Implantable insulin pumps: an effective option with restricted dissemination

Spaan, Nienke A; Teplova, Alina E; Renard, Éric; Spaan, Jos A. E.

doi:10.1016/s2213-8587(14)70035-x

Cited by 16 publications

(6 citation statements)

References 7 publications

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“…In terms of implementation of AP systems using IP insulin, a current limitation relates to the limited use of intraperitoneal insulin for diabetes therapy . Although the interest of this mode of therapy has been highlighted recently for patients who fail in controlling diabetes with SC insulin, implantable insulin pumps using the IP route and the DiaPort system remain available only in a few European countries. Of note, the second generation of DiaPort which was used in the present study has recently been reported to be associated with less frequent adverse events than that of the first generation .…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control‐based fully‐automated artificial pancreas in patients with type 1 diabetes: a pilot study

Dassau

Renard

Place

et al. 2017

Diabetes Obesity Metabolism

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Aims To compare intraperitoneal (IP) to subcutaneous (SC) insulin delivery in an artificial pancreas (AP). Research design and methods Ten adults with type 1 diabetes participated in a non-randomized, non-blinded sequential AP study using the same SC glucose sensing and Zone Model Predictive Control (ZMPC) algorithm adjusted for insulin clearance. On first admission, subjects underwent closed-loop control with SC delivery of a fast-acting insulin analogue for 24 hours. Following implantation of a DiaPort IP insulin delivery system, the identical 24-hour trial was performed with IP regular insulin delivery. The clinical protocol included 3 unannounced meals with 70, 40 and 70 g carbohydrate, respectively. Primary endpoint was time spent with blood glucose (BG) in the range of 80 to 140 mg/dL (4.4–7.7 mmol/L). Results Percent of time spent within the 80 to 140 mg/dL range was significantly higher for IP delivery than for SC delivery: 39.8 ± 7.6 vs 25.6 ± 13.1 (P = .03). Mean BG (mg/dL) and percent of time spent within the broader 70 to 180 mg/dL range were also significantly better for IP insulin: 151.0 ± 11.0 vs 190.0 ± 31.0 (P = .004) and 65.7 ± 9.2 vs 43.9 ± 14.7 (P = .001), respectively. Superiority of glucose control with IP insulin came from the reduced time spent in hyperglycaemia (>180 mg/dL: 32.4 ± 8.9 vs 53.5 ± 17.4, P = .014; >250 mg/dL: 5.9 ± 5.6 vs 23.0 ± 11.3, P = .0004). Higher daily doses of insulin (IU) were delivered with the IP route (43.7 ± 0.1 vs 32.3 ± 0.1, P < .001) with no increased percent time spent <70 mg/dL (IP: 2.5 ± 2.9 vs SC: 4.1 ± 5.3, P = .42). Conclusions Glycaemic regulation with fully-automated AP delivering IP insulin was superior to that with SC insulin delivery. This pilot study provides proof-of-concept for an AP system combining a ZMPC algorithm with IP insulin delivery.

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Section: Discussionmentioning

confidence: 99%

Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control‐based fully‐automated artificial pancreas in patients with type 1 diabetes: a pilot study

Dassau

Renard

Place

et al. 2017

Diabetes Obesity Metabolism

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“…In this scenario, a catheter-connected MDP can be advantageous. For example, insulin can be infused via a catheter into the intraperitoneal space while implanting the MDP subcutaneously for improved access to the external magnetic device42 (Supplementary Movie 2; Supplementary Table 4). …”

Section: Discussionmentioning

confidence: 99%

Implantable batteryless device for on-demand and pulsatile insulin administration

Lee

Kim

et al. 2017

Nat Commun

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Many implantable systems have been designed for long-term, pulsatile delivery of insulin, but the lifetime of these devices is limited by the need for battery replacement and consequent replacement surgery. Here we propose a batteryless, fully implantable insulin pump that can be actuated by a magnetic field. The pump is prepared by simple-assembly of magnets and constituent units and comprises a drug reservoir and actuator equipped with a plunger and barrel, each assembled with a magnet. The plunger moves to noninvasively infuse insulin only when a magnetic field is applied on the exterior surface of the body. Here we show that the dose is easily controlled by varying the number of magnet applications. Also, pump implantation in diabetic rats results in profiles of insulin concentration and decreased blood glucose levels similar to those observed in rats treated with conventional subcutaneous insulin injections.

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“…Global awareness of this treatment option is low and only a few centres have the expertise to implant and manage CIPII. It is estimated that only 400 patients in total worldwide receive CIPII treatment, with only 50 new individuals considered annually . In the UK, the first Diaport device wasn't implanted until 2015 .…”

Section: Continuous Intraperitoneal Insulin Infusionmentioning

confidence: 99%

Surgical options for glycaemic control in Type 1 diabetes

2019

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In recent years, bariatric surgery, also referred to as metabolic surgery, has become the most successful treatment option in those with Type 2 diabetes and obesity. There are some similarities in the pathological pathways in Type 1 and Type 2 diabetes, but the use of surgery in Type 1 diabetes remains unestablished and controversial. The treatment and management of Type 1 diabetes can be very challenging but recent advances in surgical interventions and technology has the potential to expand and optimize treatment options. This review discusses the current status of some surgical options available to people with Type 1 diabetes. These include implantable continuous glucose monitoring systems, continuous intraperitoneal insulin infusion pumps, closed‐loop insulin delivery systems (also known as the artificial pancreas system) utilizing the latter two modalities of glucose monitoring and insulin delivery, and bariatric or metabolic surgery. Whole pancreas and islet transplantation are beyond the scope of this review but are briefly discussed.

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Implantable insulin pumps: an effective option with restricted dissemination

Cited by 16 publications

References 7 publications

Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control‐based fully‐automated artificial pancreas in patients with type 1 diabetes: a pilot study

Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control‐based fully‐automated artificial pancreas in patients with type 1 diabetes: a pilot study

Implantable batteryless device for on-demand and pulsatile insulin administration

Surgical options for glycaemic control in Type 1 diabetes

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