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Insulins and insulin management
Published in Janet Titchener, Diabetes Management, 2020
Continuous subcutaneous insulin infusion (insulin pump) The insulin pump (Figure 5.9) is a small computerised device approximately 9 cm (3.5 inches) × 5 cm (2 inches) in size. It is worn externally, either clipped onto the waistband or belt or put in a pocket. It is connected subcutaneously by tubing and an infusion set. The insulin pump contains an analogue bolus insulin and delivers the basal component of management via a continuous 24-hour drip. One advantage of insulin delivery via an insulin pump is the ability to alter the rate of basal insulin delivery at any time to accommodate decreased or increased insulin needs, such as with exercise or illness.
Healthcare Data Organization
Published in Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam, Introduction to Computational Health Informatics, 2019
Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam
The structure that makes the medical devices plug-and-play and facilitates a data-exchange without any interoperability issue are part of the IEEE standard commonly known as HIB (Health Information Bus) or MIB (Medical Information Bus). Health-information-bus is analogous to the memory bus in a computer where data can travel in a standardized format to different destinations starting from the hardware sensors. Some devices that are covered through Health Information Bus (HIB) are: 1) vital signs monitor, 2) ventilator, 3) pulse oximeter – measures the oxygen content, 4) defibrillator – used for heart stimulation during cardiac-arrest, 5) ECG, 6) insulin pump – used for administering insulin to diabetic patients, 7) body composition analyzer – used to estimate the fat content in a body, 8) sleep-apnea breathing equipment and 9) glucose meter – used to measure the glucose in the blood.
Insulin infusion pumps in pregnancy
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Ilana Jaye Halperin, Denice S. Feig
Continuous subcutaneous insulin infusions (CSIIs), more commonly known as “insulin pumps,” were first developed as a research tool in the late 1970s.1 Insulin pumps use a battery driven motor to continuously deliver insulin through a subcutaneous port. In an effort to mimic endogenous insulin production by a healthy pancreas, prespecified rates of insulin are infused continuously as the basal rate. The patient, via the pump, delivers spurts of insulin, known as bolus doses, when carbohydrates are eaten. Components of CSII therapy include the pump, which has a battery, motor, plunger, and insulin reservoir, tubing that delivers the insulin from the reservoir to the insertion site, and the insertion port that adheres to the skin and keeps the subcutaneous cannula in place.
Emerging drugs for the treatment of type 1 diabetes mellitus: a review of phase 2 clinical trials
Published in Expert Opinion on Emerging Drugs, 2023
Insulin pumps currently mimic the most physiological delivery of insulin during a 24-hour period. Despite recent technological advances, insulin pumps available for clinical use are not fully automated yet, requiring users’ input on carbohydrate counting. The iLet bionic pancreas (BP; Beta Bionic, Inc.) is a novel fully automated delivery insulin system in conjunction with CGM, and the only input required to initiate the pump is patient’s body weight. The iLet can be used in insulin-only configuration or bihormonal configuration delivering both insulin and glucagon. In a random-order cross-over study, 43 participants with T1DM were assigned to bihormonal bionic pancreas and subsequent comparator (conventional or sensor-augmented pump therapy) or vice visa. The bihormonal bionic pancreas demonstrated superior glycemic control without the need for carbohydrate counting when compared to comparator [130]. In 2019, the FDA granted breakthrough device designation to the iLet BP system [131], and the Insulin-Only BP Pivotal Trial: Testing the iLet in Adults and Children With Type 1 Diabetes was recently published. This Pivotal trial included 440 participants with T1DM and compared efficacy and safety end points using the insulin-only configuration of the iLet BP system versus usual care during a 13-week study period [132]. The insulin-only BP demonstrated a reduction in HbA1c and an improvement in time in range without increasing hypoglycemia in both adult and children with T1DM, compared to the standard of care [133,134].
Cost-effectiveness analysis of continuous subcutaneous insulin infusion versus multiple daily insulin for treatment of children with type 1 diabetes
Published in Postgraduate Medicine, 2022
Lijuan Zhang, Xuefei Leng, Fei Tian, Dunming Xiao, Jianwei Xuan, Hongxiu Yang, Jing Liu, Zhihong Chen
First, a sensitivity analysis was conducted on the baseline HbA1c >7.5% (58 mmol/mol). Because the higher the HbA1c, the more it will decrease after treatment, a sensitivity analysis was conducted to test more conservative assumptions of baseline HbA1c. Specifically, HbA1c was reduced by 10% and 20% relative to the base case. Second, an analysis was conducted with varying price of the Medtronic insulin pump. The insulin pump price was ¥35,800, ¥49,800, and ¥60,000, respectively, and the base case was ¥49,800. Third, for the cohort with insulin pump cost at ¥49,800 and the time horizon of 70 years, the impact of cost of insulin pump upgrades (−50%, −40%, −30%, −20%, −10%) was examined. The impact of the discount rates for future costs and benefits was assessed by applying an annual discount rate of 3%, 5% (base case), and 8%, respectively. Finally, a probabilistic sensitivity analysis (PSA) that using Monte Carlo emulation with 1,000 iterations per time randomly sampling from the distribution for all parameters simultaneously, which was in order to assess the joint uncertainty associated with multiple parameters. The outcomes of analysis are represented in the scatter plot and cost-effectiveness acceptability curve.
A clinical review of the t:slim X2 insulin pump
Published in Expert Opinion on Drug Delivery, 2020
Cari Berget, Samantha Lange, Laurel Messer, Gregory P. Forlenza
Intensive insulin therapy is the gold standard of T1D care and consists of either multiple daily injections of insulin (MDI) or use of an insulin pump. MDI consists of a daily injection of a long-acting insulin (i.e. glargine, detemir, degludec) and 3–4 injections each day of a rapid-acting insulin (i.e. lispro, aspart, glulisine) with meals. An insulin pump is a small, portable medical device that delivers insulin through a small cannula inserted under the skin and secured in place with adhesive. There are many benefits to using an insulin pump compared to MDI for intensive insulin therapy. Insulin pumps allow for more precise insulin dosing, more flexibility in daily self-care, and fewer injections compared to MDI. Many studies and systematic reviews have reported improved glycemic control with insulin pumps compared to MDI [10–17]. Additionally, use of an insulin pump is associated with about a 50% reduction in risk of cardiovascular mortality compared to MDI [18] and is cost-effective, with a recent systematic review reporting a cost-effectiveness ratio of approximately 31,000 euros for each quality adjust life year (QALY) gained [19]. There are three main insulin pump manufacturers in the United States: Medtronic Minimed Inc., Insulet Corporation, and Tandem Diabetes Inc. This paper will evaluate the t:slim X2 insulin pump (Tandem Diabetes), which is approved by the Food and Drug Administration (FDA) for adults and children with T1D in the United States and used internationally.