JBM  Vol.4 No.8 , August 2016
Impairment of Continuous Insulin Delivery Therapy and Analysis from Graeco-Latin Square Design Model
Abstract: The desire to deliver measured amount of insulin continuously to patients with type I diabetes, for glycemic control, has attracted a lot of attention. Continuous subcutaneous insulin infusion has seen some success in recent years. However, occlusion of insulin delivery may prevent the patient from receiving the prescribed dosage, with adverse consequence. An in vitro study of insulin delivery is performed, using different insulin pumps, insulin analogs and operating conditions. The aim is to identify incidences of occlusion due to bubble formation in the infusion line. A detailed statistical analysis was performed on the data collected to determine any significant differences and deviations in insulin delivery rates that might be due to factors such as: pump type, the set basal flow rate, insulin type, vibration, and possible insulin occlusion due to air bubble formation within the infusion line. Our findings from the Graeco-Latin Square design model show that there are statistical differences due to the devices, and statistical identifiable clusters are used to distinguish the devices. Such hierarchical models used to describe the analyses, include the flow rate, the pump types, and the activity level.
Cite this paper: Diawara, N. , Demuren, A. and Gyuricsko, E. (2016) Impairment of Continuous Insulin Delivery Therapy and Analysis from Graeco-Latin Square Design Model. Journal of Biosciences and Medicines, 4, 40-51. doi: 10.4236/jbm.2016.48006.

[1]   Pickup, J. and Keen, H. (2002) Continuous Subcutaneous Insulin Infusion at 25 Years: Evidence Base for the Expanding Use of Insulin Pump Therapy in Type 1 Diabetes. Diabetes Care, 25, 593-598.

[2]   Blair, J., Gregory, J.W. and Peak, M. (2012) Insulin Delivery by Multiple Daily Injections or Continuous Subcutaneous Insulin Infusion in Childhood: Addressing the Evidence Gap. Practical Diabetes, 29, 47-48.

[3]   Shatilin, S. and Phillip, M. (2008) The Use of Insulin Pump Therapy in the Pediatric Age Group. Hormone Research, 70, 14-21.

[4]   Rossetti, P., Porcellati, F., Perriello, C.G., Torlone, E. and Bolli, G.B. (2008) Superiority of Insulin Analogues versus Human Insulin in the Treatment of Diabetes Mellitus. Archives of Physiology and Biochemistry, 114, 3-14.

[5]   Cryer, P.E. (2008) The Barrier of Hypoglycemia in Diabetes. Diabetes, 57, 3169-3176.

[6]   Weissberg-Benchell, J., Goodman, S.S., Lomaglio, J.A. and Zebracki, K. (2007) The Use of Continuous Subcutaneous Insulin Infusion (CSII): Parental and Professional Perceptions of Self-Care Mastery and Autonomy in Children and Adolescents. Journal of Pediatric Psychology, 32, 1196-1202.

[7]   Wolpert, H.A., Faradji, R.N., Bonner, W.S. and Lipes, M.A. (2002) Metabolic Decompensation in Pump Users Due to Lispro Insulin Precipitation. BMJ, 324, 1253.

[8]   Einhorn, D. (2004) Advances in Diabetes for the Millennium: Insulin Treatment and Glucose Monitoring. Medscape General Medicine, 6, 8.

[9]   Poulsen, C., Langkjaer, L. and Worsoe, C. (2005) Precipitation of Insulin Products Used for Continuous Subcutaneous Insulin Infusion. Diabetes Technology & Therapeutics, 7, 142-150.

[10]   Demuren, A. and Doane, S. (2007) A Study of Insulin Occlusion Using the Medtronic Paradigm 511 Insulin Pump. ODU Research Foundation Project Report.

[11]   Kerr, D., Morton, J., Whatley-Smith, C., Everett, J. and Begley, J.P. (2003) Laboratory-Based Non-Clinical Comparison of Occlusion Rates Using Three Rapid-Acting Insulin Analogs in Continuous Subcutaneous Insulin Infusion Catheters Using Low Flow Rates. Journal of Diabetes Science and Technology, 2, 450-455.

[12]   Wang, B., Demuren, A., Gyuricsko, E. and Hu, H. (2011) An Experimental Study of Pulsed Micro-Flows Pertinent to Continuous Subcutaneous Insulin Infusion Therapy. Experiments in Fluids, 51, 65-74.

[13]   Hedman, C.A., Lindstrom, T. and Arnqvist, H.J. (2001) Direct Comparison of Insulin Lispro and Aspart Shows Small Differences in Plasma Insulin Profiles after Subcutaneous Injection in Type 1 Diabetes. Diabetes Care, 24, 1120-1121.

[14]   von Mach, M.A., Brinkmann, C., Hansen, T., Weilemann, L.S. and Beyer, J. (2002) Differences in Pharmacokinetics and Pharmacodynamics of Insulin Lispro and Aspart in Healthy Volunteers. Experimental and Clinical Endocrinology & Diabetes, 110, 416-419.

[15]   Callow, M.J., Dudoit, S., Gong, E.L., Speed, T.P. and Rubin, E.M. (2000) Microarray Expression Profiling Identifies Genes with Altered Expression in HDL-Deficient Mice. Genome Research, 10, 2022-2029.

[16]   Cui, X., Hwang, J.T.G., Qiu, J., Blades, N.J. and Churchill, G.A. (2005) Improved Statistical Tests for Differential Gene Expression by Shrinking Variance Components Estimates. Biostatistics, 6, 59-75.

[17]   Cox, D.R. and Reid, N. (2000) The Theory of the Design of Experiments. Chapman & Hall.

[18]   Montgomery, D.C. (2009) Design and Analysis of Experiments. Wiley& Sons.

[19]   De Mets, D.L. (2002) Clinical Trials in the New Millennium. Statistics in Medicine, 21, 2779-2787.