Subcutaneous Insulin Infusion Research Articles

Basal and Bolus Insulin Distribution According to Treatment Modality: Data from SWEET Diabetes Registry

Background and Aims. The optimal basal and bolus insulin distribution in type 1 diabetes (T1D) is still controversial. Herein, we aimed to determine the variability of basal to total daily insulin dose according to treatment modality and diabetes technologies from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Methods. The study cohort was generated by using the SWEET database. Patients with T1D for at least 2 years, aged between 2.5 and 18 years, with at least one clinic visit between June 2010 and June 2021, were included in the study. Four groups were composed according to treatment modality as follows: multiple daily injections (MDI) without continuous glucose monitoring (CGM); MDI with CGM; subcutaneous insulin infusion (CSII) without CGM; and CSII with CGM. Data of the participants were analyzed and compared for each treatment modality separately. Results. A total of 38,956 children and adolescents were included in the study. Of the study sample, 48.6% were female, the median (range) age was 15.2 (11.9–17.2) years, and the median diabetes duration was 6.0 (3.8–9.0) years. The distribution of treatment modality was as follows: MDI without CGM, 32.9%; MDI with CGM, 18.0%; CSII without CGM, 11.7%; and CSII with CGM, 37.3%. In unadjusted data, regardless of treatment modality, all the analyses revealed a significant association between basal dose to total daily insulin dose (BD/TDD) with male gender, younger age group, and lower HbA1c, which were all related to a decreased ratio of BD/TDD (all p < 0.05 ). There was no association between BD/TDD and different diabetes technologies after the age, gender, and diabetes duration were adjusted. Conclusions. Herein, we showed that there was an association between lower proportions of basal to total insulin and lower hemoglobin A1c in a large cross-sectional cohort of children who had T1D. There was also an association between lower BD/TDD and younger age. There was no significant difference between BD/TDD ratios under different diabetes technologies (CGM and/or CSII).

A Digital Glucose Control Strategy via Subcutaneous Insulin Infusion

In this paper, the plasma glucose regulation problem for Type 2 diabetic patients by subcutaneous insulin infusion is studied. A nonlinear time-delay model of the glucose-insulin regulatory system, which takes into account the subcutaneous infusion of insulin, is exploited for the design of a quantized sampled-data static state feedback glucose controller. Quantization in both input/output channels is considered. Spline interpolation methodologies are used in order to obtain an approximation of suitable needed past values of the system state that cannot be always available from the buffer. The stabilization in the sample-and-hold sense is used in order to prove that the proposed digital glucose regulator ensures the semi-global practical stability of the related closed-loop tracking error system, with arbitrarily small final target ball. The proposed digital glucose regulator is validated through simulations.

Conservative treatment of emphysematous pyelonephritis and diabetes: A case report and literature review

Emphysematous pyelonephritis (EPN) is a rare but serious infectious disease caused by anaerobic bacteria that is characterized by necrotizing renal parenchymal infection and has a high mortality rate. The initial management of EPN includes resuscitation, antibiotics, management of any diabetes, and minimally invasive procedures, such as percutaneous drainage. Surgery is required in the most severe cases. Here, we describe a male patient with type 2 diabetes who presented with fever and abdominal pain and was diagnosed with EPN based on laboratory results and a computed tomography (CT) scan showing distension of the left kidney, several small air bubbles in the perirenal space, and thickening of the perinephric fascia. A subcutaneous insulin infusion and meropenem were administered. Repeat CT imaging 13 days later showed gas and necrotic tissue in the renal parenchyma. Therefore, CT-guided renal puncture was performed, and Escherichia coli was cultured from the drained pus. Antibiotic treatment was continued for 20 days after admission when the patient's kidney function and clinical symptoms had significantly improved. Sixty days after diagnosis, left nephrectomy was performed. The perinephric abscess was under high tension, and the left kidney was very soft. Histopathological examination revealed severe inflammation and necrosis of the renal pelvis, with fibrosis. The patient recovered well after surgery and remained alive 5 months later. EPN is a very rare disease with a high mortality rate and is more likely to occur in patients with diabetes. Early diagnosis and treatment of the infection are extremely important. For patients in whom gas and/or necrosis continue to accumulate after conservative treatment, we recommend nephrectomy.

