1
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Zhou L, Huber DE, van Antwerp B, Pennathur S. Electrooxidation of Phenol on Polyelectrolyte Modified Carbon Electrodes for Use in Insulin Pump Infusion Sets. J Diabetes Sci Technol 2024; 18:625-634. [PMID: 36112811 PMCID: PMC11089874 DOI: 10.1177/19322968221123083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many type 1 diabetes patients using continuous subcutaneous insulin infusion (CSII) suffer from the phenomenon of unexplained hypoglycemia or "site loss." Site loss is hypothesized to be caused by toxic excipients, for example, phenolic compounds within insulin formulations that are used as preservatives and stabilizers. Here, we develop a bioinspired polyelectrolyte-modified carbon electrode for effective electrooxidative removal of phenol from insulin and eventual incorporations into an infusion set of a CSII device. METHODS We modified a carbon screen printed electrode (SPE) with poly-L-lysine (PLL) to avoid passivation due to polyphenol deposition while still removing phenolic compounds from insulin injections. We characterized these electrodes using scanning electron microscopy (SEM) and electrochemical impedance spectroscopy (EIS) and compared their data with data from bare SPEs. Furthermore, we performed electrochemical measurements to determine the extent of passivation, and high-performance liquid chromatography (HPLC) measurements to confirm both the removal of phenol and the integrity of insulin after phenol removal. RESULTS Voltammetry measurements show that electrode passivation due to polyphenol deposition is reduced by a factor of 2X. HPLC measurements confirm a 10x greater removal of phenol by our modified electrodes relative to bare electrodes. CONCLUSION Using bioinspired polyelectrolytes to modify a carbon electrode surface aids in the electrooxidation of phenolic compounds from insulin and is a step toward integration within an infusion set for mitigating site loss.
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Affiliation(s)
- Lingyun Zhou
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - David E. Huber
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | - Sumita Pennathur
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA
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2
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Abstract
Continuous subcutaneous insulin infusion (CSII, or insulin pump) and continuous glucose monitoring (CGM) sensors have been increasingly used and associated with improved glycemic control by people with type 1 diabetes and insulin-requiring type 2 diabetes. Commonly used infusion sets in most CSII systems are limited to a wear time of 3 days. In contradistinction, CGM sensors are currently approved for seven and more days of wear. With the motivation to provide a 7-day infusion set that matches the CGM wear time and to improve patient experience, the recently CE-marked and FDA 510k-cleared Medtronic extended infusion set (EIS) was designed.s The EIS offers enhanced new features that include use for up to 7 days, improved convenience, comfort, and better quality of life for insulin pump users.
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Affiliation(s)
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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3
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Lal R, Leelarathna L. Insulin Delivery Hardware: Pumps and Pens. Diabetes Technol Ther 2024; 26:S32-S44. [PMID: 38441453 DOI: 10.1089/dia.2024.2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Rayhan Lal
- Division of Endocrinology, Department of Medicine and Department Pediatrics
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, and Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, United Kingdom
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4
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Kastner JR, Eisler G, Torjman MC, Khalf A, Diaz D, Dinesen AR, Loeum C, Strasma PJ, Joseph JI. In Vivo Study of the Inflammatory Tissue Response Surrounding a Novel Extended-Wear Kink-Resistant Insulin Infusion Set Prototype Compared With a Commercial Control Over Two Weeks of Wear Time. J Diabetes Sci Technol 2023; 17:1563-1572. [PMID: 35533132 PMCID: PMC10658669 DOI: 10.1177/19322968221093362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infusion set function remains the limiting factor of insulin pump therapy due to nonmetabolic complications. Here, we tested an investigational extended-wear infusion set prototype with a soft, angled, wire-reinforced cannula with three additional side holes, and compared failure mechanisms and tissue response with a commercial Teflon control. METHODS A total of 48 Teflon and 48 prototype infusion sets were inserted subcutaneously every other day for 14 days in 12 swine and infused with dilute insulin. After two weeks, tissue around cannulas was excised, and occlusions, leaks, and kinks were determined. Tissue was processed and stained to assess the total area of inflammation (TAI) and the inflammatory layer thickness (ILT) around the cannulas. Data were analyzed using Fisher's exact, analysis of variance-general linear model, Kruskal-Wallis, and post hoc tests. RESULTS On average, the TAI surrounding the investigational cannula was 52.6% smaller than around the commercial control. The ILT was 66.3% smaller around investigational cannulas. Kinks occurred in 2.1% (investigational) vs 32.4% (commercial) cannulas (P < .001). There was no difference in occlusion alarms and leaks onto skin. CONCLUSIONS The data suggest that the infusion set prototype elicits less inflammation over an extended wear time and is resistant to kinking, compared with a commercial Teflon device. This is consistent with previously published data on the impact of cannula material/angle on the inflammatory tissue response. We highlight the following important aspects of infusion set design: (1) secure skin adhesion, (2) reliable cannula insertion, (3) automatic removal of the stylet, (4) cannula material/design that resists kinking, and (5) minimization of local tissue inflammation.
