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Insulin pump

G Todd Alonso, Raquel Hink, Michael R De Georgeo, Katherine Vidal, Sarah Thomas, David Swaschnig, Gail Spiegel, Susan Owen, Jessica Thurston, Laura Pyle, Robert Slover
CONTEXT: Our pediatric diabetes center initiated insulin pump therapy for more than 250 patients with type 1 diabetes in 2014, but onboarding was inefficient. OBJECTIVE: To decrease time from the decision to initiate pump therapy to the ambulatory encounter after pump start (lead time) for new pump users from 132.5 days to less than 110 days within 5 months. DESIGN: Define, Measure, Analyze, Improve, Control method. We identified key problems: Long wait for training classes, unclear metrics, complicated scheduling, and nonstandardized processes...
July 12, 2018: Permanente Journal
Ulrike Kamecke, Delia Waldenmaier, Cornelia Haug, Ralph Ziegler, Guido Freckmann
BACKGROUND: Adequate testing of delivery accuracy of insulin pumps is under discussion. Especially for patch pumps, test settings are challenging. In addition, evaluation and presentation of accuracy results in a way that is reasonable and useful for clinicians, not only for technicians, is important. METHODS: Test setups based on IEC 60601-2-24 were used and, in addition, different setups for patch pumps were compared to identify an adequate alternative for pumps without external infusion set...
July 1, 2018: Journal of Diabetes Science and Technology
Delia Waldenmaier, Eva Zschornack, Lucas Kalt, Andreas Buhr, Stefan Pleus, Cornelia Haug, Guido Freckmann
INTRODUCTION: A new insulin pump system was tested under everyday conditions for user evaluation and safety assessment prior to its launch in Europe. This insulin pump is focused on easy handling and uses prefilled cartridges. METHODS: The pump system was used by 35 adult subjects with type 1 diabetes, experienced in insulin pump therapy, under everyday conditions for approximately one month each. All subjects rated various aspects of the system after home use; technical issues and safety parameters were assessed throughout the study...
July 1, 2018: Journal of Diabetes Science and Technology
Ricardo Sánchez-Peña, Patricio Colmegna, Fabricio Garelli, Hernán De Battista, Demián García-Violini, Marcela Moscoso-Vásquez, Nicolás Rosales, Emilia Fushimi, Enrique Campos-Náñez, Marc Breton, Valeria Beruto, Paula Scibona, Cintia Rodriguez, Javier Giunta, Ventura Simonovich, Waldo H Belloso, Daniel Cherñavvsky, Luis Grosembacher
BACKGROUND: Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial...
July 1, 2018: Journal of Diabetes Science and Technology
Anna R Kahkoska, Madison E Watts, Kimberly A Driscoll, Franziska K Bishop, Paul Mihas, Joan Thomas, Jennifer R Law, Nina Jain, Elizabeth J Mayer-Davis
Aims: No current clinical guidelines focus on weight management in youth with type 1 diabetes mellitus (T1DM). Our aim was to characterize the patient-perceived experience and barriers to weight management in youth with T1DM. Methods: Participants were recruited from the University of North Carolina (n = 16, 56% female, 60% White, 50% insulin pump users, mean age 14.8 years, mean HbA1c 8.5% (69 mmol/mol)) and the University of Colorado (n = 18, 50% female, 80% white, 53% pump users, mean age 15...
March 2018: Obesity medicine
Marc D Breton, Stephen D Patek, Dayu Lv, Elaine Schertz, Jessica Robic, Jennifer Pinnata, Laura Kollar, Charlotte Barnett, Christian Wakeman, Mary Oliveri, Chiara Fabris, Daniel Chernavvsky, Boris P Kovatchev, Stacey M Anderson
BACKGROUND: Glucose variability (GV) remains a key limiting factor in the success of diabetes management. While new technologies, for example, accurate continuous glucose monitoring (CGM) and connected insulin delivery devices, are now available, current treatment standards fail to leverage the wealth of information generated. Expert systems, from automated insulin delivery to advisory systems, are a key missing element to richer, more personalized, glucose management in diabetes. METHODS: Twenty four subjects with type 1 diabetes mellitus (T1DM), 15 women, 37 ± 11 years of age, hemoglobin A1c 7...
