PMID- 28503717
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220330
IS  - 1869-6953 (Print)
IS  - 1869-6961 (Electronic)
IS  - 1869-6961 (Linking)
VI  - 8
IP  - 3
DP  - 2017 Jun
TI  - A Review of the Current Challenges Associated with the Development of an 
      Artificial Pancreas by a Double Subcutaneous Approach.
PG  - 489-506
LID - 10.1007/s13300-017-0263-6 [doi]
AB  - INTRODUCTION: 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. METHODS: 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. RESULTS: 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. The maximum blood insulin 
      level is reached after 45 min and the maximum glucose-lowering effect is observed 
      after 1.5-2 h, while the glucose-lowering effect lasts for at least 5 h. 
      CONCLUSIONS: Although using a double SC AP leads to significant improvements in 
      glucose control, the SC approach has severe limitations that hamper further 
      progress towards a robust AP.
FAU - Christiansen, Sverre Christian
AU  - Christiansen SC
AD  - Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, 
      Trondheim, Norway. sverre.christiansen@ntnu.no.
AD  - Department of Cancer Research and Molecular Medicine, Norwegian University of 
      Science and Technology (NTNU), Trondheim, Norway. sverre.christiansen@ntnu.no.
FAU - Fougner, Anders Lyngvi
AU  - Fougner AL
AD  - Department of Engineering Cybernetics, Norwegian University of Science and 
      Technology (NTNU), Trondheim, Norway.
AD  - Central Norway Regional Health Authority, Stjordal, Norway.
FAU - Stavdahl, Oyvind
AU  - Stavdahl O
AD  - Department of Engineering Cybernetics, Norwegian University of Science and 
      Technology (NTNU), Trondheim, Norway.
FAU - Kolle, Konstanze
AU  - Kolle K
AD  - Department of Engineering Cybernetics, Norwegian University of Science and 
      Technology (NTNU), Trondheim, Norway.
AD  - Central Norway Regional Health Authority, Stjordal, Norway.
FAU - Ellingsen, Reinold
AU  - Ellingsen R
AD  - Department of Electronic Systems, Norwegian University of Science and Technology 
      (NTNU), Trondheim, Norway.
FAU - Carlsen, Sven Magnus
AU  - Carlsen SM
AD  - Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, 
      Trondheim, Norway.
AD  - Department of Cancer Research and Molecular Medicine, Norwegian University of 
      Science and Technology (NTNU), Trondheim, Norway.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170513
PL  - United States
TA  - Diabetes Ther
JT  - Diabetes therapy : research, treatment and education of diabetes and related 
      disorders
JID - 101539025
PMC - PMC5446388
OTO - NOTNLM
OT  - Artificial pancreas
OT  - Continuous glucose monitoring
OT  - Continuous subcutaneous insulin infusion
OT  - Type 1 diabetes
EDAT- 2017/05/16 06:00
MHDA- 2017/05/16 06:01
PMCR- 2017/05/13
CRDT- 2017/05/16 06:00
PHST- 2017/03/09 00:00 [received]
PHST- 2017/05/16 06:00 [pubmed]
PHST- 2017/05/16 06:01 [medline]
PHST- 2017/05/16 06:00 [entrez]
PHST- 2017/05/13 00:00 [pmc-release]
AID - 10.1007/s13300-017-0263-6 [pii]
AID - 263 [pii]
AID - 10.1007/s13300-017-0263-6 [doi]
PST - ppublish
SO  - Diabetes Ther. 2017 Jun;8(3):489-506. doi: 10.1007/s13300-017-0263-6. Epub 2017 
      May 13.