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Diabetologia

Erschienen in:

12.03.2021 | Review

‘Smart’ insulin-delivery technologies and intrinsic glucose-responsive insulin analogues

verfasst von: Mark A. Jarosinski, Balamurugan Dhayalan, Nischay Rege, Deepak Chatterjee, Michael A. Weiss

Erschienen in: Diabetologia | Ausgabe 5/2021

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Abstract

Insulin replacement therapy for diabetes mellitus seeks to minimise excursions in blood glucose concentration above or below the therapeutic range (hyper- or hypoglycaemia). To mitigate acute and chronic risks of such excursions, glucose-responsive insulin-delivery technologies have long been sought for clinical application in type 1 and long-standing type 2 diabetes mellitus. Such ‘smart’ systems or insulin analogues seek to provide hormonal activity proportional to blood glucose levels without external monitoring. This review highlights three broad strategies to co-optimise mean glycaemic control and time in range: (1) coupling of continuous glucose monitoring (CGM) to delivery devices (algorithm-based ‘closed-loop’ systems); (2) glucose-responsive polymer encapsulation of insulin; and (3) mechanism-based hormone modifications. Innovations span control algorithms for CGM-based insulin-delivery systems, glucose-responsive polymer matrices, bio-inspired design based on insulin’s conformational switch mechanism upon insulin receptor engagement, and glucose-responsive modifications of new insulin analogues. In each case, innovations in insulin chemistry and formulation may enhance clinical outcomes. Prospects are discussed for intrinsic glucose-responsive insulin analogues containing a reversible switch (regulating bioavailability or conformation) that can be activated by glucose at high concentrations.

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Titel: ‘Smart’ insulin-delivery technologies and intrinsic glucose-responsive insulin analogues
verfasst von: Mark A. Jarosinski
Balamurugan Dhayalan
Nischay Rege
Deepak Chatterjee
Michael A. Weiss
Publikationsdatum: 12.03.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Diabetologia / Ausgabe 5/2021
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-021-05422-6

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