July 6, 2018: Diabetes Technology & Therapeutics
Abigayle Davis, Jolly Kuriakose, Jennifer N Clements
Since the approval of bolus insulin, it has been used frequently in clinical practice for the management of type 1 and 2 diabetes mellitus for postprandial control. Another new product is faster insulin aspart (Fiasp, Novo Nordisk), a fast-acting insulin with 100 units/mL. Several studies have been conducted evaluating the pharmacokinetics and pharmacodynamics of faster insulin aspart, compared with insulin aspart. This new bolus insulin provides greater glucose-lowering effect at 20 min, following subcutaneous administration...
July 6, 2018: Clinical Pharmacokinetics
Bartłomiej Matejko, Aneta Kukułka, Beata Kieć-Wilk, Agnieszka Stąpór, Tomasz Klupa, Maciej T Malecki
Introduction: Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. The recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control. Materials and Methods: We included 260 consecutive patients with T1DM (159 women and 101 men) treated with continuous subcutaneous insulin infusion at the Department of Metabolic Diseases, Krakow, Poland...
2018: Advances in Medicine
Beat Knechtle, Pantelis T Nikolaidis
Ultramarathon with Type 1 Diabetes Abstract. We report the case of a 63-year-old runner with type 1 diabetes mellitus requiring insulin since the age of 21. At the age of 32, he ran his first marathon, and at the age of 34 the first ultramarathon. So far, he has finished more than 90 marathons and ultramarathons. Thanks to an insulin pump and continuous glucose monitoring, he has so far completed 48 24-h-runs with an average distance of 133 km. The analysis of running volume and HbA1c values showed a significant increase in monthly exercise volume, a significant decrease in HbA1c values over the years, and a significant correlation between monthly running kilometers and HbA1c values...
July 2018: Praxis
Jordan E Pinsker, Alejandro J Laguna Sanz, Joon Bok Lee, Mei Mei Church, Camille Andre, Laura E Lindsey, Francis J Doyle, Eyal Dassau
BACKGROUND: We investigated the safety and efficacy of the addition of a trust index to enhanced Model Predictive Control (eMPC) Artificial Pancreas (AP) that works by adjusting the responsiveness of the controller's insulin delivery based on the confidence intervals around predictions of glucose trends. This constitutes a dynamic adaptation of the controller's parameters in contrast with the widespread AP implementation of individualized fixed controller tuning. MATERIALS AND METHODS: After 1 week of sensor-augmented pump (SAP) use, subjects completed a 48-h AP admission that included three meals/day (carbohydrate range 29-57 g/meal), a 1-h unannounced brisk walk, and two overnight periods...
July 2018: Diabetes Technology & Therapeutics
Susanna Esposito, Elisa Santi, Giulia Mancini, Francesco Rogari, Giorgia Tascini, Giada Toni, Alberto Argentiero, Maria Giulia Berioli
BACKGROUND: Type 1 diabetes (DM1) is one of the most common chronic diseases in childhood and requires life-long insulin therapy and continuous health care support. An artificial pancreas (AP) or closed-loop system (CLS) have been developed with the aim of improving metabolic control without increasing the risk of hypoglycaemia in patients with DM1. As the impact of APs have been studied mainly in adults, the aim of this review is to evaluate the efficacy and safety of the AP in the paediatric population with DM1...
June 28, 2018: Journal of Translational Medicine
P Balseiro, Ø Moe, I Gamlem, M Shimizu, H Sveier, T O Nilsen, N Kaneko, L Ebbesson, C Pedrosa, V Tronci, A Nylund, S O Handeland
The use of closed containment (CCS) or semi-closed containment systems (S-CCS) for Atlantic salmon Salmo salar aquaculture is under evaluation in Norway. One such system is the Preline S-CCS, a floating raceway system that pumps water from 35 meters depth creating a constant current through the system. Exposing fish to moderate water currents is considered aerobic exercise and it is often perceived as positive for fish welfare, growth, food utilization, muscle development and cardiac health. The present study compared fish reared in the Preline S-CCS and in a reference open pen...
June 28, 2018: Journal of Fish Biology
Martin Tauschmann, Roman Hovorka
Type 1 diabetes mellitus (T1DM) represents 5-10% of diabetes cases worldwide. The incidence of T1DM is increasing, and there is no immediate prospect of a cure. As such, lifelong management is required, the burden of which is being eased by novel treatment modalities, particularly from the field of diabetes technologies. Continuous glucose monitoring has become the standard of care and includes factory-calibrated subcutaneous glucose monitoring and long-term implantable glucose sensing. In addition, considerable progress has been made in technology-enabled glucose-responsive insulin delivery...
