title: Insulin pump therapy in youth with type 1 diabetes: toward closed-loop systems.
abstract: BACKGROUND
  Insulin pump technology has advanced considerably over the past three decades, leading to more favorable metabolic control and less hypoglycemic events when compared with multiple daily injection therapy. The use of insulin pumps is increasing, particularly in children and adolescents with type 1 diabetes.
  
  
  METHODS
  This review outlines recent developments in insulin pump therapy from a pediatric perspective. 'Smart' pumps, sensor-augmented pump therapy and threshold-suspend feature of insulin pumps are reviewed in terms of efficacy, safety and psychosocial impact. The current status of closed-loop systems focusing on clinical outcomes is highlighted.
  
  
  CONCLUSIONS
  Closed-loop insulin delivery is gradually progressing from bench to the clinical practice. Longer and larger studies in home settings are needed to expand on short- to medium-term outpatient evaluations. Predictive low glucose management and overnight closed-loop delivery may be the next applications to be implemented in daily routine. Further challenges include improvements of control algorithms, sensor accuracy, duration of insulin action, integration and size of devices and connectivity and usability. Gradual improvements and increasing sophistication of closed-loop components lie on the path toward unsupervised hands-off fully closed-loop system.
authors.affiliation: University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science , Cambridge , UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Tauschmann
authors.forename: Roman
authors.initials: R
authors.lastname: Hovorka
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: bolus calculator; bolus profile; closed-loop insulin delivery; continuous glucose monitor; control algorithm; diabetes; euglycemia; insulin pump; sensor-augmented pump therapy; smart pump; suspend