Glucose control using fast-acting insulin aspart in a real-world setting: A 1-year, two-centre study in people with type 1 diabetes using continuous glucose monitoring.

To evaluate the efficacy and safety of switching from traditional mealtime insulins to fast-acting insulin aspart (Fiasp) in a "real-world" clinical practice setting in adult people with type 1 diabetes (PWD1) who were using intermittently scanned or real-time continuous glucose monitoring (isCGM or rtCGM, respectively). Data from 438 adult PWD1 (60% men, age 44.6± 16.2 years, diabetes duration 21.5± 14.0 years, isCGM/rtCGM: 391/47, multiple daily injections/continuous subcutaneous insulin infusion: 409/29), who initiated Fiasp from January 2018 to May 2020, were analysed. The primary objective was the evolution of time in range (TIR; 70-180 mg/dL) at 6 and 12 months. Secondary objectives included change in HbA1c, body mass index (BMI), insulin doses, time below range (<70 and <54 mg/dL), and time above range (>180 and >250 mg/dL). TIR improved from 50.3% ± 15.6% to 54.3% ± 15.1% at 6months (n=425) and to 55.5% ± 15.2% at 12 months (n=385) (P< .001), corresponding to 57 min/d at 6months and 75 min/d at 12 months. Time spent below 54 mg/dL evolved from 3.1% ± 3.3% to 3.1% ± 3.7% and 2.5% ± 3.0% at 6 and 12 months, respectively (P= .011). Also, time spent above 180 mg/dL decreased from 42.3% ± 16.7% at start by 4.2% at 6months and by 4.6% at 12 months (P< .001). The proportion of people reaching TIR more than 70% increased from 11.0% to 14.8% (P= .002), and those spending less than 4% at time less than 70 mg/dL increased from 36.1% to 42.1% (P= .002). After 12 months, HbA1c, insulin doses, and BMI did not change significantly. In a Belgian real-world setting of adult PWD1, switching to Fiasp was associated with a 5% increased TIR after 12 months, corresponding to 75 min/d, in combination with less time spent below and above range.

An algorithm mimicking pancreas pulsatile behavior improves artificial pancreas performance.

Artificial pancreas design using subcutaneous insulin infusion without pre-meal feed-forward boluses often induces an over-response leading to hypoglycemia due to the increase of blood insulin concentration sustained in time. The objective of this work was to create an algorithm for controlling the function of insulin pumps in closed-loop systems to improve blood glucose management in type 1 diabetic patients by mimicking the pulsatile behaviour of the pancreas. A controller tuned in a pulsatile way promotes damped oscillations of blood insulin concentration injected through an insulin pump. We tested it in a simulated environment, using nine 'in silica' subjects. The control algorithm is founded on feedback linearization where through a change of variables, the nonlinear system turns into an equivalent linear system, suitable for implementing through a PID controller. We compared the results obtained 'in silica' with the volume injected by an insulin pump controlled by this algorithm. The use of this algorithm resulted in a pulsatile control of postprandial blood glucose concentration, avoiding hypoglycaemic episodes. The results obtained 'in silica' were replicated in a real pump 'in vitro'. With this proposed linear system, an appropriate control input can be designed. The controller works with a damped pulsatile pattern making the insulin infusion from the pump and blood insulin concentration pulsatile. This operational would improve the performance of an artificial pancreas.

Hypoglycemia in a Surgical Intensive Care Unit.

