Development of glucose-responsive 'smart' insulin systems. Issue 4 (August 2017)

• Record Type: Journal Article
• Authors: Rege, Nischay K.; Phillips, Nelson F.B.; Weiss, Michael A.
• Is Part Of: Current opinion in endocrinology, diabetes and obesity. Volume 24:Issue 4(2017:Aug.)
• Publication Date: 2017-08
• Subjects: artificial pancreas -- diabetes -- glucose-responsive insulin -- glucose-responsive polymers -- hypoglycemia; Endocrinology -- Periodicals; Diabetes -- Periodicals; Obesity -- Periodicals; Diabetes Mellitus -- Periodicals; Endocrine System Diseases -- Periodicals; Endocrine Glands -- Periodicals; Obesity -- Periodicals; Endocrinologie -- Périodiques; Diabète -- Périodiques; Obésité -- Périodiques; Diabetes; Endocrinology; Obesity; Periodicals; 616.4
• DOI: 10.1097/MED.0000000000000345
• Languages: English
• ISSNs: 1752-296X

Abstract

Abstract : Purpose of review: The complexity of modern insulin-based therapy for type I and type II diabetes mellitus and the risks associated with excursions in blood–glucose concentration (hyperglycemia and hypoglycemia) have motivated the development of 'smart insulin' technologies (glucose-responsive insulin, GRI). Such analogs or delivery systems are entities that provide insulin activity proportional to the glycemic state of the patient without external monitoring by the patient or healthcare provider. The present review describes the relevant historical background to modern GRI technologies and highlights three distinct approaches: coupling of continuous glucose monitoring (CGM) to deliver devices (algorithm-based 'closed-loop' systems), glucose-responsive polymer encapsulation of insulin, and molecular modification of insulin itself. Recent findings: Recent advances in GRI research utilizing each of the three approaches are illustrated; these include newly developed algorithms for CGM-based insulin delivery systems, glucose-sensitive modifications of existing clinical analogs, newly developed hypoxia-sensitive polymer matrices, and polymer-encapsulated, stem-cell-derived pancreatic β cells. Summary: Although GRI technologies have yet to be perfected, the recent advances across several scientific disciplines that are described in this review have provided a path towards their clinical implementation.