Closed-loop insulin delivery - what lies between where we are and where we are going?
Closed-loop insulin delivery in individuals with diabetes can potentially lead to near-normal glucose profiles. To this end, existing subcutaneous glucose sensors and external insulin pumps can be linked with an insulin delivery algorithm to create a completely automated closed-loop system. This paper reviews current research into the development of such a system, with particular emphasis on creating a system emulating the physiological properties of the beta-cell. Issues related to using subcutaneous interstitial fluid for glucose sensing and insulin delivery are reviewed. Criteria for optimising the system are discussed using historical data. Existing strategies for open-loop pump therapy are presented with the objective of defining a path to advance from the existing physician/patient determined insulin therapy to a completely automated system.
Steil
Garry M
GM
Medtronic MiniMed, Northridge, CA 91325, USA. garry.steil@Medtronic.com
Rebrin
Kerstin
K
D000465:Algorithms; D000818:Animals; D015374:Biosensing Techniques; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000592:standards / Q000639:trends*; D050417:Insulin-Secreting Cells / Q000502:physiology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin