Continuous Glucose Monitoring, Future Products, and Update on Worldwide Artificial Pancreas Projects

Abstract

The development of accurate and easy-to-use continuous glucose monitoring (CGM) improved diabetes treatment by providing additional temporal information on glycemia and glucose trends to patient and physician. Although CGM enables users to lower their average glucose level without an increased incidence of hypoglycemia, this comes at the price of additional patient effort. Automation of insulin administration, also known as closed-loop (CL) or artificial pancreas treatment, has the promise to reduce patient effort and improve glycemic control. CGM data serve as the conditional input for insulin automation devices. The first commercial product for partial automation of insulin administration used insulin delivery shutoff at a predefined glucose level. These systems showed a reduction in hypoglycemia. Insulin-only CL devices show increased time spent in euglycemia and a reduction of hypo-and hyperglycemia. Improved glycemic control, coinciding with a minor decrease in hemoglobin A1c level, was confirmed in recent long-term home studies investigating these devices, paving the way for pivotal studies for commercialization of the artificial pancreas. Although the first results from dual-hormone CL systems are promising, because of increased cost of consumables of these systems, long-term head-to-head studies will have to prove superiority over insulin-only approaches. Now CL glucose control for daily use might finally become reality. Improved continuous glucose sensing technology, miniaturization of electrical devices, and development of algorithms were key in making this possible. Clinical adoption challenges, including device usability and reimbursement, need to be addressed. Time will tell for which patient groups CL systems will be reimbursed and whether these devices can deliver the promise that they hold.

Application of Zone Model Predictive Control Artificial Pancreas During Extended Use of Infusion Set and Sensor: A Randomized Crossover-Controlled Home-Use Trial

“…Algorithms to control blood glucose (BG) using an AP include model predictive control (MPC), proportional integral derivative control, and fuzzy logic (3–8). Testing of AP systems has progressed from in silico models to hospital-based studies, followed by supervised hotel studies, and is now reaching prepivotal and pivotal outpatient testing (1,2,9,10). As AP systems evolve toward unsupervised home use, consideration of safety analysis and fault detection and mitigation becomes vital.…”

Continuous Glucose Monitoring With New Advanced Devices.

“…Physicians prescribe different types of insulin to each patient according to a person's overall lifestyle. There are rapid-acting, regular, intermediate-acting and long-acting types of insulin Philadelphia, USA 527 [2]. Also, sometimes doctors prescribe premixed insulin.…”

The Future of Continuous Glucose Monitoring

“…17 Another advantage of CGM use is alerts and alarms where subjects can be alarmed for impending hypoglycemia and hyperglycemia based on the rate of change of glucose, and thus patients can act accordingly. 18,19 Using CGM may have great Significant advances with CGM and insulin pumps have allowed CGM data to be used to drive insulin delivery. 21 The first such system hybrid closed loop, also called as artificial pancreas by the FDA, was approved in September 2016.…”