Closed-loop for type 1 diabetes – an introduction and appraisal for the generalist

Abstract

BackgroundRapid progress over the past decade has been made with the development of the ‘Artificial Pancreas’, also known as the closed-loop system, which emulates the feedback glucose-responsive functionality of the pancreatic beta cell. The recent FDA approval of the first hybrid closed-loop system makes the Artificial Pancreas a realistic therapeutic option for people with type 1 diabetes. In anticipation of its advent into clinical care, we provide a primer and appraisal of this novel therapeutic approach in type 1 diabetes for healthcare professionals and non-specialists in the field.DiscussionRandomised clinical studies in outpatient and home settings have shown improved glycaemic outcomes, reduced risk of hypoglycaemia and positive user attitudes. User input and interaction with existing closed-loop systems, however, are still required. Therefore, management of user expectations, as well as training and support by healthcare providers are key to ensure optimal uptake, satisfaction and acceptance of the technology. An overview of closed-loop technology and its clinical implications are discussed, complemented by our extensive hands-on experience with closed-loop system use during free daily living.ConclusionsThe introduction of the artificial pancreas into clinical practice represents a milestone towards the goal of improving the care of people with type 1 diabetes. There remains a need to understand the impact of user interaction with the technology, and its implication on current diabetes management and care.

Participants' Experiences of, and Views About, Daytime Use of a Day-and-Night Hybrid Closed-Loop System in Real Life Settings: Longitudinal Qualitative Study

“…To be eligible for this trial, individuals had to have used an insulin pump for ‡3 months, a screening HbA1c ‡7.5% (58.5 mmol/mol) and £10% (86 mmol/mol) and a diabetes duration of ‡6 months. 19 Individuals randomized to a closed loop were invited to opt-in to the interview study by staff in the four participating U. K Participants were interviewed before commencing use of the closed-loop system (baseline) and 3 months later.…”

Bridging technology and clinical practice: innovating inpatient hyperglycaemia management in non‐critical care settings

“…Autonomous glucose control can thus be potentially achieved and maintained by a closed-loop system. Manual meal-time announcement and prandial insulin boluses are currently still recommended to overcome the delay in the insulin action profile of currently available insulin analogues [76]. This 'hybrid' closed-loop approach is in contrast to a 'fully' closed-loop approach, in which user input to the control algorithm-related to meals is not required.…”

Fully closed-loop insulin delivery improves glucose control of inpatients with type 2 diabetes receiving hemodialysis

“…7,8 Hence, glucose management may be better facilitated by an algorithm-driven insulin therapy, also known as closedloop insulin delivery or artificial pancreas, which is an emerging therapeutic approach combining continuous glucose monitoring with insulin pump therapy to achieve a more physiological means of replacing insulin. 9 The role of the control algorithm is to continuously modulate insulin delivery based on realtime sensor glucose values, thereby responding to the inherent variability of insulin requirements. The closed-loop system used in the present study incorporates a control algorithm that is initialized based on the subject's body weight and estimated total daily insulin dose, and calculates the required insulin infusion rate, aiming at a target glucose level between 5.8 and 7.2 mmol/l by continuously adapting model parameters.…”