Combining glucose monitoring and insulin delivery into a single device: current progress and ongoing challenges of the artificial pancreas

Abstract

Despite the widespread availability of insulin pumps, continuous glucose sensors, and insulin analogs with rapid-acting pharmacokinetic profiles, most people with type 1 diabetes fail to meet recommended glycemic targets, rates of severe hypoglycemia remain unacceptably high, and the burden of care on patients and loved ones exacts an enormous psychosocial toll. The combination of continuous glucose monitoring with insulin delivery into an integrated automated system promises to improve diabetes control while at the same time reduce the burden of care. A wide variety of automated insulin delivery systems, ranging in scope from simple pump suspension to reduce hypoglycemia, to complex multiple hormone systems under separate regulation and delivery, have been studied in both controlled inpatient settings and more free-ranging outpatient environments. Preliminary findings have been positive, with most studies demonstrating reduction in overall glucose levels, increased time-in-target range, and reductions in exposure to hypoglycemia. As these systems move closer to commercialization, the focus of ongoing efforts will need to address the continuing challenges of sensor accuracy and reliability, connectivity issues, and human factors considerations.

A critical review and analysis of ethical issues associated with the artificial pancreas

“…As patients become familiar with the AP’s capabilities and limitations, and as they witness its performance and reliability, they will develop trust in the technology in partly controlling their T1D. Yet, technical problems (e.g., issues with the equipment or software) or limitations of current AP versions (e.g., imprecise glucose sensor readings in hypoglycaemic or hyperglycaemic peaks or due to inappropriate calibration [28, 30, 72]) could diminish users’ trust in the technology.…”

“…Despite making T1D management more discrete, the AP still contributes to the visibility of the illness by being a cumbersome and an uncomfortable external system for some patients [30, 77]. The insulin pump and the catheter can impose restrictions or adjustments on clothing and are also problematic for intimate relationships [78].…”

De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial

“…Aunque su nombre sugiere la creación de un páncreas por ingeniería, este tipo de tratamiento dista de ser un páncreas igual al humano [15][16] . El paciente debe cambiar el set de infusión y el sensor de glicemia periódicamente y también debe informar al equipo de la ingesta de comida.…”

Survey about do-it-yourself closed loop systems in the treatment of diabetes in Germany

“…More sophisticated controller algorithms, such as proportional–integral–derivative (PID) control, model predictive control, fuzzy logic (FL) control, and adaptive control algorithms have been developed and extensively evaluated for insulin delivery in AP systems [ 14 , 15 ].…”