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The
aim of this survey was to establish the limitations of open loop continuous
subcutaneous insulin infusion (CSII) as perceived by current users of the
technology, and to ascertain their interest in and requirements for a
non-electronic implantable closed loop insulin pump, INSmart, currently under
development for the treatment of type 1 diabetes. INSmart has been surgically
implanted in the peritoneum in animal models and continuously restored
normoglycaemia.
A
bottom-up survey design was used to determine both positive and negative
experiences of patients currently using CSII to define the performance
characteristics they would require from a non-electronic, implantable closed
loop insulin pump.
A
total of 360 insulin pump users completed the survey. All respondents had
type 1 diabetes, were predominantly from English-speaking countries and had
been diagnosed before age 34 years. Most had well controlled blood glucose
(BG) according to their self-reported HbA1c results.
They reported a reduction in this value after transferring to CSII from
multi-dose injections. However, 70% of pump users had more than three
hypoglycaemic episodes per week. Eighty percent reported self-measured BG
values >10mmol/L three or more times per month; 94% of respondents
considered a (non-electronic implantable) closed loop insulin pump would make
their BG management easier and improve their quality of life.
The
majority of respondents felt there were still many disadvantages to current
external insulin pumps such as their constant visible presence, rotation of
insertion sites and skin inflammation. These shortfalls could be overcome by
a device, such as INSmart, that provides a relatively instant feedback
mechanism for controlling insulin release due to its proposed location in the
peritoneal cavity.
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ملخص المشاركة:
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Using a questionnaire, we
compared T1D and T2D regarding glucose management relative to type and
intensity of appropriate exercise. The 240 respondents completed the
questionnaire, 64% of which were T1D and 36% being T2D. Approximately 65%
thought that exercise had a positive effect on their diabetes with 95% of T1D
and T2D preferring walking as the main form of exercise. 62% of T1D and only
8% of T2D tested their blood glucose (BG) more than four times daily on a
non-exercise day. For T1D 57% tested BG more often than usual on an exercise
day compared with only 12% of T2D. About 90% did not change the number of
insulin injections for an exercise day. Only 23% of T1D did not change the
dose, whereas 43% of T2D did and this is weakly dependent in each case on the
type of exercise anticipated. Of these, 60% administered their dose following
exercise with few interrupting exercise to do so. About 52% of T1D and 20% of
T2D had hypos up to three times in the previous month, with the major risk
period up to 2 hours following the exertion. To mitigate this threat,
carbohydrate boosts were more common before exercise than after and again,
few disturbed the session for this purpose. Insulin users of both diabetic
types understand that to use exercise regimens safely they must monitor their
glucose and prepare on an individual basis for hypoglycaemia, using BG tests
and carbohydrate support but making adjustments to dose a lower priority.
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ملخص المشاركة:
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The estimated prevalence of diabetes
Type 1(T1D) and 2 (T2D) 90% of total, worldwide for 2014 was 382 million and
is expected to increase in the future beyond 592 million in less than 25
years. Some of the factors that may have contributed to increases in T2D
include obesity, unhealthy dietary and sedentary lifestyles. There is a
continuous relationship between glycosylated haemoglobin (HbA1c) and the risk
of microvascular and macrovascular complication of diabetes. Aerobic (AE) and resistance (RE) exercise
are recommended in the prevention and management of diabetes.
With institutional ethics approval, 25
volunteers from 4 different groups: Non- diabetics (ND) = 7, (T1D) = 7, Type
2 tablet (T2T) = 7, Type 2 Insulin
(T2I) = 4, participated in the study. Following preliminary tests, volunteers
undertook 2 x 2 hour exercise sessions a week for a 6 week period. Each
exercise session consisted of a combined of 35 min RE (3 sets of 8 -10
repetitions at 50 – 60% of predicted one-repetition maximum strength 1-RM )
followed by 20 min AE which was moderate cycling at 50 – 60% of predetermined
heart rate reserve (HRR).
Data were compared by Paired samples
T-Test and are presented as mean ± SD. Significance was accepted at P ˂
0.05. HbA1c values were decreased in all the groups after the exercise trial
compared to before the exercise (ND: 5.4± 0.3 to 5.2± 0.3, P ˂ 0.01, T1D: 7±
0.7 to 6.7± 0.7, P ˂ 0.01, T2T: 7.6± 1.2 to 7.2± 1.1, P ˂ 0.01, T2I: 7.3± 0.7
to 6.8± 0.7, P ˂ 0.06). These findings
suggested those six weeks of combined RE and AE at moderate intensity has
improved glycaemic control for people with diabetes and ND volunteers.
Further studies on a larger sample population need to be done to confirm
these findings.
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