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      New technologies for diabetes: a review of the present and the future

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          Abstract

          This review summarizes the technologies in use and in the pipeline for the management of diabetes. The review focuses on glucose meters, continuous glucose monitoring devices, insulin pumps, and getting clinicians connected to technologies. All information presented can be found in the public domain, and was obtained from journal articles, websites, product review tables in patient publications, and professional conferences. The technology concerns, ongoing development and future trends in this area are also discussed.

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          Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes.

          Richard M. Bergenstal, William Tamborlane, Andrew Ahmann … (2010)
          Recently developed technologies for the treatment of type 1 diabetes mellitus include a variety of pumps and pumps with glucose sensors. In this 1-year, multicenter, randomized, controlled trial, we compared the efficacy of sensor-augmented pump therapy (pump therapy) with that of a regimen of multiple daily insulin injections (injection therapy) in 485 patients (329 adults and 156 children) with inadequately controlled type 1 diabetes. Patients received recombinant insulin analogues and were supervised by expert clinical teams. The primary end point was the change from the baseline glycated hemoglobin level. At 1 year, the baseline mean glycated hemoglobin level (8.3% in the two study groups) had decreased to 7.5% in the pump-therapy group, as compared with 8.1% in the injection-therapy group (P<0.001). The proportion of patients who reached the glycated hemoglobin target (<7%) was greater in the pump-therapy group than in the injection-therapy group. The rate of severe hypoglycemia in the pump-therapy group (13.31 cases per 100 person-years) did not differ significantly from that in the injection-therapy group (13.48 per 100 person-years, P=0.58). There was no significant weight gain in either group. In both adults and children with inadequately controlled type 1 diabetes, sensor-augmented pump therapy resulted in significant improvement in glycated hemoglobin levels, as compared with injection therapy. A significantly greater proportion of both adults and children in the pump-therapy group than in the injection-therapy group reached the target glycated hemoglobin level. (Funded by Medtronic and others; ClinicalTrials.gov number, NCT00417989.) 2010 Massachusetts Medical Society
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            Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion.

            J Pickup, A Sutton (2008)
            Continuous subcutaneous insulin infusion (CSII) is a recommended treatment for reducing severe hypoglycaemia in Type 1 diabetes, but the change in hypoglycaemia compared with multiple daily insulin injections (MDI) is unclear. We therefore conducted a meta-analysis comparing severe hypoglycaemia and glycaemic control during CSII and MDI. Databases and literature (1996-2006) were searched for randomized controlled trials (RCTs) and before/after studies of > or = 6 months' duration CSII and with severe hypoglycaemia frequency > 10 episodes/100 patient years on MDI. In 22 studies (21 reports), severe hypoglycaemia during MDI was related to diabetes duration (P = 0.038) and was greater in adults than children (100 vs. 36 events/100 patient years, P = 0.036). Severe hypoglycaemia was reduced during CSII compared with MDI, with a rate ratio of 2.89 (95% CI 1.45 to 5.76) for RCTs and 4.34 (2.87 to 6.56) for before/after studies [rate ratio 4.19 (2.86 to 6.13) for all studies]. The reduction was greatest in those with the highest initial severe hypoglycaemia rates on MDI (P < 0.001). The mean difference in glycated haemoglobin (HbA(1c)) between treatments was less for RCTs [0.21% (0.13-0.30%)] than in before/after studies [0.72% (0.55-0.90%)] but strongly related to the initial HbA(1c) on MDI (P < 0.001). The severe hypoglycaemia rate in Type 1 diabetes was markedly less during CSII than MDI, with the greatest reduction in those with most severe hypoglycaemia on MDI and those with the longest duration of diabetes. The biggest improvement in HbA(1c) was in those with the highest HbA(1c) on MDI.
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              Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring.

              Dorothee Deiss, Jan Bolinder, Jean-Pierre Riveline … (2006)
              Article 0 comments Cited 109 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Neesha Ramchandani
                Rubina A Heptulla
                Journal
                Journal ID (nlm-ta): Int J Pediatr Endocrinol
                Journal ID (iso-abbrev): Int J Pediatr Endocrinol
                Title: International Journal of Pediatric Endocrinology
                Publisher: BioMed Central
                ISSN (Print): 1687-9848
                ISSN (Electronic): 1687-9856
                Publication date (Print): 2012
                Publication date (Electronic): 26 October 2012
                Volume: 2012
                Issue: 1
                Page: 28
                Affiliations
                [1 ]The Children’s Hospital at Montefiore, Division of Pediatric Endocrinology & Diabetes, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
                [2 ]Albert Einstein College of Medicine, Division of Pediatric Endocrinology, Bronx, NY, 10461, USA
                Article
                Publisher ID: 1687-9856-2012-28
                DOI: 10.1186/1687-9856-2012-28
                PMC ID: 3541087
                PubMed ID: 23098076
                SO-VID: 6f1abd2e-d302-4e63-9111-af32c03c7b71
                Copyright © Copyright ©2012 Ramchandani and Heptulla; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 August 2012
                Date accepted : 15 October 2012
                Categories
                Subject: Review

                ScienceOpen disciplines: Pediatrics
                Keywords: insulin patch,continuous glucose monitoring,blood glucose meter,insulin pump,inhaled insulin,smartinsulin,diabetes technology,new therapies,insulin pill
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: insulin patch, continuous glucose monitoring, blood glucose meter, insulin pump, inhaled insulin, smartinsulin, diabetes technology, new therapies, insulin pill

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