Glycemic control is an important aspect of critical care because derangements are associated with morbidity and mortality. Patients at highest risk for hypoglycemia in the surgical intensive care unit (SICU) are incompletely described by existing literature. Our objective was to delineate this high-risk patient population in our SICU. In this single-center, retrospective, observational study, SICU patients admitted from June 1, 2019 to July 31, 2020 with ≥1 episode of hypoglycemia (blood glucose <60mg/dL) were included. There were 41 hypoglycemic events in 27 patients, comprising an incidence of 1.5% among SICU patients. The most common admission diagnoses were cirrhosis (n = 13, 48%), polytrauma (n = 12, 44%), multisystem organ failure (n = 11, 41%), diabetes mellitus (n = 9, 33%), and soft tissue infection (n = 8, 30%). Four high-risk populations were identified: patients in multisystem organ failure (MSOF) (n = 11, 41%); those who were nil per os (NPO) (n = 10, 37%); patients receiving long acting subcutaneous insulin, for example, Lantus (n = 3, 11%); and those on continuous intravenous insulin infusions (n = 3, 11%). After multi-disciplinary peer review, most hypoglycemic events (n = 16, 59%) were deemed iatrogenic. Hypoglycemia is rare in surgical critical care. When it does occur, patients are typically in MSOF, NPO, on long acting subcutaneous insulin or continuous insulin infusions, have soft tissue infections, or have acute or chronic liver failure. Increased vigilance with frequent blood glucose monitoring in these high-risk patients may reduce the risk of hypoglycemia in the SICU.

Investigation and nursing strategy of the current status of insulin therapy in 450 children with type 1 diabetes mellitus

Objective To investigate in children with type 1 diabetes mellitus and provide evidence for nursing education. Methods From January to December 2016, 450 patients with T1DM were enrolled in this research, all of them were outpatients of diabetes clinic of Beijing Children′s Hospital Affiliated to Capital Medical University. The clinical data of the patients were collected through questionnaires and physical examinations to assess the insulin treatment and related factors. Results Among 450 patients, 221 were males and 229 were females, aged 9.40 (0.83-17.97) years old; body mass index was 17.43 (12.81-28.22) kg/m2; course of disease was 2.32 (0.05-12.89) years; daily insulin dosage was 0.66 (0.11-1.78) IU·kg-1·d-1; glycosylated hemoglobin (HbA1c) was 7.54 (4.4-14.9)%, of which HbA1c 9.0% accounted for 14.2%(64/450). 44.9%,47.1%,8.0% (202, 212,36 cases) patients were treated respectively with routine treatment, multiple daily injection or continuous subcutaneous insulin infusion. There was no significant difference in HbA1c between patients with different insulin regimens (P > 0.05), but there were significant differences in age, course of disease, body mass index and insulin dosage (P< 0.05). Conclusion Because children with type 1 diabetes have different physiological and psychological characteristics in different stages, the content of health education should be adjusted according to the patient's condition. Key words: Children; Diabetes mellitus, type 1; Insulin; Health education

Guiding Diabetic Therapy for Children and Adolescents with Type I Diabetes

Studies indicate children and adolescents with Type 1 diabetes need treatment with multiple daily insulin injections (MDI) or subcutaneous insulin infusion (CSII) for glycemic control. This research study explored the efficacy of MDI’s compared to CSII therapy in children and adolescents with Type I diabetes in an urban setting by examining their HgbA1C outcomes. Retrospective chart review examined 58 records of children and adolescents (ages 0-21) in two outpatient settings who transitioned from MDI's to CSII. HgbA1c values were recorded during MDI use over one year and during the initial year of CSII use and the means were compared. The difference in mean HbA1c values during MDI and CSII therapies were tested using paired t-tests. HgbA1c values differed between age groups under and over 13. Reduction in mean HbA1c of 0.79 (p=0.02) in the older group was statistically significant. The change in the younger group of -0.09 (p=0.75) was not significant. Results suggest that children over 13 have improved glycemic outcomes using pump therapy. Nurses can build a long-term relationship with the patient and family, teaching self-management and offering choices of insulin administration as this study revealed that there was no difference in how they received insulin.

Adjunct Antihyperglycemic Agents in Overweight and Obese Adults With Type 1 Diabetes.

