Pfützner, AndreasAndreasPfütznerRaz, ItamarItamarRazBitton, GabrielGabrielBittonKlonoff, DavidDavidKlonoffNagar, RonRonNagarHermanns, NorbertNorbertHermanns0000-0002-2903-2677Haak, ThomasThomasHaak2019-09-192016-06-1520151932-2968https://fis.uni-bamberg.de/handle/uniba/40567Temperature changes on the surface of the skin lead to modifications of subcutaneous microcirculation. This phenomenon is employed in a standardized way by the m InsuPad device to stabilize skin conditions before injections, which is associated with enhanced prandial insulin absorption. Three programmed warming cycles to 40°C within 50 minutes are resulting in faster insulin appearance in the plasma. Early standardized meal tolerance studies indicated a substantial improvement in postprandial glucose control when the same short-acting insulin analog dose was applied using InsuPad, and a dose reduction by 20% resulted in comparable glucose excursions. Similar results were obtained when patients applied the device under realworld conditions for 1 month. The InsuPad device was also tested in a prospective, controlled, parallel 3-month real-world study with 145 well-controlled but insulin-resistant patients with type 1 or type 2 diabetes. Patients were treated to target in both treatment arms (6.2 ± 0.5% in each group), with or without the device. However, patients with InsuPad needed 28% less prandial insulin, needed 12.5% less total insulin, and had 46% less confirmed hypoglycemic events (blood glucose < 63 mg/dL) as compared to the control group. Except for very few inflammatory or allergic skin reactions, there were no device-specific adverse events reported from these studies. In conclusion, use of InsuPad when applying prandial insulin doses may result in a safer and more efficient treatment of type 1 or type 2 diabetes.enginsulin treatmentInsuPadinjection site modulationprandial insulin dosehypoglycemiaarticle10.1177/1932296814555400http://dst.sagepub.com/content/9/1/116.full.pdf+html