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Affiliation(s)
- Jasmin R. Kastner
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
- Capillary Biomedical Inc, Irvine, CA, USA
| | - Gabriella Eisler
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marc C. Torjman
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Abdurizzagh Khalf
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Diaz
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alek R. Dinesen
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Channy Loeum
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Jeffrey I Joseph
- Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, PA, USA
- Capillary Biomedical Inc, Irvine, CA, USA
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5
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Huang J, Yeung AM, Kerr D, Gentile S, Heinemann L, Al-Sofiani ME, Joseph JI, Seley JJ, Klonoff DC. Lipohypertrophy and Insulin. An Old Dog that Needs New Tricks. Endocr Pract 2023:S1530-891X(23)00386-5. [PMID: 37098370 DOI: 10.1016/j.eprac.2023.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To review the current status of practical knowledge related to insulin-associated lipohypertrophy (LH) - an accumulation of fatty subcutaneous nodules commonly caused by repeated injections and/or infusions of insulin into the same site. METHODS Review of published literature with additional contributions from leading multidisciplinary experts with the emphasis on clinical aspects including pathophysiology, clinical and economic consequences, diagnosis, prevention and treatment. RESULTS LH is the most common dermatologic complication of insulin therapy. Risk factors for the development of lipohypertrophy include repeated delivery of large amounts of insulin into the same location over time, repeated injection trauma to the skin and subcutaneous tissue, and multiple injections using the same needle. Subcutaneous insulin injection in skin areas with lipohypertrophy is associated with reduced pain; however, this problem can interfere with insulin absorption, thereby increasing the likelihood of glucose variability, hypo- and hyperglycemia when a site is changed. Modern visualization technology of the subcutaneous space with ultrasound can demonstrate lipohypertrophy early in the course of its development. CONCLUSIONS The physiological and psychological consequences of developing insulin lipohypertrophy can be prevented and treated with education focusing on insulin injection techniques.
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Affiliation(s)
- Jingtong Huang
- Diabetes Technology Society, Burlingame, California, USA.
| | - Andrea M Yeung
- Diabetes Technology Society, Burlingame, California, USA
| | - David Kerr
- Diabetes Technology Society, Burlingame, California, USA
| | - Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy; NefroCenter Research Network, Torre del Greco, Naples, Italy
| | | | - Mohammed E Al-Sofiani
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University, Baltimore, Maryland, USA; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jeffrey I Joseph
- Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - David C Klonoff
- Diabetes Technology Society, Burlingame, California, USA; Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, California, USA
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6
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Garhyan P, Pratt E, Klein O, Famulla S, Zijlstra E, Lalonde A, Swinney M, Kazda C, Dassau E. Evaluation of Insulin Lispro Pharmacokinetics and Pharmacodynamics Over 10 Days of Continuous Insulin Infusion in People With Type 1 Diabetes. J Diabetes Sci Technol 2023; 17:274-282. [PMID: 36575993 PMCID: PMC10012385 DOI: 10.1177/19322968221145200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND We evaluated the effect of meloxicam on insulin lispro pharmacokinetics and glucose pharmacodynamics over 10 days of continuous subcutaneous insulin infusion (CSII) at one infusion site in people with type 1 diabetes (T1D). METHOD This phase 1, randomized, double-blind, single-center, two-way crossover study enrolled adults with T1D for ≥1 year on stable CSII for ≥3 months. Participants randomly received U100 insulin lispro and LY900027 (U100 insulin lispro + 0.25 mg/mL meloxicam). Primary end points were area under the insulin lispro curve from 0 to 5 hours (AUCIns.0-5h) after bolus administration prior to a mixed-meal tolerance test (MMTT) and maximum observed concentration of insulin lispro (CIns.max) on days 5, 7, and 10, versus day 3 (baseline). RESULTS A total of 20 participants were randomized. Insulin absorption was accelerated for insulin lispro and LY900027 from days 1 to 7. The AUCIns.0-5h was significantly lower on day 10 versus day 3 for LY900027 (-19%) and insulin lispro (-14%); the AUCIns.0-5h did not differ significantly between treatments. The CIns.max increased with LY900027 and insulin lispro (by ~14%-23% and ~16%-51%) on days 5, 7, and 10 versus day 3. The CIns.max of LY900027 was ~14%-23% lower than insulin lispro CIns.max on days 7 and 10 (P ≤ .0805). Accelerated insulin absorption and a modest loss of total insulin exposure led to a loss of MMTT glycemic control at later time points. CONCLUSIONS The pharmacokinetics of insulin changed over catheter wear time even when an anti-inflammatory agent was present. Postprandial glycemic control was adversely affected by the accelerated insulin absorption and decreased insulin exposure.
