Recent Advances in Insulin Delivery Devices and Modes of Insulin Therapy

The discovery of insulin was 100 years old till 2021. Insulin, the first diabetic medication, is now the safest and most effective glucose-lowering medication available. Despite its efficacy, the most significant challenge with insulin has been the prevalence of hypoglycemia, which has resulted in the majority of patients being prescribed optimum dosages. Insulin delivery devices include syringes, pens, and pumps. Soon, artificial pancreas (AP) by using a very closed-loop delivery method will be a big step towards the advancement of insulin delivery devices. This article looks at the invention of syringes, disposable, long-lasting pens, and smart connected pens, continuous intraperitoneal insulin infusion (CIPII) and patch insulin pumps, artificial pancreas and other medical devices. Hence, insulin administration that is both minimally invasive and non-invasive towards the advancement is required. We review the available information on the evolution of insulin delivery systems, focusing on the advantages and disadvantages of technology as well as anticipated advances. Due to the wide variety of technological solutions accessible via the international platform, only the most common methods essential to the patient’s care are detailed here in the article.

Intraperitoneal insulin administration in pigs: effect on circulating insulin and glucose levels

IntroductionThe effect of intraperitoneal insulin infusion has limited evidence in the literature. Therefore, the aim of the study was to investigate the pharmacokinetics and pharmacodynamics of different intraperitoneal insulin boluses. There is a lack of studies comparing the insulin appearance in the systemic circulation after intraperitoneal compared with subcutaneous insulin delivery. Thus, we also aimed for a comparison with the subcutaneous route.Research design and methodsEight anesthetized, non-diabetic pigs were given three different intraperitoneal insulin boluses (2, 5 and 10 U). The order of boluses for the last six pigs was randomized. Endogenous insulin and glucagon release were suppressed by repeated somatostatin analog injections. The first pig was used to identify the infusion rate of glucose to maintain stable glucose values throughout the experiment. The estimated difference between insulin boluses was compared using two-way analysis of variance (GraphPad Prism V.8).In addition, a trial of three pigs which received subcutaneous insulin boluses was included for comparison with intraperitoneal insulin boluses.ResultsDecreased mean blood glucose levels were observed after 5 and 10 U intraperitoneal insulin boluses compared with the 2 U boluses. No changes in circulating insulin levels were observed after the 2 and 5 U intraperitoneal boluses, while increased circulating insulin levels were observed after the 10 U intraperitoneal boluses. Subcutaneously injected insulin resulted in higher values of circulating insulin compared with the corresponding intraperitoneal boluses.ConclusionsSmaller intraperitoneal boluses of insulin have an effect on circulating glucose levels without increasing insulin levels in the systemic circulation. By increasing the insulin bolus, a major increase in circulating insulin was observed, with a minor additive effect on circulating glucose levels. This is compatible with a close to 100% first-pass effect in the liver after smaller intraperitoneal boluses. Subcutaneous insulin boluses markedly increased circulating insulin levels.

Route of Insulin Does Not Influence 25-Hydroxyvitamin D Concentrations in Type 1 Diabetes: A Brief Report

The increased prevalence of vitamin D [25(OH)D] deficiency in type 1 diabetes mellitus (T1DM) may be related to low insulin levels in the hepatic portal venous system. In this prospective matched-control study, we demonstrate that long-term intraperitoneal insulin does not influence 25(OH)D concentrations in patients with T1DM as compared with subcutaneous insulin administration.

New Design of a Percutaneous Port System for Continuous Intraperitoneal Insulin Infusion

Insulin-dependent diabetes mellitus is treated with intensive insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion with insulin pumps. For people with diabetes who cannot achieve acceptable glycemic control despite the use of intensive insulin therapy and continuous glucose measurement, there exists the possibility of continuous intraperitoneal insulin delivery via an implantable pump or a percutaneous port system that is connected to an external insulin pump. In this article, the current second generation of the Accu-Chek® DiaPort system for continuous intraperitoneal insulin delivery with its improvements over the former generation is presented and discussed.