Augmenting engraftment of beta cell replacement therapies for T1DM

Aggarwal, Saloni; Pepper, Andrew R.; Jahdhami, Najwa Al

doi:10.1016/j.regen.2021.100058

Cited by 4 publications

(2 citation statements)

References 236 publications

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“…Supporting the glucocentric cause of HAAF, findings in transplant patients indicate that the prolonged, near complete elimination of hypoglycemia, can completely reverse HAAF. Transplantation is therefore a very effective treatment for IAH; however, like any tissue transplant program, both availability of tissues/cells, as well as transplant rejection, are the primary challenges with such approaches ( Aggarwal et al, 2022 ; Opara et al, 2023 ).…”

Section: Impaired Awareness Of Hypoglycemia (Iah) Therapiesmentioning

confidence: 99%

Current and future therapies to treat impaired awareness of hypoglycemia

Macon,

Devore,

Lin

et al. 2023

Front. Pharmacol.

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In order to achieve optimal glycemic control, intensive insulin regimes are needed for individuals with Type 1 Diabetes (T1D) and insulin-dependent Type 2 Diabetes (T2D). Unfortunately, intensive glycemic control often results in insulin-induced hypoglycemia. Moreover, recurrent episodes of hypoglycemia result in both the loss of the characteristic warning symptoms associated with hypoglycemia and an attenuated counterregulatory hormone responses. The blunting of warning symptoms is known as impaired awareness of hypoglycemia (IAH). Together, IAH and the loss of the hormonal response is termed hypoglycemia associated autonomic failure (HAAF). IAH is prevalent in up to 25% in people with T1D and up to 10% in people with T2D. IAH and HAAF increase the risk of severe hypoglycemia 6-fold and 25-fold, respectively. To reduce this risk for severe hypoglycemia, multiple different therapeutic approaches are being explored that could improve awareness of hypoglycemia. Current therapies to improve awareness of hypoglycemia include patient education and psychoeducation, the use of novel glycemic control technology, pancreas/islet transplantation, and drug therapy. This review examines both existing therapies and potential therapies that are in pre-clinical testing. Novel treatments that improve awareness of hypoglycemia, via improving the counterregulatory hormone responses or improving hypoglycemic symptom recognition, would also shed light on the possible neurological mechanisms that lead to the development of IAH. To reduce the risk of severe hypoglycemia in people with diabetes, elucidating the mechanism behind IAH, as well as developing targeted therapies is currently an unmet need for those that suffer from IAH.

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Section: Impaired Awareness Of Hypoglycemia (Iah) Therapiesmentioning

confidence: 99%

Current and future therapies to treat impaired awareness of hypoglycemia

Macon,

Devore,

Lin

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

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“…Proper glucose homeostasis relies on the coordinated function of the liver and pancreas [21]. The pancreas, upon detecting fluctuations in blood glucose, instructs the islets of Langerhans to regulate insulin production, prompting the liver to either reduce or increase glucose release [22][23][24]. Inadequate control of blood glucose levels can lead to severe complications [25].…”

Section: Introductionmentioning

confidence: 99%

Optimizing Blood Glucose Regulation in Type 1 Diabetes Patients via Genetic Algorithm-Based Fuzzy Logic Controller Considering Substantial Meal Protocol

Ndakara Abubakar,

Essabbar,

Saikouk

2024

Int. J. Onl. Eng.

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Effective management of blood glucose levels in individuals with type 1 diabetes, especially after meals, is crucial for diabetes care. Artificial pancreas systems (APS) perform automated insulin delivery in subjects with type 1 diabetes mellitus (T1DM). In this study, an optimized fuzzy logic controller was designed to achieve a euglycemic range after a substantial meal intake. All in silico simulations were performed using the MATLAB/Simulink environment, leveraging control variability grid analysis (CVGA), and the performance of the controller was evaluated. The proposed controller is based on a fuzzy-logic control law designed in three stages. First, a nonlinear framework of the glucose-insulin regulatory system was identified based on the heavy meal protocol of three patients given as follows: for subject ID 117-1, a total of 295 gCHO; for subject ID 126-1, 236 gCHO; and subject ID 128-1, 394 gCHO over a day. Then, an iterative tree structure was employed to establish a stabilizing control rule for insulin delivery, integrating inputs from two Mamdani Fuzzy Inference System (FIS) objects. Finally, a genetic algorithm refines the control system by fine-tuning the uncertainty of the fuzzy membership functions. Two scenarios were considered for three patients to assess the performance of the proposed controller. The results indicated its effectiveness under various conditions, achieving a time in the range of 61.25%, 71% and 61.10% respectively for the three subjects. The obtained results are analyzed and compared with IMC and multi-objective output feedback controllers. The findings of the study reveal that the proposed controller shows promising advancements in tailored strategies for type 1 diabetes patients, outperforming the other controllers in terms of blood glucose regulation.

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