Effect of Insulin Catheter Wear-Time on Subcutaneous Adipose Tissue Blood Flow and Insulin Absorption in Humans

Clausen, T.; Kaastrup, Peter; Stallknecht, Bente

doi:10.1089/dia.2009.0058

Cited by 35 publications

(46 citation statements)

References 33 publications

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“…These results were generally consistent with the finding that local blood flow at an infusion site increases in the first 3 days (leading to accelerated insulin pharmacokinetics), but decreases after that. 16 Our results agree with the past literature that on average, day 3 is an appropriate recommendation for changing infusion sets, [16][17][18][19][20] although individual variations exist.…”

Section: Discussionsupporting

confidence: 92%

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Duration of Infusion Set Survival in Lipohypertrophy Versus Nonlipohypertrophied Tissue in Patients with Type 1 Diabetes

Karlin

Pyle

et al. 2016

Diabetes Technology & Therapeutics

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Background: Improved insulin infusion set survival and faster insulin action are important issues for pump users and for the development of an artificial pancreas. The current recommendation is to change infusion sets every 3 days. Our objectives were to determine the effect of lipohypertrophy (LH) on infusion set survival and continuous glucose monitoring glucose levels. Research Design and Methods: In this multicenter crossover trial, we recruited 20 subjects (age 28.1 -9.0 years) with type 1 diabetes (duration 17.5 -8.8 years) and an area of lipohypertrophied tissue >3 cm. Subjects alternated weekly wearing a Teflon infusion set in an area of either LH or non-LH for 4 weeks. Sets were changed after (a) failure or (b) surviving 7 days of use. Results: The least-squares mean duration of infusion set survival for sets that lasted <7 days in lipohypertrophied tissue was 4.31 days compared with 4.12 days in nonlipohypertrophied tissue (P = 0.71). The average duration of set survival for individual subjects ranged from 2.2 to 7.0 days. Infusion sets in lipohypertrophied tissue failed due to hyperglycemia in 35% of subjects compared with 23% in nonlipohypertrophied tissue (P = 0.22). Both lipohypertrophied and nonlipohypertrophied tissues displayed a general increase in mean daily glucose after the third day of infusion set wear, but daily mean glucose did not differ by tissue type (P > 0.38 on each day). Conclusion: LH did not significantly affect infusion set survival or mean glucose. Achieving optimal infusion set performance requires research into factors affecting set survival. Additionally, the recommendation for duration of set change may need to be individualized.

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Section: Discussionsupporting

confidence: 92%

“…17 Additionally, mean daily blood glucose has been documented to increase with the number of days of infusion set use. [16][17][18][19][20] We have found that there is considerable variability in the duration of set survival for individual subjects in this study (Fig. 1B).…”

Section: Discussionmentioning

confidence: 96%

Duration of Infusion Set Survival in Lipohypertrophy Versus Nonlipohypertrophied Tissue in Patients with Type 1 Diabetes

Karlin

Pyle

et al. 2016

Diabetes Technology & Therapeutics

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“…There was no single specific event related to an extended catheter use but events of all kinds and nature occurred after day 3, including but not limited to pulling out, kinking, adhesive getting loose, leakage of insulin from the infusion set or the infusion site, and signals of skin irritation, such as bruising, redness, or swelling. Even when the patients locally tolerated a longer use of the infusion sets at the infusion site for up to 7 days, there appeared to be changes in the insulin absorption leading to a slow but steady loss in glycemic control with increased duration of use, as indicated by a steady increase in mean daily blood glucose concentrations, which is in line with a most recent observational study by Perrin et al 11,12 In general, potential problems that may occur in adult and adolescent patients when using the infusion sets longer than the recommended 48-72 hours may be technical problems, such as catheter occlusions or kinking, 13,14 bacterial contaminations leading to skin inflammation, [15][16][17] potential changes in physicochemical delivery characteristics, 18,19 and local skin reactions to the adhesive, resulting in redness, itching, and other symptoms of skin irritation. 12 The purpose of this study was to evaluate the safety and efficacy of using infusion sets for 2 days versus 4 days during a period of 3 months each in a prospective and randomized crossover protocol in patients with type 1 diabetes.…”

supporting

confidence: 72%

Using Insulin Infusion Sets in CSII for Longer Than the Recommended Usage Time Leads to a High Risk for Adverse Events

