title: Combining glucose monitoring and insulin delivery into a single device: current progress and ongoing challenges of the artificial pancreas.
abstract: Despite the widespread availability of insulin pumps, continuous glucose sensors, and insulin analogs with rapid-acting pharmacokinetic profiles, most people with type 1 diabetes fail to meet recommended glycemic targets, rates of severe hypoglycemia remain unacceptably high, and the burden of care on patients and loved ones exacts an enormous psychosocial toll. The combination of continuous glucose monitoring with insulin delivery into an integrated automated system promises to improve diabetes control while at the same time reduce the burden of care. A wide variety of automated insulin delivery systems, ranging in scope from simple pump suspension to reduce hypoglycemia, to complex multiple hormone systems under separate regulation and delivery, have been studied in both controlled inpatient settings and more free-ranging outpatient environments. Preliminary findings have been positive, with most studies demonstrating reduction in overall glucose levels, increased time-in-target range, and reductions in exposure to hypoglycemia. As these systems move closer to commercialization, the focus of ongoing efforts will need to address the continuing challenges of sensor accuracy and reliability, connectivity issues, and human factors considerations.
authors.affiliation: a 1 Yale University, Department of Pediatrics , PO Box 208064, New Haven, CT 06520-8064, USA +1 203 785 7924 ; +1 203 737 2829 ; stuart.weinzimer@yale.edu.
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Ang
authors.affiliation: a 1 Yale University, Department of Pediatrics , PO Box 208064, New Haven, CT 06520-8064, USA +1 203 785 7924 ; +1 203 737 2829 ; stuart.weinzimer@yale.edu.
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.affiliation: a 1 Yale University, Department of Pediatrics , PO Box 208064, New Haven, CT 06520-8064, USA +1 203 785 7924 ; +1 203 737 2829 ; stuart.weinzimer@yale.edu.|b 2 Yale School of Nursing , New Haven, CT, USA.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Weinzimer
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy; D016503:Drug Delivery Systems; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems; D019397:Pancreas, Artificial; D015203:Reproducibility of Results
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: artificial pancreas; closed loop; continuous glucose monitor; insulin pump