People with type 1 diabetes often have suboptimal glycemic control. The gold standard of treatment is basal-bolus insulin or subcutaneous insulin infusion via insulin pump. Although insulin therapy improves glycemic control, weight gain and hypoglycemia often limit achievement of hemoglobin A1C (A1C) goals. The number of people with type 1 diabetes who are overweight or obese is increasing, and there are many similarities between what was historically called type 1 and type 2 diabetes. Therefore, there is rationale for using antihyperglycemic agents that target other pathophysiological abnormalities to facilitate weight loss and improve glycemic control. We performed a MEDLINE search from 1975 through October 2018 to identify articles that studied noninsulin agents in adults with type 1 diabetes and body mass index (BMI) ≥25 kg/m2. Identified articles were included if the study duration was ≥4 weeks, included ≥20 patients, and set mean baseline BMI ⩾25kg/m2. This review summarizes 32 clinical trials. Amylin mimetics, sodium-glucose-like transporter-2 inhibitors, and glucagon-like-peptide-1 receptor agonists demonstrate the greatest improvements in body weight and A1C. The most common adverse effects are hypoglycemia and ketosis. Relevance to Patient Care and Clinical Practice: Patients with type 1 diabetes may have interest in starting noninsulin agents. Clinicians need to be knowledgeable in the efficacy and adverse effect profile of these agents, specifically in people with type 1 diabetes. Adding noninsulin antihyperglycemic agents may benefit select overweight or obese adults with type 1 diabetes. These agents are off-label, and if used, close monitoring is essential.

Poor Adherence in Adolescents with Type 1 Diabetes Associated with Distress, Fear of Hypoglycemia, and Executive Functioning

Introduction: T1D poses unique challenges to adherence-related behavior due to complex treatment regimens. This study aimed to determine prevalence rates of adherence in adolescents on multiple daily injections (MDI) or subcutaneous insulin infusion (CSII). Additional aims included determination of whether adherence correlated to HbA1c and whether psychological factors predicted adherence. Methods: Self-monitoring of blood glucose (SMBG) and insulin delivery data were downloaded for the previous 30 days. Distress was measured using the Problem Areas in Diabetes-Teen Version, the Blood Glucose Monitoring Communication Questionnaire, and the Barriers to Diabetes Adherence survey. The Hypoglycemia Fear Survey and Behavior Rating of Executive Function were administered. Bivariate correlations and hierarchical regressions were used to determine how adherence related to HbA1c and the predictive value of psychological factors. Continuous glucose monitor (CGM) use was considered as a covariate. Results: Adolescents (N=81; 41 on MDI and 40 on CSII; 32 on CGM) aged 11 to 17 years completed the study. The mean HbA1c was 8.74% (SD=1.74%). Daily, &amp;lt;7% of participants engaged in SMBG ≥4 times; &amp;lt;7% engaged in carbohydrate entry ≥3 times, and &amp;lt;20% engaged in bolus delivery ≥3 times. Hyperglycemia readings were followed by a correction bolus in 58% of cases. HbA1c was negatively correlated with several adherence domains: frequency of SMBG (r=-0.465, p&amp;lt;.01), carbohydrate entry (r=-0.511, p&amp;lt;.01), and bolus insulin delivery (r=-0.522, p&amp;lt;.01). Distress and fear of hypoglycemia predicted adherence to correction bolusing for hyperglycemia (R2=.237, p&amp;lt;.05) in a model with child age, gender, and executive functioning. Conclusions: Findings suggest adolescents do not adequately adhere to treatment for T1D. The use of diabetes treatment technology is helpful to measure specific domains of adherence and clarify relationships with psychological factors. Disclosure S.C. Westen: None. J. Warnick: None. M. Entessari: None. A. Albanese-O'Neill: None. D. Schatz: None. M.J. Haller: None. D.M. Janicke: None.

Parametric Identification of Sorensen model for glucose-insulin-carbohydrates dynamics using evolutive algorithms

Diabetes mellitus (DM) is a disease affecting millions of people worldwide, and its medical care brings an economic wear to patients and public health systems. Many efforts have been made to deal with DM, one of them is the full-automation of insulin delivery. This idea consists in design a closed-loop control system to maintain blood glucose levels (BGL) within normal ranges. Dynamic models of glucose-insulin-carbohydrates play an important role in synthesis of control algorithms, but also in other aspects of DM care, such as testing glucose sensors, or as support systems for health care decisions. Therefore, there are several mathematical models reproducing glycemic dynamics of DM, most of them validated with nominal parameters of standardized patients. Nevertheless, individual patient-oriented models could open the possibility of having closed-loop personalized therapies. This problem can be addressed through the information provided by open-loop therapy based on continuous glucose monitoring and subcutaneous insulin infusion. This paper considers the problem of identifying particular parameters of a compartmental model of glucose-insulin dynamics in DM; the goal is fitting the model response to historical data of a diabetic patient collected during a time period of her/his daily life. At this time, Sorensen model is one of the most complete compartmental models representing the complex dynamics of the glucose-insulin metabolism. This is a system of 19 ordinary differential equations (ODEs), thus the identification of its parameters is a non-easy task. In this contribution, parameter identification was performed via three evolutionary algorithms: differential evolution, ant colony optimization and particle swarm optimization. The obtained results show that evolutionary algorithms are powerful tools to solve problems of parametric identification. Also, a comparative analysis of the three algorithms was realized throw a wilcoxon sign-rank test, in which colony optimization had the better performance. The model obtained with the estimated parameters could be used to in type 1 diabetes mellitus (T1DM) care, such as in the design of full-automation of insulin infusion.

