Insulin pump failures are still frequent: A prospective study over 6 years from 2001 to 2007
Department of Endocrinology, CHU Rennes, Hôpital sud, 16 boulevard de Bulgarie, 35203, Rennes, France.Diabetologia (Impact Factor: 6.67). 10/2009; 52(12):2662-4. DOI: 10.1007/s00125-009-1549-7
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- "However, the challenge for achieving a clinically suitable application for GDNF is its localized and sustained release to the nerve injury site  . Current investigational methods of GDNF local delivery include viral transfected Schwann cells  , and catheter/mini-osmotic pump systems . While viral transduction of primary cells generates local release, regulation of GDNF release is difficult to manage and can result in excess and toxic GDNF release. "
ABSTRACT: Statement of significance: This work addresses the common clinical situation in which a nerve gap is bridged using acellular nerve allografts. However, these allografts are not as effective in supporting nerve regeneration as the gold standard method of autografting. The novel local drug delivery system used in this study provides sustained and controlled release of glial cell line-derived neurotrophic factor (GDNF), one of the most potent neurotrophic factors, which significantly improves nerve regeneration following severe nerve injuries. Results from this research will provide a mean of improving nerve allografts with locally delivered GDNF. This strategy may lead to a novel "off the shelf" alternative to the current management of severe nerve injuries.
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- "Other potential issues include infections at infusion sites and pump malfunctions. In a recent survey of 640 new pumps from four different manufacturers , 36 % were reported to have had a defect of some sort including 16 % which had to be replaced. The T1D Exchange Clinic Registry data suggests 4.4 % of patients discontinued insulin pump therapy, with a variety of reasons cited, the most common being comfort. "
ABSTRACT: Achieving optimal glucose control with minimal hypoglycemia and minimizing the impact of diabetes on quality of life are the aims of management of type 1 diabetes. The main therapeutic options for patients include multiple daily injections (MDI) and continuous subcutaneous insulin therapy (CSII). It is important to differentiate fixed dose MDI with more flexible use, based on carbohydrate counting and structured education programmes, often termed functional insulin therapy (FIT), shown to deliver better outcomes. A significant proportion of patients can achieve optimal glucose control with either therapy, and for those who are unable to achieve desired glucose control with MDI, there is a large body of observational data showing CSII enables them to reduce HbA1c and hypoglycemia, with associated improvements in diabetes-related quality of life. However, in many healthcare systems, guidelines restrict the use of CSII on the basis of cost, with only 20-35 % of patients with type 1 diabetes across Europe using CSII. Although data support improved glucose control and quality of life with CSII, we must recognize that insulin pump therapy is not for everyone and has some downsides such as being attached to a device or issues with cannulas. When we sit down with our patients, we have a responsibility to support those patients with the therapeutic strategy that is best suited to them. In this paper, we review some of the literature that informs this decision-making, highlighting areas where CSII offers clear benefits and also some areas where it may not be appropriate.
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ABSTRACT: KeywordsInsulin-Insulin pump-Overdose-Hypoglycemia-Diabetes-Adolescent