Insulin detection in diabetes mellitus: challenges and new prospects

Abstract

Tremendous progress has been made towards achieving tight glycaemic control in individuals with diabetes mellitus through the use of frequent or continuous glucose measurements. However, in patients who require insulin, accurate dosing must consider multiple factors that affect insulin sensitivity and modulate insulin bolus needs. Accordingly, an urgent need exists for frequent and real-time insulin measurements to closely track the dynamic blood concentration of insulin during insulin therapy and guide optimal insulin dosing. Nevertheless, traditional centralized insulin testing cannot offer timely measurements, which are essential to achieving this goal. This Perspective discusses the advances and challenges in moving insulin assays from traditional laboratory-based assays to frequent and continuous measurements in decentralized (point-of-care and home) settings. Technologies that hold promise for insulin testing using disposable test strips, mobile systems and wearable real-time insulin-sensing devices are discussed. We also consider future prospects for continuous insulin monitoring and for fully integrated multisensor-guided closed-loop artificial pancreas systems.

The Minimally-Invasive Oral Glucose Minimal Model: Estimation of Gastric Retention, Glucose Rate of Appearance, and Insulin Sensitivity From Type 1 Diabetes Data Collected in Real-Life Conditions

“…We believe that the performance of MI-OMM could greatly improve if the model was fed with the data collected with such devices. Furthermore, with the advent of real-time insulin sensors [ 38 ], [ 39 ], [ 40 ], the complexity of the MI-OMM could be reduced by eliminating, in part or completely, the insulin subsystem ( Section II-C1 ) and using measurements from the insulin sensors instead. In addition to that, the direct measurement of plasma insulin would allow for the identification of the MI-OMM in subjects with T2D, without the need to extend the already-complex MI-OMM with a submodel for insulin secretion, which may be a rather challenging task.…”

Adoption of Wearable Insulin Biosensors for Diabetes Management: A Cross-Sectional Study

“…These devices can communicate wirelessly with a user's smartphone, providing real-time data and alerts, and allowing for remote monitoring and adjustments by healthcare providers and caregivers [ 14 , 15 ]. The potential advantages of wearable insulin biosensors are numerous [ 16 - 20 ].…”

Clinical Endocrinology—Time for a Reset?

“…Technology has now moved on, most particularly via dramatic developments in wearable sensor technology. The potential power of these sensors is clearly illustrated by the revolution taking place in diabetes mellitus, where the use of continuous glucose monitors can provide a high level of personalized precision medicine advancing the single hemoglobin A1c determination to complex glucose profiles with analysis of “time in range.” A sensor device for insulin measurements would further improve the indices for exogenous insulin administration [ 4 ]. This knowledge of dynamic changes in glucose across the day can not only improve blood sugar control but also empower patients to understand and improve their disease management.…”