insulin delivery method for the prevention of hypoglycemia recorded by continuous monitoring of glucose in patients with insulin pump and PEN. Material and Methods: The study included patients up to 18 years of age with diagnosed T1DM and treated with insulin pump and by insulin therapy with PEN at the Pediatric Clinic of the Clinical Center in Sarajevo...
December 2017: Medical Archives
Clifford J Bailey
This overview considers the opportunities and challenges that face the use of gluco-regulatory peptides to treat type 2 diabetes. New insulin analogues and formulations are being developed with pharmacokinetic properties to speed-up or prolong transfer from a subcutaneous injection site to the target tissues, or to selectively favour effects on the liver. Alternative routes of insulin administration continue to attract attention, and advances in the integration of glucose monitoring with insulin pump devices are improving miniaturised 'closed loop' artificial pancreas systems...
February 2018: Peptides
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