Towards a Physiological Prandial Insulin Profile: Enhancement of Subcutaneously Injected Prandial Insulin Using Local Warming Devices

The need to develop an insulin delivery system that can closely mimic physiologically induced changes in prandial insulin release has been a major research target since the discovery of insulin. The challenges facing existing insulin delivery systems, related to relatively slow pharmacokinetics and pharmacodynamics, have been further highlighted by rapid advances in diabetes technology and progress in artificial pancreas research. Despite the growing interest in alternative routes of insulin administration, the subcutaneous route remains—at least for now—the preferred route for insulin administration. In this article, we review efforts aimed at developing subcutaneously injected ultrafast-acting insulin and measures aimed at enhancing insulin absorption, focusing on local warming devices

Measures of Glycemic Variability In Type 1 Diabetes and the Effect of Real-Time Continuous Glucose Monitoring

Objective: To report the impact of continuous glucose monitoring (CGM) on glycemic variability (GV) indices, factors predictive of change and to correlate variability with conventional markers of glycaemia. Methods: Data from the JDRF study of CGM in participants with type 1 diabetes were used. Participants were randomised to CGM or self-monitored blood glucose (SMBG). GV indices at baseline, at 26 weeks in both groups, and at 52 weeks in the control group were analysed. The associations of demographic and clinical factors with change in GV indices from baseline to 26 weeks were evaluated. Results: Baseline data were available for 448 subjects. GV indices were all outside normative ranges (P<0.001). Inter-correlation between GV indices was common and, apart from coefficient of variation (CV), low blood glucose index (LBGI) and percentage of glycemic risk assessment diabetes equation score attributable to hypoglycaemia (%GRADEhypoglycaemia), all indices correlate positively with HbA1c. There was strong correlation between time spent in hypoglycaemia, and CV, LBGI and %GRADEhypoglycaemia, but not with HbA1c. A significant reduction in all GV indices, except lability index and mean absolute glucose change per unit time (MAG), was demonstrated in the intervention group at 26 weeks compared with the control group. Baseline factors predicting a change in GV with CGM include baseline HbA1c, baseline GV, frequency of daily SMBG and insulin pump use. Conclusions: CGM reduces most GV indices compared with SMBG in people with type 1 diabetes. The strong correlation between time spent in hypoglycaemia and CV, LBGI and %GRADEhypoglycaemia highlights the value of these metrics in assessing hypoglycaemia as an adjunct to HbA1c in overall assessment of glycaemia

Clinical and in vitro

Treatment of infections caused by Burkholderia cepacia complex (Bcc) in cystic fibrosis (CF) patients poses a complex problem. Bcc is multidrug-resistant due to innate and acquired mechanisms of resistance. As CF patients receive multiple courses of antibiotics, susceptibility patterns of strains from CF patients may differ from those noted in strains from non-CF patients. Thus, there was a need for assessing in vitro and clinical data to guide antimicrobial therapy in these patients. A systematic search of literature, followed by extraction and analysis of available information from human and in vitro studies was done. The results of the analysis are used to address various aspects like use of antimicrobials for pulmonary and non-pulmonary infections, use of combination versus monotherapy, early eradication, duration of therapy, route of administration, management of biofilms, development of resistance during therapy, pharmacokinetics–pharmacodynamics correlations, therapy in post-transplant patients and newer drugs in Bcc-infected CF patients