June 26, 2018: Nature Reviews. Endocrinology
Andrew Ziegler, Timothy Williams, Nicole Yarid, Daniel L Schultz, Elizabeth A Bundock
Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA)...
June 25, 2018: Journal of Forensic Sciences
Petros Thomakos, Andriani Vazeou, Dimitris Sakkas, Georgios Panagopoulos, Kostas Anifantakis, Penelope Smyrnaki, Theodosia Arvanitaki, Euridiki Kyrlaki, Nikolaos Kefalogiannis, Dimitris Mamoulakis, Aggelos Pappas, Asimina Mitrakou
Background: Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring Systems (CGMS) have been proven very effective in diabetes management. Aim: This study evaluated the usefulness of these devices during prolonged, intense physical activity in an uncontrolled natural environment away from the clinical research center. Design: Non-randomized, prospective, observational study. Methods: During the summer thirty-eight participants with Type 1 Diabetes crossed the Samaria gorge, the 2nd largest gorge in Europe (17 km)...
June 23, 2018: QJM: Monthly Journal of the Association of Physicians
Guillermo E Umpierrez, David C Klonoff
The use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems has gained wide acceptance in diabetes care. These devices have been demonstrated to be clinically valuable, improving glycemic control and reducing risks of hypoglycemia in ambulatory patients with type 1 diabetes and type 2 diabetes. Approximately 30-40% of patients with type 1 diabetes and an increasing number of insulin-requiring patients with type 2 diabetes are using pump and sensor technology. As the popularity of these devices increases, it becomes very likely that hospital health care providers will face the need to manage the inpatient care of patients under insulin pump therapy and CGM...
June 23, 2018: Diabetes Care
Sathya Krishnasamy, Thomas L Abell
This article is a comprehensive review of diabetic gastroparesis, defined as delayed or disordered gastric emptying, including basic principles and current trends in management. This review includes sections on anatomy and physiology, diagnosis and differential diagnosis as well as management and current guidelines for treatment of diabetic gastroparesis. Diabetic gastroparesis (DGp) is a component of autonomic neuropathy resulting from long-standing poorly controlled type 1 and type 2 diabetes. The diagnostic workup of DGp first excludes obstruction and other causes including medications that may mimic delayed/disordered gastric emptying...
June 22, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
F F Zhao, T Y Wu, H Zhang, J J Loor, M Z Wang, A L Peng, H R Wang
The main purpose of this work was to evaluate the effects of jugular L-arginine infusion on antioxidant mechanisms in lactating dairy cows challenged intravenously with lipopolysaccharide (LPS). Eight multiparous Holstein cows (609 ± 32 kg) at mid-lactation were randomly assigned to 5-d jugular infusions of Control (saline), Arginine (Arg, 18 g/d), LPS (0.2 μg/kg BW per d), and LPS + Arginine (0.2 μg/kg BW per d of LPS and 18 g/d of Arg) in a replicated 4 4 Latin square design with 4 infusion periods separated by 10-d...
June 20, 2018: Journal of Animal Science
Sultan Aldebeyan, Ahmed Aoude, Edward J Harvey
Over the past few decades, sensors have been gaining a lot of popularity in the medical field. These sensors have helped shift the paradigm in medicine from having things done manually to digitalizing them. In the medical field, sensors have been manufactured in different forms and shapes including wearable and implantable wireless devices. With the aid of these sensors, healthcare professionals hope to revolutionize the system in a cost-effective way. In fact, this is already evident in most healthcare systems with the use of sensors for blood pressure, oxygen saturation, and arrhythmias on a daily basis...
June 2018: Injury
Daniel J DeSalvo, Kellee M Miller, Julia M Hermann, David M Maahs, Sabine E Hofer, Mark A Clements, Eggert Lilienthal, Jennifer L Sherr, Martin Tauschmann, Reinhard W Holl
BACKGROUND: To assess change in rates of pediatric real time or intermittent scanning CGM use over the past 5 years, and how it impacts glycemic control, data from 2 registries were compared: the US-based T1DX and the German/Austrian DPV. METHODS: Registry participants aged <18 years with T1D duration ≥ 1 year encompassed 29,007 individuals in 2011 and 29,150 participants in 2016. Demographic data, CGM use and HbA1c were obtained from medical records. RESULTS: CGM use increased from 2011 to 2016 in both registries across all age groups, regardless of gender, ethnic minority status or insulin delivery method...
June 20, 2018: Pediatric Diabetes
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