New technologies in insulin delivery

Abstract

The electronic age is bringing advances in the treatment of diabetes, and this is important because the complications of diabetes remain despite the availability of effective therapeutic tools such as insulin. These developments focus on the need to deliver accurately timed and sized doses for predicted blood glucose levels. In this review, blood monitoring methods are discussed since, although the chemistry remains based on the enzymic oxidation of glucose, the display, storage and manipulation of data have transformed recently to engage with smartphone users. Continuous glucose monitoring sensing (CGMS) types are described along with an appreciation of the shortcomings of sensor technology. The discussion includes responses to other barriers to CGMS use for reducing the HbA1c value safely so that hypoglycaemia can be avoided. The newer pumps and the emergence of the minimalised patch pumps and patch pens are described. This includes the moves to attract more type 2 users to pump use, addresses the perceived obtrusiveness noted by younger users, and reviews the obstacles to rolling out pump use more widely in the UK. Penultimately, after reference to islet implants, the combination of the continuous sensing and conventional pump strategies to form a closed loop system is described, including a summary of the electronic algorithms and the clinical performance of systems in research settings. The review closes with an explanation of how other closed loop systems have been developed including the peritoneal Medtronic and the DiaPort and a smart gel, non-electronic design. Copyright © 2013 John Wiley & Sons.