Clinical features and treatment strategy of patients with fulminant type 1 diabetes

Objective To discuss the clinical features and treatment strategy of patients with fulminant type 1 diabetes mellitus (FT1DM). Methods Clinical and laboratory data of 4 patients diagnosed as FT1DM in our hospital from January 2008 to February 2016 were retrospectively analyzed. Results 2 females and 2 males aged from 22 to 68 years old were included.They were developed to ketoacidosis rapidly after the appearance of diabetic symptoms in 2-6 days.Some cases complicated with shock, acute renal insufficiency and rhabdomyolysis.One case with late pregnancy had a stillbirth.The plasma glucose level was ranged from 35.6 to 67.8 mmol/L, HbA1c ranged from 5.8 % to 6.7%, fasting C peptide ranged from lower than 0.01 to 0.11 ng/mL and 2-hour postprandial C peptide ranged from lower than 0.01 to 0.12 ng/mL.No improvement in C peptide levels were followed up for 9-43 months.After acute phase, intensive insulin therapy was used to control blood glucose.The patients had a great glycaemia excursion and were subjected to hypoglycaemia. Conclusion FTlDM is a special type of diabetes developed rapidly with dangerous prognosis.It is often shown as ketoacidosis and the HbA1c level is normal or mildly elevated.Serious cases are associated with other organ damage, pregnancy fetal death rate is very high.Because the serious impaired islet B-cell function, FTlDM patients has a great glycaemia excursion, continuous subcutaneous insulin infusion is the first choice to control plasma glycemia. Key words: Diabetes mellitus, type 1; Fulminans; Diabetic ketoacidosis; Glycesylated hemoglobin

Nursing care and the development of CSII in clinical application

Continuous subcutaneous insulin infusion (CSII) is an equipment simulating human physiological insulin secretion. It has been world widely used as an advanced method to enhance the effects of treatment for diabetes, and has significant effects on controlling blood glucose level and preventing or postponing the onset of complications. Therefore, the appropriate utilization and the reasonable nursing care in clinic are extremely critical. This review will summarize the clinical application and the development of nursing care of the CSII. Key words: Diabetes; Nursing; Continuous subcutaneous insulin infusion; Review

Velocity-weighting to prevent controller-induced hypoglycemia in MPC of an artificial pancreas to treat T1DM.

The design of a Model Predictive Control (MPC) strategy for the closed-loop operation of an Artificial Pancreas (AP) to treat type 1 diabetes mellitus is considered. The contribution of this paper is to propose a velocity-weighting mechanism, within an MPC problem's cost function, that facilitates penalizing predicted hyperglycemic blood-glucose excursions based on the predicted blood-glucose levels' rates of change. The method provides the control designer some freedom for independently shaping the AP's uphill versus downhill responses to hyperglycemic excursions; of particular emphasis in this paper is the downhill response. The proposal aims to tackle the dangerous issue of controller-induced hypoglycemia following large hyperglycemic excursions, e.g., after meals, that results in part due to the large delays of subcutaneous glucose sensing and subcutaneous insulin infusion - the case considered here. The efficacy of the proposed approach is demonstrated using the University of Virginia/Padova metabolic simulator with both unannounced and announced meal scenarios.

