Controlled drug delivery in the treatment of XXXX .

@entity1 @entity2175 @entity6 @entity2690 @entity413
@entity6 not only requires correction of an @entity2690 deficiency but it also demands adequate @entity2690 delivery. A short historical review is given over the first 60 years of @entity2690 treatment, where emphasis was mainly on the correction of @entity2690 deficiency. Despite concerted efforts, metabolic results were often poor, and there was a high incidence of late complications, which will be described briefly. A major aim of new treatment approaches, which emphasizes better routes of @entity2690 delivery, is the prevention or reversal of these late complications. Closed-loop systems are infusion systems located outside the body which deliver @entity2690 according to @entity413 values that are measured continuously. The state of the art for such systems will be described with examples of clinical applications and results. These systems aid and stimulate research, but offer no long-term application for treatment. Open-loop systems are portable, both external and implantable, and lack an accurate @entity413 sensor so that the loop can be closed. A number of @entity2690 delivery systems have been developed in this category ranging from highly complex, fully implantable units, programable from outside, to simple basal-rate infusion pumps. Various pumps are designed to be used with varying delivery routes, and the evaluation of different routes will be a vital topic in this article. Pros and cons of the intravenous, intraperitoneal, and subcutaneous routes will be discussed, with supporting research referenced. Clinical experience will be cited for both the complex and the simple infusion systems. Other topics to be covered include feasibility of long-term treatment, complications of this new treatment approach, guidelines for @entity1 instruction and supervision, requirements for treatment of large @entity1 groups with pumps in a modern @entity6 center, requirements for the physician, the influence of improved metabolic control on late complications (prevention or regression), the possibility for a portable closed-loop system, and future outlook. The primary author is the founder of an international study group on @entity6 treatment with implantable @entity2690 delivery devices. The common goals of this study group will also be presented. Special emphasis will be placed on a differentiated approach to treatment of Type I and @entity2175 with a family of devices. Clinical work and results from a large @entity1 group will be included throughout.
