Dual‐hormone artificial pancreas for management of type 1 diabetes: Recent progress and future directions

Abstract

Over the last few years, technological advances have led to tremendous improvement in the management of type 1 diabetes (T1D). Artificial pancreas systems have been shown to improve glucose control compared with conventional insulin pump therapy. However, clinically significant hypoglycemic and hyperglycemic episodes still occur with the artificial pancreas. Postprandial glucose excursions and exercise‐induced hypoglycemia represent major hurdles in improving glucose control and glucose variability in many patients with T1D. In this regard, dual‐hormone artificial pancreas systems delivering other hormones in addition to insulin (glucagon or amylin) may better reproduce the physiology of the endocrine pancreas and have been suggested as an alternative tool to overcome these limitations in clinical practice. In addition, novel ultra‐rapid‐acting insulin analogs with a more physiological time–action profile are currently under investigation for use in artificial pancreas devices, aiming to address the unmet need for further improvements in postprandial glucose control. This review article aims to discuss the current progress and future outlook in the development of novel ultra‐rapid insulin analogs and dual‐hormone closed‐loop systems, which offer the next steps to fully closing the loop in the artificial pancreas.

A wearable, minimally-invasive, fully electrochemically-controlled feedback minisystem for diabetes management

“…The Ag electrode was then chloridized to form the Ag/AgCl layer as the reference/counter electrode (8). The Au electrode was modified successively with a Prussian blue layer (9), a GOD matrix (10), a chitosan layer (11), and a Nafion membrane (12) to form the working electrode. As can be seen in Fig.…”

“…[7][8][9] It has been demonstrated clinically that a closedloop system can manage both type 1 and type 2 diabetes effectively and improve the overall glycemic control significantly. [10][11][12][13][14] However, for a commercial closed-loop system, the CGM biosensor is normally constructed on a several millimeters-long needle, and insulin is delivered by a mechanical pump that is driven by an electrical-motor. 15 The size is usually very large, for example, in the MiniMed™ 770G closed-loop system developed by Medtronic Inc., the sensor and the pump are separated, and the pump occupies a size of This journal is © The Royal Society of Chemistry 2023 about 9 × 6 × 2 cm.…”

Automated Insulin Delivery (AID) Systems: Use and Efficacy in Children and Adults with Type 1 Diabetes and Other Forms of Diabetes in Europe in Early 2023

“…In the same years, dual hormone HCL systems capable of delivering both glucagon (or amylin) and insulin were extensively studied. Studies and trials performed with these instruments have not always shown superiority over single-hormone closed-loop systems and are not yet used in clinical practice [ 9 ].…”

The Psychological Implications of Automated Insulin Delivery Systems in Type 1 Diabetes Care

“…There are several commercial AID systems available in routine diabetes care, with multiple others being developed [for an overview, please refer to ( 1 , 3 )]. Dual-hormone closed loop systems are also finding their way to the market, adding other hormones to more closely imitate physiological glucose regulation ( 4 ). Unregulated open-source or Do-It-Yourself systems have been co-created by online communities and provide open-access algorithms for building one’s own AID system, allowing considerable user customization ( 5 ).…”