Safety and efficacy of sensor augmented insulin pump versus double C therapy in poorly controlled type 2 diabetes

To compare the efficacy, safety and efficiency of sensor augmented insulin pump (SAP) versus double-C therapy in poorly controlled type 2 diabetes (T2DM). A total of 81 patients with T2DM, HbA1c ≥ 9%, were divided randomly into SAP or continuous subcutaneous insulin infusion and retrospective continuous glucose monitoring (double C) group for both 6 days. In both groups, mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE) and 24 h area under the curve at 10 (AUC10) significantly decreased after therapy (P < 0.05). These parameters in SAP group were lower than those in double C group (P < 0.05). No significant difference existed in 24 h area under the curve at 3.9 (AUC3.9) (P > 0.05). Compared with double C group, time spend to-blood glucose-target was shorter and in-target range proportion higher in SAP group (P < 0.05). Logistic regression analysis showed that 2 h C peptide (CP)/fasting C peptide (FCP), HbA1c and sensor alert on (all P < 0.05) were independently correlated with up-to blood glucose target. Compared with double C, SAP therapy may decrease blood glucose (BG), reduce glucose fluctuation and improve up-to target proportions without a higher risk of hypoglycemia.

PTU-177 Diabetic gastroparesis- a review of clinical practice in county durham

<h3>Introduction</h3> Diabetic gastroparesis represents a significant health burden not only for patients and their families but also for health care systems.¹Treatment guidelines for gastroparesis are limited²and evidence base for effectiveness of current treatment modalities is lacking. <h3>Method</h3> This study aims to evaluate patients with diabetic gastroparesis, assess disease burden and response to therapy. The diabetes database was used to identify patients, epidemiological and clinical data acquired from electronic pt records. A quality of life index³(QoLI) and Gastroparesis Cardinal Symptom Index⁴(GPCSI) questionnaire was completed. <h3>Results</h3> 40 pts identified but 7 excluded due to moving away (5), not consenting for participation (1) or dying (1). Median age 48 yrs (21–85), 61% female. 73% had Type 1 diabetes mellitus, duration of diabetes 18 yrs (2–53). BMI = 26.7 (16.2–40) kg/m². 39% nonsmokers, 21% current smokers. 82% of patients had one or more diabetes related complications. Median duration of diabetes before diagnosis 11.5 yrs (0–43). The cohort had 65 hospital admissions in the preceding 12 mths, median of 1 (0–15) per pt. 332 outpatient clinic visits were recorded. In those with T1DM, 33% had subcutaneous insulin infusion (CSII), while 67% of those with T2DM were receiving insulin. Diabetes was stable in 30% of pts. Nausea and vomiting were the most prominent symptoms in 97% of patients. Other symptoms included bloating (61%), early satiety (30%), constipation (33%) and diarrhoea (21%). Diagnosis was confirmed by scintigraphic single phase solid meal gastric emptying studies in 88%. 64% adopted life style modifications with 43% reporting sustained benefit. Prokinetic medications tried included: metoclopramide (58%), domperidone (76%), prochlorperazine (12%) and erythromycin (33%) with less than half of patients experiencing lasting benefit. Prucalopride was used in 11%. Pyloric injection with Botulinum toxin A was carried out in 15% with 20% reporting lasting benefit. Gastric electric stimulator was inserted in 8 (24%) patients 2 of whom had maintained benefit while rest of patients lost benefit within few month of device insertion. Surgical procedures were required in 3 (9%) pts. QoLi and GPCSI scores showed no correlation with glycaemic control or diabetes stability. <h3>Conclusion</h3> Diabetic patients with gastroparesis have increased health needs and multiple complications. Majority of treatments have only transient benefit, which tend to wane off. There was no correlation between duration of diabetes, diabetes control or diabetes stability and QoLI or GPCSI scores. A multi disciplinary appraoch is needed to manage these patients and new treatments need to be developed for long term benefits. <h3>Disclosure of interest</h3> A. Aldibbiat: None Declared, E. Nash: None Declared, C. Sinclair: None Declared, P. Praveen: None Declared, P. Peter: None Declared, A. Dhar Grant/ Research Support from: Carefusion UK, Consultant for: Takeda Pharmaceuticals, Speaker Bureau of: Falk Pharmaceuticals, Covidien.