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Affiliation(s)
| | - Edward Pratt
- Lilly Centre for Clinical Pharmacology,
Singapore, Singapore
| | | | | | | | - Amy Lalonde
- Eli Lilly and Company, Indianapolis,
IN, USA
| | | | | | - Eyal Dassau
- Eli Lilly and Company, Indianapolis,
IN, USA
- Eli Lilly and Company, Cambridge, MA,
USA
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7
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Lal RA, Leelarathna L. Insulin Delivery Hardware: Pumps and Pens. Diabetes Technol Ther 2023; 25:S30-S43. [PMID: 36802186 PMCID: PMC10081698 DOI: 10.1089/dia.2023.2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Rayhan A Lal
- Division of Endocrinology, Department of Medicine & Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK and Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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8
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Nguyen KT, Xu NY, Buckingham BA, Chattaraj S, Cohen O, Heinemann L, Pickup J, Svensson J, Vigersky RA, Wong JC, Ziegler R. Improving the Patient Experience With Longer Wear Infusion Sets Symposium Report. J Diabetes Sci Technol 2022; 16:775-782. [PMID: 35227075 PMCID: PMC9294583 DOI: 10.1177/19322968221078884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Continuous subcutaneous insulin infusion (CSII) therapy is becoming increasingly popular. CSII provides convenient insulin delivery, precise dosing, easy adjustments for physical activity, stress, or illness, and integration with continuous glucose monitors in hybrid or other closed-loop systems. However, even as insulin pump hardware and software have advanced, technology for insulin infusion sets (IISs) has stayed relatively stagnant over time and is often referred to as the "Achilles heel" of CSII. To discuss barriers to insulin pump therapy and present information about advancements in, and results from clinical trials of extended wear IISs, Diabetes Technology Society virtually hosted the "Improving the Patient Experience with Longer Wear Infusion Sets Symposium" on December 1, 2021. The symposium featured experts in the field of IISs, including representatives from Steno Diabetes Center Copenhagen, University of California San Francisco, Stanford University, Medtronic Diabetes, and Science Consulting in Diabetes. The webinar's seven speakers covered (1) advancements in insulin pump therapy, (2) efficacy of longer wear infusion sets, and (3) innovations to reduce plastics and insulin waste.
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Affiliation(s)
