scholarly journals Beyond the barriers of the use of continuous subcutaneous insulin therapy in type 1 diabetes: a new opportunity from catheter-less insulin pumps

ABOUTOPEN ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 55-70
Author(s):  
Katherine Esposito ◽  
Andrea Mario Bolla ◽  
Francesco Costantino ◽  
Maurizio Delvecchio ◽  
Chiara Molinari ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Drop Out ◽  
Insulin Pump Therapy ◽  
Subcutaneous Insulin ◽  
Insulin Pumps ◽  
Pump Therapy ◽  
Recurrent Hypoglycemia

Although it represents a valid alternative for patients with type 1 diabetes (T1DM) with insufficient glycemic control and/or with recurrent hypoglycemia, insulin pump therapy (Continuous Subcutaneous Insulin Infusion, CSII) in Italy is nowadays still relatively uncommon. The following review aims to investigate the barriers that limit the transition to CSII and the reasons behind the widespread cases of drop-out, particularly evident in younger patients. Among the interventions that could contribute to the solution of the problem, catheter-less insulin pumps (or patch-pumps) will be described: a tool potentially able to reduce, if not eliminate, some of the main obstacles encountered by patients. In particular, a new opportunity has become available today thanks to the evolution of the generation of catheter-less insulin pumps represented by Accu-Chek® Solo (Roche Diabetes Care GmbH), therefore three clinical cases of patients with T1DM undergoing therapy with the Accu-Chek® Solo insulin pump will be presented and discussed herein.

Cost-Effectiveness of Sensor-Augmented Insulin Pump Therapy Versus Continuous Insulin Infusion in Patients with Type 1 Diabetes in Turkey

2019 ◽  
Vol 21 (12) ◽  
pp. 727-735
Author(s):  
Stéphane Roze ◽  
Jayne Smith-Palmer ◽  
Simona de Portu ◽  
A. Zeynep Özdemir Saltik ◽  
Tuğba Akgül ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cost Effectiveness ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Continuous Insulin Infusion

scholarly journals Characterization of Exercise and Alcohol Self-Management Behaviors of Type 1 Diabetes Patients on Insulin Pump Therapy

2016 ◽  
Vol 11 (2) ◽  
pp. 240-246 ◽  
Author(s):  
Maria Adela Grando ◽  
Danielle Groat ◽  
Hiral Soni ◽  
Mary Boyle ◽  
Marilyn Bailey ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Pump ◽  
Blood Glucose Control ◽  
Real Life ◽  
Insulin Pump Therapy ◽  
Insulin Pumps ◽  
Pump Therapy ◽  
Diabetes Patients

Background: There is a lack of systematic ways to analyze how diabetes patients use their insulin pumps to self-manage blood glucose to compensate for alcohol ingestion and exercise. The objective was to analyze “real-life” insulin dosing decisions occurring in conjunction with alcohol intake and exercise among patients using insulin pumps. Methods: We recruited adult type 1 diabetes (T1D) patients on insulin pump therapy. Participants were asked to maintain their daily routines, including those related to exercising and consuming alcohol, and keep a 30-day journal on exercise performed and alcohol consumed. Thirty days of insulin pump data were downloaded. Participants’ actual insulin dosing behaviors were compared against their self-reported behaviors in the setting of exercise and alcohol. Results: Nineteen T1D patients were recruited and over 4000 interactions with the insulin pump were analyzed. The analysis exposed variability in how subjects perceived the effects of exercise/alcohol on their blood glucose, inconsistencies between self-reported and observed behaviors, and higher rates of blood glucose control behaviors for exercise versus alcohol. Conclusion: Compensation techniques and perceptions on how exercise and alcohol affect their blood glucose levels vary between patients. Improved individualized educational techniques that take into consideration a patient’s unique life style are needed to help patients effectively apply alcohol and exercise compensation techniques.

scholarly journals Predictors of the Effectiveness of Insulin Pumps in Patients with Type 1 Diabetes Mellitus

