INNOVATIVE DEVICES FOR THE TREATMENT OF INSULINE DEPENDANT DIBETES MELLITUS

Abstract: Current standard therapy for T1DM involves multiple daily glucose measurements and insulin injections. Advances in glucose monitors,
hormone delivery systems, and control algorithms generate more autonomous and personalised treatments through hybrid and fully automated closed-
loop systems, which significantly reduce hypo- and hyperglycaemic episodes and their subsequent complications. Stimuli responsive materials for the
controlled delivery of insulin or glucagon are a promising alternative to glucose monitors and insulin pumps. By their self-regulated mechanism, these
“smart” drugs modulate their potency, pharmacokinetics and dosing depending on patients’ glucose levels.

Introduction: DM is a major chronic disease associated with many
complications and high morbidity. This review covers the most
recent technological advances envisioned to control and/or reverse
T1DM.
•2017, the first hybrid closed-loop system, the MiniMed 670G insulin
pump with a Guardian 3 sensor
•In auto mode, it functions as a hybrid closed-loop system that
automatically controls basal insulin delivery every 5 min based on the
CGM values.
•2018: Insulet’s Omnipod Dash System

Alternate Controller Enabled Infusion (Ace) Pumps

The ACE insulin pump can be combined with automated insulin dosing
(AID) systems, CGMs, BG meters etc.
2019: Slim X2 insulin pump
2020: tandem diabetes

Bionic Pancreas (BP)

closed-loop system consisting of two infusion pumps (separately for
insulin and glucagon) and connected to a CGM via a smartphone app.
Insulin Pumps (Continuous Subcutaneous Insulin Infusion-CSII) 2019: iLet BP (by Beta Bionics) was granted the ‘breakthrough device
•The infusion site needs to be changed only once every 2–3 days. designation’ by the FDA .
Therefore, insulin pumps eliminate the need for multiple injections
on a daily basis resulting in less insulin variation.
•Components: insulin reservoir, infusion set, and tubing.
•user-specific in-built programs to dispense insulin at basal and
incremental rates.
•Currently popular insulin pumps: Medtronic MiniMed, OmniPod
(Insulet), T:Slim (Tandem), DANA R (SOOIL), Accu-Chek Solo Tandem t:slimG4 INSULIN PUMP
Micropump (Roche), and Ypsomed.
• Patch Pumps: attached to the skin through an adhesive Conclusion:
•Eg. Omnipod patch, PAQ (CeQur), V-Go •In the past decade, there has been a high-speed evolution in
diabetes technologies to improve the quality of life.
Sensor-Augmented Pump Therapy (SAP) •TIR is achievable upto 90–95%
2006: MiniMed, MiniMed Paradigm REAL-Time system •serious issues associated: cannula blockages, infusion set
insulin pump and CGM system handling, Bluetooth connectivity, user-friendliness.
2009: Medtronic launched the MiniMed Veo System.

Artificial Pancreas (AP) References:

AP links three devices: (1) a sensor like CGM that measures
BG and sends data to a computer algorithm,
(2) a control algorithm to analyze the data and calculate the
required insulin dose, and
(3) an insulin infusion pump to deliver insulin as per the
computer instructions.
•Kesavadev J et al. Evolution of Insulin Delivery Devices: From
Syringes, Pens, and Pumps to DIY Artificial Pancreas Diabetes
Ther. 2020 Jun; 11(6): 1251–1269
•Magennis C. The different types of insulin pumps available in
2019. https://www.dreambigtravelfarblog.com/blog/types-of-
insulin-pumps (2019). Accssed 16 Feb 2020.