Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes

Author:

Lal Rayhan A12ORCID,Ekhlaspour Laya1ORCID,Hood Korey13ORCID,Buckingham Bruce1ORCID

Affiliation:

1. Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

2. Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California

3. Department of Psychiatry, Stanford University School of Medicine, Stanford, California

Abstract

Abstract Recent, rapid changes in the treatment of type 1 diabetes have allowed for commercialization of an “artificial pancreas” that is better described as a closed-loop controller of insulin delivery. This review presents the current state of closed-loop control systems and expected future developments with a discussion of the human factor issues in allowing automation of glucose control. The goal of these systems is to minimize or prevent both short-term and long-term complications from diabetes and to decrease the daily burden of managing diabetes. The closed-loop systems are generally very effective and safe at night, have allowed for improved sleep, and have decreased the burden of diabetes management overnight. However, there are still significant barriers to achieving excellent daytime glucose control while simultaneously decreasing the burden of daytime diabetes management. These systems use a subcutaneous continuous glucose sensor, an algorithm that accounts for the current glucose and rate of change of the glucose, and the amount of insulin that has already been delivered to safely deliver insulin to control hyperglycemia, while minimizing the risk of hypoglycemia. The future challenge will be to allow for full closed-loop control with minimal burden on the patient during the day, alleviating meal announcements, carbohydrate counting, alerts, and maintenance. The human factors involved with interfacing with a closed-loop system and allowing the system to take control of diabetes management are significant. It is important to find a balance between enthusiasm and realistic expectations and experiences with the closed-loop system.

Funder

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

The Endocrine Society

Subject

Endocrinology,Endocrinology, Diabetes and Metabolism

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