2021 ◽  
Author(s):  
Joana Camões Neves ◽  
João Sérgio Neves ◽  
Celestino Neves ◽  
Davide Carvalho
Keyword(s):  
Type 1 Diabetes ◽  
Family History ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Baseline Hba1c ◽  
Insulin Pumps ◽  
Pump Therapy ◽  
Family History Of Diabetes ◽  
History Of

Abstract Purpose Insulin pump therapy has become the preferential treatment for type 1 diabetes (T1D) as it mimics the physiological secretion of insulin better than multiple daily injections. However, not all patients improve with insulin pump therapy. This study aims to determine the predictors of the effectiveness of insulin pumps in T1D. Methods We conducted a retrospective observational study of patients who started insulin pumps. Data from four timepoints (before, at 6, 12 and 36 months) were evaluated for outcomes of glycemic control and safety. The association of baseline predictors with outcomes was analyzed using linear and logistic regression models. Results We evaluated 136 patients (57.4% females, age 36 ± 12 years, duration of T1D 14 ± 9 years). During the follow-up, there was a mean decrease of HbA1c of 0.9 ± 1.2%. The improvement in HbA1c was independent of sex, age and duration of T1D. Higher baseline HbA1c, family history of diabetes and not being treated with statins were predictors of improvement in HbA1c. Not being treated with statins and higher baseline HbA1c predicted improvement in HbA1c without worsening hypoglycemia. History of hypoglycemia was a predictor of severe hypoglycemia. Family history, higher baseline HbA1c and psychological/psychiatric disorders were predictors of ketoacidosis. Conclusion Benefits of insulin pump were independent of sex, age, and duration of T1D. Baseline HbA1c, family history of diabetes, treatment with statins, history of hypoglycemia and psychological/psychiatric disorders were predictors of outcomes and may allow the identification of patients who benefit most from insulin pump therapy or who are at increased risk of complications.

scholarly journals Twenty-Four Hour Fasting (Basal Rate) Tests to Achieve Custom-Tailored, Hour-by-Hour Basal Insulin Infusion Rates in Patients With Type 1 Diabetes Using Insulin Pumps (CSII)

2019 ◽  
pp. 193229681988275
Author(s):  
Michael A. Nauck ◽  
Anna M. Lindmeyer ◽  
Chantal Mathieu ◽  
Juris J. Meier
Keyword(s):  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Basal Insulin ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Target Range ◽  
Pump Therapy ◽  
Basal Rate

Background: Twenty-four hour fasting periods are being used to scrutinize basal insulin infusion rates for pump-treated patients with type 1 diabetes. Methods: Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy undergoing a 24-hour fast as a basal rate test were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations within, below, or above arbitrarily defined target ranges were assessed for periods of the day of special interest (eg, 01:00-07:00 am, “dawn” period, 04:00-07:00 pm, and “dusk” period). Statistics: χ2-tests, paired t-tests were used. Results: Basal rates (mean: 0.90 ± 0.02 IU/h) showed circadian variations with peaks corresponding to “dawn” (1.07 ± 0.02 IU/h from 01:00 to 07:00 am) and, less prominently, “dusk” (0.95 ± 0.02 IU/h from 03:00 to 07:00 pm). Individual mean plasma glucose concentrations averaged 6.6 ± 0.1 mmol/L, with 53.1% in the predefined “strict” (4.4-7.2 mmol/L) target range. Interestingly, during the “dawn” period, plasma glucose was significantly higher (by 0.5 ± 0.1 mmol/L [95% confidence interval: 0.3-0.8 mmol/L; P < .0001]) and the odds ratio for hypoglycemia was significantly lower compared to the reference period. Interpretation: Twenty-four hour fasting periods as basal rate tests frequently unravel periods with inappropriate basal insulin infusion rates potentially responsible for fasting hyper- or hypoglycemia. Notably, the higher basal insulin infusion rate found during the “dawn” period seems to be justified and may need to be accentuated.

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