Magazine article Drug Topics

Insulin Delivery: Disposable Device Ends Need for Repeated Injections

Magazine article Drug Topics

Insulin Delivery: Disposable Device Ends Need for Repeated Injections

Article excerpt

As rates of type 2 diabetes increase each year, novel approaches to management are necessary. Type 2 diabetes is a progressive disease requiring a variety of treatment regimens specific to each patient. Often patients require treatment intensification beyond oral diabetic medications, with subcutaneous basal insulin and eventually prandial insulin to obtain HbAlc goals.

One treatment shown to be effective for insulin-dependent patients with type 2 diabetes is continuous subcutaneous insulin infusion (CSII).1 In 2012 Valeritas launched V-Go, a disposable insulin delivery device (DIDD) that attaches with an adhesive patch.2 Approved for adults with type 2 diabetes, the V-Go may turn out to be a valuable treatment option for patients requiring mealtime insulin.3

How it works

Through CSII, the V-Go controls basal and bolus mealtime insulin coverage without need for multiple daily injections. It delivers insulin through a 30-gauge, 4.6-mm floating hypodermic needle. The lightweight device is mechanical, not electronic, and does not require batteries or software.45 It supplies CSII for 24 hours and bolus doses of rapid-acting insulin on demand.

Both insulin aspart and insulin lispro have been tested in the V-Go. The bolus doses can be administered with two separate clicks. Clicking the bolusready button enables the activation of the bolus-delivery button. Pressing the bolus-delivery button releases two units of subcutaneous insulin, which should be administered 0-15 minutes before a meal.

The V-Go is available in three preset basal rates of 20, 30, and 40 units daily. Bolus dosing is in two-unit increments, with a total daily maximum of 36 units.4

Proof of concept

The proof-of-concept study to evaluate blood glucose control with a DIDD in type 2 diabetic patients was conducted over seven days. The device enabled patients to maintain blood glucose control with a mean reduction in basal insulin of 19 units per day. Continuous glucose monitoring changes from 173 mg/dl to 157 mg/dl (P=0.063) demonstrated overall glycémie improvement. Although the study sample size (N=6) was too small to prove safety and efficacy, the device was well tolerated, with 100% compliance.5

A retrospective analysis of glycémie control in a cohort of 23 patients over 12 weeks found a statistically significant reduction in mean HbAlc by 1.2% (P=0.005), achieved through use of DIDD. Twelve weeks after discontinuation, the HbAlc increased to 8.2% (P=0.011).6

Patient adherence

Patient adherence is an ongoing challenge in diabetes management. DIDD permits combined control of basal insulin with bolus insulin for mealtime coverage in a once-daily injection. The mealtime insulin is readily available; it is delivered when the appropriate buttons are pressed through the patient's clothing. …

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