Registre épidémiologique du diabète chez l’enfant en Languedoc-Roussillon

Since 1st January 2000, the PEDIAB-LR registry has listed new cases of diabetes in children under 16 years of age in the Languedoc-Roussillon region of France, in order to assess the incidence and epidemiological characteristics of children affected by diabetes. At the end of December 2010, 745 children had been registered. The characteristics of these children included an identical proportion of girls and boys, a mean age of 8 years at diagnosis, and a family history of type 1 diabetes in 8.4% of the cases. Inaugural ketoacidosis was observed in 69.5% of the patients and was severe in 23.7% of these cases. To replace intravenous insulin, a two-injection dosing regimen (in the morning and before dinner) was prescribed in 76.5% of cases, multi-injections of basal-bolus in 16%, and subcutaneous insulin infusion (insulin pump therapy) in 7.5% of cases. Between 2000 and 2010, there was no increase in overall incidence. It is noteworthy that age at diagnosis tended to decrease, but this was not statistically significant. In conclusion, the PEDIAB-LR registry is currently the only French registry on diabetes in children, analyzing many factors related to its incidence, such as age at diagnosis and the existence of ketoacidosis.

Assessing Patient Satisfaction of Providers’ Adherence to Inpatient Management with Continuous Subcutaneous Insulin Infusion (CSII) Policy: A Cross-Sectional Study

There are unique challenges in managing patients with Continuous Subcutaneous Insulin Infusion (CSII) in the inpatient setting, but these challenges may be mitigated by institutional protocols and staff education. The purpose of our study was to determine the current level of patient satisfaction with the staff’s adherence with anthe insulin pump policy and to identify areas for improvement. We hypothesize that the majority of patients will be satisfied with inpatient CSII management, as our institute’s insulin pump policy had been implemented with educational sessions one year prior. We created a 20- question survey to assess patient satisfaction in regards to their inpatient CSII management which is governed by a system-wide insulin pump policy. 50 adult patients with both type 1 and type 2 diabetes managed with insulin pumps admitted to the hospital for medical care were surveyed. Fisher’s exact test was used to measure the association between categorical variables and satisfaction. Of those surveyed, 78% were satisfied with CSII management in the hospital . However, only 62% of participants answered favorably to the statement which evaluated Emergency Department (ED) staff communication regarding the current insulin pump policy. Therefore, targeted education to Emergency Department (ED) staff regarding the availability of an insulin pump protocol and nursing measures to limit CSII disconnection time may further improve patient satisfaction.

The single-port concept: combining optical glucose measurement with insulin infusion

The aim of this study was to develop a single-port system that combines glucose monitoring and insulin infusion. In a preclinical proof-of-concept trial, the performance of the glucose measurement at the site of insulin infusion was assessed. Glucose levels were clamped from 40 to 250mg/dL by intravenous glucose infusion and subcutaneous insulin infusion via the glucose sensor. Sensor-glucose values correlated well with reference blood-glucose values, despite infusion at the site of glucose measurement. The average median ARE value was 21.6±5.7% for sensors used for insulin infusion, 18.1±5.8% for sensors used for NaCl infusion and 19.2±7.9% for sensors without infusion. These preclinical in vivo results demonstrate that single-port glucose monitoring is feasible at the site of insulin infusion.

Nursing care for patients with inslin pump to improve failed response to sulfonylureas

Objective To explore the effect of clinical nursing care for patients undergoing continuous subcutaneous insulin infusion (CSII) to improve failed response to sulfonylureas.Methods 128 patients with failed response to sulfonylureas were randomly divided into two groups to receive CSII or multiple subcutaneous insulin injection (MSII),64 for each group.The clinical efficacy,adverse reactions,and the nursing effect were observed in the two groups.Results After a course of 3-week treament in both groups,monitoring control index of blood sugar,CSII group than in MSII group standard after intensive treatment effect was obvious (P＜ 0.05).Reach the target also significantly shorten the time needed for blood sugar,significantly lower adverse reactions; Nursing effect was obvious,with a significant difference between the two group (P＜0.05).The incidende of skin redness,swelling,and itching was higher in CSII group than in MSII group.Conclusions CSII therapy can effectively control blood sugar,reduce the occurrence of hypoglycemia,decline the development of complications,improve quality of life in patients,reduce the workload of nursing staff,and improve patient satisfaction. Key words: Insulin pump; Patients with failed response to sulfonylureas; Nursing observation