A Review of the Current Challenges Associated with the Development of an Artificial Pancreas by a Double Subcutaneous Approach

Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders
Sverre Christian ChristiansenSven Magnus Carlsen

Abstract

Patients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range. Based on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach. Finally, we discuss safety measures and the achievements reported in some recent AP studies that have utilized the double SC approach. Most studies show that a double SC AP increases the time in range compared to a sensor-augmented insulin pump and shortens the time in hypoglycemia. Despite these achievements, the proportion of time spent in hyperglycemia is still roughly 20-40%, and hypoglycemia is still present 1-4% of the time. The main factors limiting further progress are the latency of SC CGM (at least 5-10 min) and the slow pharmacokinetics of SC-delivered fast-acting insulin. T...Continue Reading

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Citations

Oct 10, 2018·PloS One·Marte Kierulf ÅmSverre Christian Christiansen
Nov 30, 2018·BMJ Open Diabetes Research & Care·Ilze Dirnena-FusiniSverre Christian Christiansen
Sep 27, 2018·Current Diabetes Reports·Michiel F Nijhoff, Eelco J P de Koning
Jan 17, 2021·BMJ Open Diabetes Research & Care·Ilze Dirnena-FusiniSverre Christian Christiansen
Apr 24, 2021·World Journal of Diabetes·Masaki NagayaHiroshi Nagashima
Jun 6, 2021·Biosensors & Bioelectronics·Nur Farrahain Nadia AhmadYew Hoong Wong

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