Feature Article

Reducing risk and severity of hypoglycemia with closed loop insulin delivery in type 1 diabetes: from dream to reality

Dr Roman Hovorka, Department of Pediatrics, University of Cambridge, UK

Diabetic Hypoglycemia June 2010, Volume 3, Issue 1: page 3-7

Abstract
Automated electromechanical closed-loop insulin delivery, also known as the artificial pancreas, has been a major goal of diabetes treatment research for many years. Foundations for the artificial pancreas date back to the development of continuous glucose monitoring in the early 1960s, followed by the first commercial hospital-based artificial pancreas in the late 1970s. In the last 10 years, most ongoing research into the artificial pancreas has focused on the subcutaneous route for glucose measurement and insulin delivery, reflecting technological advances in interstitial glucose measurement and widespread use of continuous subcutaneous insulin delivery. Modern generations of the modern artificial pancreas aim, in the first instance, to prevent hypoglycemia, or to reduce its severity and duration.

This article discusses developments in the design and production of an artificial pancreas system, reviewing system components and challenges to development. The advantages and disadvantages of different types of closed-loop system are discussed, current research collaborations in this field are highlighted, and potential future advances in closed-loop systems are reviewed. Closed-loop systems can be perfected with the use of superfast-acting insulin analogs, dual hormone approaches or novel means to accelerate insulin absorption such as dermal delivery. Challenges to the introduction of closed-loop systems into clinical practice include optimization of the clinical infrastructure.

Keywords: hypoglycemia, closed-loop system, artificial pancreas, diabetes