Pfützner¹,

Sachsenheimer²,

Grenningloh

et al. 2015

J Diabetes Sci Technol

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Background: Infusion sets for use with insulin pumps are recommended for use for 2 to 3 days to avoid local skin reactions, for example, to the insulin formulation and preservatives like meta-cresol. However, many patients use the catheters longer for economic reasons. We performed this study to investigate the tolerability of 2-day use of infusion sets in comparison to 4-day use in a real-world setting. Methods: This prospective randomized controlled crossover study with 2 × 3-month observation periods was performed with 24 type 1 patients. At baseline, patients were trained on the use of the infusion system (Medtronic /Mio® or inset™ II) and randomized to any of the 2 treatment sequences. Observation parameters included glycemic control, frequency and nature of device-related, and procedure-related adverse events and patient preference. Results: The per-protocol analysis was performed with 22 patients (5 men, 17 women, age 39 ± 11 years, BMI 27.0 ± 3.5 kg/m2). The number of catheter related adverse events was 290 with 2-day use versus 495 with 4-day use ( P < .05). The overall number of treatment related events was 750 with 2-day use versus 934 with 4-day use ( P < .001). There was no difference in glycemic control between the treatment arms. Treatment satisfaction was higher with 2-day use (very high/high satisfaction: 90.4% versus 4 day-use: 77.3%, P < .05). Conclusion: Our results demonstrate that using the infusion sets for a longer usage period of 2-3 days resulted in a clinically relevant increase in treatment-related tolerability problems. Patients should be trained and encouraged not to use insulin pump infusion sets for a longer than the recommended time period.

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“…9,10 While the cause for this effect was not determined, we speculated that increased blood flow and/or foreign body reaction might be playing a role. More recently, Clausen and colleagues 11 demonstrated such an increase in blood flow around the insulin infusion site from day 1 until day 4 in healthy adults. Techniques mimicking the changes in the aged infusion site to increase insulin absorption and action without adverse effects will be ideal options to generate a UFI profile.…”

Section: Advances In Insulin Therapy: Introduction Of Rapid-acting Inmentioning

confidence: 94%

Undeniable Need for Ultrafast-Acting Insulin: The Pediatric Perspective

Cengiz

2012

J Diabetes Sci Technol

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Insulin therapy in youth with type 1 diabetes mellitus (T1DM) poses a special challenge because childhood is an unsteady state with increasing weight, height, and caloric needs, leading to varying insulin requirements. The current rapid-acting insulin analogs are not as fast and short-acting as needed to meet these challenges. This review describes the unique characteristics of insulin action in youth with T1DM based on previously published euglycemic clamp studies. It also explains the rationale behind the need for ultrafast-acting insulins to advance open-and closed-loop insulin therapy for the pediatric population with diabetes. Lastly, it briefly summarizes ongoing and future projects to accelerate insulin action in youth with T1DM.

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Effect of Insulin Catheter Wear-Time on Subcutaneous Adipose Tissue Blood Flow and Insulin Absorption in Humans

Abstract: Insertion of a Teflon insulin catheter into the SAT results in increased ATBF and faster absorption of insulin aspart in a period of 4 days without any change in the total amount of insulin aspart absorbed.

Cited by 35 publications

References 33 publications

Duration of Infusion Set Survival in Lipohypertrophy Versus Nonlipohypertrophied Tissue in Patients with Type 1 Diabetes

Duration of Infusion Set Survival in Lipohypertrophy Versus Nonlipohypertrophied Tissue in Patients with Type 1 Diabetes

Using Insulin Infusion Sets in CSII for Longer Than the Recommended Usage Time Leads to a High Risk for Adverse Events

Undeniable Need for Ultrafast-Acting Insulin: The Pediatric Perspective

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