Continuous Insulin Infusion Pump Therapy Research Articles

Increasing the Lifetime of Insulin Cannula with Antifouling and Nitric Oxide Releasing Properties.

Many Type 1 diabetes patients utilize insulin pumps, which rely on a small subcutaneous insulin infusion cannula. However, insulin cannulas still suffer from infection and inflammation, which impacts the wear time of the insulin cannula, reduces the efficiency of insulin infusion, and requires frequent rotation of the insulin infusion site. Infection and inflammation of continuous insulin infusion pump therapy are growing issues and are estimated to cost billions of dollars globally each year. This study aims to develop a potent antibacterial and antifouling insulin cannula with a synergistic effect of bioinspired polymers, integrating antifouling slippery, liquid-infused porous surface technology with an active nitric oxide (NO) releasing polymer. The cannulas were developed by impregnating the NO donor molecule S-nitroso-N-acetylpenicillamine (SNAP) and silicone oil (Si) in commercial medical-grade silicone rubber (SR) tubing (SR-SNAP-Si) via a solvent-impregnation process. The efficiency of the SR-SNAP-Si to reduce protein adsorption and provide antibacterial properties against Staphylococcus aureus and Staphylococcus epidermidis were studied using in vitro bioassays. The SR-SNAP-Si cannula released NO for more than 14 d at physiological levels and were stable during storage for 30 d at room temperature. Scanning electron microscopy images revealed no observable changes to the material surface after the solvent impregnation process. The infusion of silicone oil significantly reduced the protein adsorption on the cannula by 66.40%, and the NO release reduced the viable bacterial cell adhesion of S. epidermidis and S. aureus after 24 h by 94.89% and 99.77%, respectively, as compared to SR controls. This insulin cannula provided continuous NO release and an antifouling interface for more than 14 d and exhibited significant reduction in protein and bacterial adhesion. This method of developing dual-function nitric oxide releasing and antifouling surface for subcutaneous insulin infusion cannulas holds great potential to reduce infection and inflammation associated with insulin pump delivery systems.

Long-term Efficacy of Insulin Pump Therapy in Children with Type 1 Diabetes Mellitus

Objective: Insulin pumps have been well established for insulin delivery. However, questions about long-term efficacy of insulin pump therapy still remain. We evaluated the long-term efficacy of continuous insulin infusion pump therapy (CSII) in pediatric patients with type 1 diabetes mellitus (T1DM).Methods: This was a retrospective observational study which included 131 patients with T1DM who transitioned to an insulin pump from multiple daily insulin (MDI) injections between 1999 and 2009 and were followed by one endocrinologist. Data were collected from 6 months prior to switching to CSII to 30 months after initiation of CSII and included glycated hemoglobin (HbA1c) and insulin requirement. Of the 131 patients, 45 had complete data consisting of a visit and HbA1c every 6 months for 30 months after transition to CSII and were included for analysis. Results: Mean HbA1c prior to starting the CSII was 8.0 +0.9 %, 7.7 +1.0 % at 6 months and 7.8+1.2 % at 1 yr post initiation of CSII. However, at 30 months, HbA1c increased to 8.0+1.3%. A trend in transient improvement in HbA1c was limited only to those patients >11 yr of age and those requiring >0.75 u/kg/day of insulin at transition and was not seen in those <11 yr of age or those requiring <0.75 u/kg/day and did not persist beyond 1 year. Conclusions: There was no long-term significant difference in glycemic control in patients with CSII as compared to MDI. Conflict of interest:None declared.

Mean Glucose Slope – Principal Component Analysis Classification to Detect Insulin Infusion Set Failure

AbstractThe bivariate classification technique using the mean glucose slope (MGS) and the first component of the principal component analysis (PCA), is applied to insulin infusion set failure detection (IISF), a challenging problem faced by individuals with type 1 diabetes that are on continuous insulin infusion pump therapy. The objective of this study was to determine if the proposed approach could be used to distinguish between normal patient data and data from patients under IISF online, in a reasonably short period of time. The proposed approach was applied to simulated glucose concentrations for 10 patients, based on a nonlinear physiological model of insulin and glucose dynamics. Although it presents few false alarms, it was capable of detecting most drifting (ramp) infusion set failures before complete failure occurred.

Cellulitis Caused by Rhizomucor pusillus in a Diabetic Patient Receiving Continuous Insulin Infusion Pump Therapy

We have reported a case of primary cutaneous zygomycosis in a diabetic patient receiving continuous insulin infusion pump therapy. We believe this to be the first reported case of a fungal infection associated with the use of an insulin pump. The infection itself was an unusually mild and chronic zygomycosis, possibly due to a low production rate of proteolytic enzymes by a rare opportunistic human pathogen, Rhizomucor pusillus.