title: Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes: Injection Site Warming to Improve Glycemic Control.
abstract: BACKGROUND
  Delays in the time-action profiles of premeal boluses of rapid-acting insulin analogs contribute to early postmeal hyperglycemia in patients with diabetes. We tested whether applying local heat to skin around the injection site to increase the rate of insulin absorption reduces postprandial hyperglycemia in patients with type 2 diabetes.
  
  
  METHODS
  Fourteen patients with type 2 diabetes (4 females; age 61.6 ± 8.4 years, HbA1c 8.42 ± 1.13%; BMI 29.10 ± 5.61 kg/m(2)) on intensified insulin therapy underwent 5-hour meal tolerance tests (MTTs) with a standardized liquid meal after an overnight fast on 2 study days. Subjects injected 0.2 U/kg of insulin aspart or lispro subcutaneously into the abdominal skin on both days with and without the use of the InsuPad device.
  
  
  RESULTS
  Following the premeal bolus injection of rapid-acting insulin analog, infusion site warming led to a rise in plasma insulin levels to peak concentrations that were significantly earlier than without skin warming (mean ± SD 52 ± 26.7 vs 80 ± 51.3 minutes, P < .005) as well as increase in plasma insulin levels during the first hour after injection (mean ± SD 63.5 ± 32.7 IU vs 48.0 ± 25.0 uU.min/ml, P = .019). As a result, the area under the curve of the postprandial glucose excursion during the first 2 hours (the primary study outcome) and the entire 5 hours after the meal were significantly reduced (P = .007 and P = .03, respectively) with skin warming around the injection site.
  
  
  CONCLUSIONS
  Use of the InsuPad to increase the rate of insulin absorption provides an effective means to achieve better control of postmeal glucose excursions in type 2 diabetic patients receiving premeal injections of rapid-acting insulin analogs.
authors.affiliation: Department of Medicine, Diabetes Unit, Hadassah University Hospital, Jerusalem, Israel ntv502@netvision.net.il.
authors.forename: Itamar
authors.initials: I
authors.lastname: Raz
authors.affiliation: Insuline Medical Ltd, Petach Tikva, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Bitton
authors.affiliation: Insuline Medical Ltd, Petach Tikva, Israel.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Feldman
authors.affiliation: Insuline Medical Ltd, Petach Tikva, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Alon
authors.affiliation: Diabetes Center and Practice, Mainz, Germany Insuline Medical Ltd, Pfützner Science & Health Institute, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pfutzner
authors.affiliation: Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D013696:Temperature; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: glucose control; hyperglycemia; postprandial; warming device