Adherence and Persistence to Insulin Therapy in People with Diabetes: Impact of Connected Insulin Pen Delivery Ecosystem.

Diabetes is an increasing public health problem, and insulin is the mainstay for treatment of type 1 diabetes. In type 2 diabetes treatment, insulin therapy is used after oral or other injectable agents become inadequate to achieve glycemic control. Despite the advances in insulin therapy, management of diabetes remains challenging. Numerous studies have reported low adherence and persistence to insulin therapy, which acts as a barrier to successful glycemic control and diabetes management. The aim of this targeted review article is to provide an overview of adherence and persistence to insulin therapy in people with diabetes and to discuss the impact of the emergence of a new connected ecosystem of increasingly sophisticated insulin pens, glucose monitoring systems, telemedicine, and mHealth on diabetes management. With the emergence of a connected diabetes ecosystem, we have entered an era of advanced personalized insulin delivery, which will have the potential to enhance diabetes self-management and clinical management. Early systems promise to unlock the potential to address missed or late bolus insulin delivery, which should help to address non-adherence and non-persistence. Over time, improvements in this ecosystem have the potential to combine insulin data with previously missing contextualized patient data, including meal, glucose, and activity data to support personalized clinical decisions and ultimately revolutionize insulin therapy.

The Development of an Exercise Advisor App for Type 1 Diabetes: Digitization Facilitates More Individualized Guidance.

Maintaining blood glucose levels in the target range during exercise can be onerous for people with type 1 diabetes (T1D). Using evidence-based research and consensus guidelines, we developed an exercise advisor app to reduce some of the burden associated with diabetes management during exercise. The app will guide the user on carbohydrate feeding strategies and insulin management strategies before, during, and after exercise and provide targeted and individualized recommendations. As a basis for the recommendations, the decision trees for the app use various factors including the type of insulin regimen, time of activity, previous insulin boluses, and current glucose level. The app is designed to meet the various needs of people with T1D for different activities to promote safe exercise practices.

Evaluation of folate conjugated pegylated thermosensitive magnetic nanocomposites for tumor imaging and therapy.

Superparamagnetic iron oxide nanoparticles (SPIONs) have been receiving great attention lately in biomedical applications, such as in magnetic resonance imaging and drug delivery. However, their systemic administration still remains a challenge due to their hydrophobic nature with instances of aggregation leading to fast reticuloendothelial system (RES) uptake. In this study, magnetic nanocomposites with thermosensitive polymer have been investigated. Random polymers of N-isopropylacrylamide (NIPAAM), acrylic acid (AA) and PEGMA have been coated on SPIONs followed by conjugation with folic acid. Particles of ∼200 nm and low polydispersity 0.1-0.2 having a critical temperature (T(c)) of 44 °C were formed. Thermogravimetric and powder X-ray diffraction studies showed that the nanocomposites were composed of 90% cubic face-centered magnetite. Nearly 76.5% doxorubicin was loaded onto the nanoparticles by diffusion method. Drug release was higher at the hyperthermia temperature (72.42 ± 5.25% in 48 h) proving the thermoresponsive nature of the polymer. Folate conjugated samples showed a magnetization value of 32 emu/g as well as high r1 and r2 relaxivities in magnetic resonance imaging. R2 weighted images of nanocomposites were darker than the control with 20 µg/mL as the darkest. At this concentration the magnetic composites showed nearly 95% viability in L929 fibroblast cells. These thermoresponsive nanosystems with pegylated surfaces and size of ∼200 nm are therefore highly suitable for in vivo imaging and hyperthermia based drug delivery.

Characterization and cell material interactions of PEGylated PNIPAAM nanoparticles.

The aim of this study was to investigate the haemocompatibility of poly(N-isopropylacrylamide)-co-poly(ethylene glycol), PNIPAAM-PEG based nanoparticles and the influence of poly(ethylene glycol), PEG on the interactions of nanoparticles with cells. To achieve this purpose, thermosensitive PNIPAAM-PEG nanoparticles were synthesized by free radical dispersion polymerization method. Optimized nanosystems had particle sizes less than 200 nm, low polydispersity and LCST of 40-41 degrees C. The nanoparticles also showed nearly 83% encapsulation efficiency for doxorubicin HCl with temperature dependent release. Presence of PEG resulted in reduced protein adsorption by more than 50% in comparison to non-PEG containing nanoparticles. Protein adsorption was noted to be dependent on PEG chain length and was the least with M(n)=4000. The particles up to a concentration of 2mg/ml did not show any toxicity on J774 and L929 cell lines. No interactions were observed when NIPAAM-PEG nanoparticles were incubated with blood cells viz. RBCs, neutrophils, platelets and the coagulation system suggesting their haemocompatibility.