Closed-loop artificial pancreas:  current studies and promise for the future.
OBJECTIVE
The availability of glucose sensors and insulin pumps has enabled the development of devices and software to partially or completely automate insulin delivery. Over the last 2 years, the number of centers developing and evaluating such systems, as well as the number of reports of these studies in the literature, have expanded dramatically. The purpose of this review is to highlight the progress along multiple fronts to develop automated systems to improve control of type 1 diabetes.


RESULTS
Multiple approaches, including automated suspension for actual or impending hypoglycemia, automated augmentation for hyperglycemia, as well as hybrid and full closed-loop control, are in parallel development. So far, early hypoglycemia prevention studies and small inpatient feasibility studies have demonstrated the potential for reducing hypoglycemia and improving overall diabetes control.


CONCLUSIONS
Current sensors, pumps, and control algorithms show promise for use in a closed-loop system but have been limited to inpatient studies. The next phase of development should focus on their evaluation in controlled short-term outpatient safety and efficacy trials.
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA. stuart.weinzimer@yale.edu
Stuart A
SA
Weinzimer
D000465:Algorithms; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015918:Infusion Pumps, Implantable / Q000639:trends; D007328:Insulin / Q000008:administration & dosage* / Q000378:metabolism; D007332:Insulin Infusion Systems / Q000639:trends; D000078790:Insulin Secretion; D008297:Male; D019397:Pancreas, Artificial / Q000639:trends; D016032:Randomized Controlled Trials as Topic
D007004:Hypoglycemic Agents; D007328:Insulin