Stimuli-Responsive Insulin Delivery Devices
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EXPERT REVIEW
Stimuli-Responsive Insulin Delivery Devices Stephanie Fuchs 1 & Kaavian Shariati 1 & Minglin Ma 1
Received: 8 July 2020 / Accepted: 26 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
ABSTRACT The development of new diabetes treatment strategies has garnered much interest given that conventional management therapies for type 1 diabetes fail to provide optimal glycemic control while creating a high burden of selfcare to patients. Stimuli-responsive, “closed-loop” systems are particularly attractive due to their ability to mimic dynamic ß cell function by releasing insulin in response to fluctuating glucose levels in real-time and with minimal patient discomfort. In this short review, we focus on stimuli-responsive, reservoir-based insulin delivery devices. We explore and evaluate systems that are either physiologically or externally triggered. While obstacles remain before such technologies can be translated to clinical settings, further optimization of delivery systems forebodes that these technologies will have a tremendous impact on type 1 diabetes treatment.
KEY WORDS closed-loop devices . drug delivery . stimuli-responsive . type 1 diabetes
INTRODUCTION In 2019, around 463 million adults were living with diabetes, a chronic disease characterized by high blood glucose levels; this number is projected to reach 700 million in 2045 (1). In healthy individuals, blood sugar is maintained by ß cells within the pancreatic islets of Langerhans that secret insulin in response to fluctuations in blood glucose (2). Type 1 diabetes Guest Editors: Meng Deng and Shihuan Kuang * Minglin Ma [email protected] 1
Department of Biological and Environmental Engineering, Cornell University, 332 Riley Robb Hall 332, Ithaca, New York 14853, USA
(T1D), estimated to account for 10% of all diabetes, is an immune-mediated disease where the ß cells of a patient are destroyed (2). As a result, normoglycemia is not maintained because very little to no insulin is produced. Consistent blood glucose control is therefore achieved via lifelong administration of exogenous insulin (2). However, current therapies cannot prevent glycemic variability, and improper dosing of insulin can lead to severe complications (3). Moreover, these conventional therapies are “open loop” given that they require patients monitoring their blood glucose to determine the corresponding insulin dosages. Consequently, sustaining normoglycemia for T1D patients is very difficult and imposes a high burden of diabetes self-care. As such, there is a great interest in “closed-loop” therapies capable of mimicking dynamic ß cell function by precisely releasing insulin in response to fluctuating glucose levels in real-time with minimal side effects or burden to the patient. Broadly, three “closed-loop” strategies have been developed: (i) insulin infusion pumps, which continuously adjust insulin delivery in response to sensor-detected glucose concentrations; (ii) ß cell replacement therapy via islet cell transplantations; and (iii)
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