- Kevin T. Nguyen
- Diabetes Technology Society, Burlingame, CA,
USA
- Kevin T. Nguyen, BA, Diabetes Technology Society,
845 Malcolm Road Suite 5, Burlingame, CA 94010, USA.
| | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA,
USA
| | | | | | - Ohad Cohen
- Medtronic Diabetes EMEA, Tolochenaz,
Switzerland
| | | | - John Pickup
- Faculty of Life Sciences & Medicine,
King’s College London, London, UK
| | | | | | - Jenise C. Wong
- University of California, San Francisco, San
Francisco, CA, USA
| | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents,
Muenster, Germany
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9
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Regittnig W, Tschaikner M, Tuca A, Simic A, Feiel J, Schaller‐Ammann R, Licht AH, Jungklaus M, Pieber TR. Insulin induces a progressive increase in the resistance of subcutaneous tissue to fluid flow: Implications for insulin pump therapy. Diabetes Obes Metab 2022; 24:455-464. [PMID: 34739179 PMCID: PMC9299465 DOI: 10.1111/dom.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
AIM To determine the effect of insulin on the resistance of subcutaneous tissue to the flow of infusion fluids. MATERIALS AND METHODS Thirty subjects with type 1 diabetes wore two Accu-Chek Spirit Combo insulin pumps with Accu-Chek FlexLink infusion sets (Roche Diabetes Care, Mannheim, Germany) for 7 days. One pump was filled with insulin aspart (Novo Nordisk, Bagsvaerd, Denmark) and used for continuous subcutaneous insulin infusion (CSII). The other pump was filled with insulin diluting medium (IDM; Novo Nordisk) and used to deliver IDM subcutaneously at rates identical to those employed for CSII. Both infusion sites were assessed daily by measuring the pressure required to infuse various bolus amounts of IDM. RESULTS On day 1, maximum pressure (Pmax ) and tissue flow resistance (TFR; calculated from measured pressure profiles) were similar for both infusion sites (P > 0.20). During the subsequent study days, the Pmax and TFR values observed at the IDM infusion site remained at levels comparable to those seen on day 1 (P > 0.13). However, at the site of CSII, Pmax and TFR progressively increased with CSII duration. By the end of day 7, Pmax and TFR reached 25.8 */2.11 kPa (geometric mean */geometric standard deviation) and 8.64 */3.48 kPa*s/μL, respectively, representing a remarkable 3.5- and 20.6-fold increase relative to the respective Pmax and TFR values observed on day 1 (P < 0.001). CONCLUSION Our results suggest that insulin induces a progressive increase in the resistance of subcutaneous tissue to the introduction of fluid; this has important implications for the future design of insulin pumps and infusion sets.
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Affiliation(s)
- Werner Regittnig
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Mathias Tschaikner
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Alexandru‐Cristian Tuca
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Amra Simic
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Jürgen Feiel
- JOANNEUM RESEARCH Forschungsgesellschaft mbHHEALTH–Institute for Biomedicine and Health SciencesGrazAustria
| | - Roland Schaller‐Ammann
- JOANNEUM RESEARCH Forschungsgesellschaft mbHHEALTH–Institute for Biomedicine and Health SciencesGrazAustria
| | | | - Miró Jungklaus
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Thomas R. Pieber
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- JOANNEUM RESEARCH Forschungsgesellschaft mbHHEALTH–Institute for Biomedicine and Health SciencesGrazAustria
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10
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Mulka A, Lewis BE, Mao L, Sharafieh R, Kesserwan S, Wu R, Kreutzer DL, Klueh U. Phenolic Preservative Removal from Commercial Insulin Formulations Reduces Tissue Inflammation while Maintaining Euglycemia. ACS Pharmacol Transl Sci 2021; 4:1161-1174. [PMID: 34151206 DOI: 10.1021/acsptsci.1c00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 11/28/2022]
Abstract
Background: Exogenous insulin therapy requires stabilization of the insulin molecule, which is achieved through the use of excipients (e.g., phenolic preservatives (PP)) that provide protein stability, sterility and prolong insulin shelf life. However, our laboratory recently reported that PP, (e.g., m-creosol and phenol) are also cytotoxic, inducing inflammation and fibrosis. Optimizing PP levels through filtration would balance the need for insulin preservation with PP-induced inflammation. Method: Zeolite Y (Z-Y), a size-exclusion-based resin, was employed to remove PP from commercial insulin formulations (Humalog) before infusion. Results: PP removal significantly decreased cell toxicity in vitro and inflammation in vivo. Infusion site histological analysis after a 3 day study demonstrated that leukocyte accumulation increased with nonfiltered preparations but decreased after filtration. Additional studies demonstrated that a Z-Y fabricated filter effectively removed excess PP such that the filtered insulin solution achieved equivalent glycemic control in diabetic mice when compared to nonfiltered insulin. Conclusion: This approach represents the proof of concept that using Z-Y for in-line PP removal assists in lowering inflammation at the site of insulin infusion and thus could lead to extending the functional lifespan of insulin infusion sets in vivo.
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Affiliation(s)
- Adam Mulka
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, Michigan 48202,United States
| | - Brianne E Lewis
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, Michigan 48202,United States
| | - Li Mao
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, Michigan 48202,United States
| | - Roshanak Sharafieh
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, Connecticut 06030-2100, United States
| | - Shereen Kesserwan
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, Michigan 48202,United States
| | - Rong Wu
- Connecticut Convergence Institute, School of Medicine, University of Connecticut, Farmington, Connecticut 06030-6022, United States
| | - Donald L Kreutzer
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, Connecticut 06030-2100, United States
| | - Ulrike Klueh
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, Michigan 48202,United States
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