title: Coming of age: the artificial pancreas for type 1 diabetes.
abstract: The artificial pancreas (closed-loop system) addresses the unmet clinical need for improved glucose control whilst reducing the burden of diabetes self-care in type 1 diabetes. Glucose-responsive insulin delivery above and below a preset insulin amount informed by sensor glucose readings differentiates closed-loop systems from conventional, threshold-suspend and predictive-suspend insulin pump therapy. Insulin requirements in type 1 diabetes can vary between one-third-threefold on a daily basis. Closed-loop systems accommodate these variations and mitigate the risk of hypoglycaemia associated with tight glucose control. In this review we focus on the progress being made in the development and evaluation of closed-loop systems in outpatient settings. Randomised transitional studies have shown feasibility and efficacy of closed-loop systems under supervision or remote monitoring. Closed-loop application during free-living, unsupervised conditions by children, adolescents and adults compared with sensor-augmented pumps have shown improved glucose outcomes, reduced hypoglycaemia and positive user acceptance. Innovative approaches to enhance closed-loop performance are discussed and we also present the outlook and strategies used to ease clinical adoption of closed-loop systems.
authors.affiliation: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Level 4, Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK.|Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Hood
authors.initials: H
authors.lastname: Thabit
authors.affiliation: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Level 4, Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK. rh347@cam.ac.uk.|Department of Paediatrics, University of Cambridge, Cambridge, UK. rh347@cam.ac.uk.
authors.forename: Roman
authors.initials: R
authors.lastname: Hovorka
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D019397:Pancreas, Artificial
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Artificial pancreas; Closed-loop system; Continuous glucose monitor; Control algorithm; Insulin pump; Review; Type 1 diabetes