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Review
. 2020 Mar;49(1):167-178.
doi: 10.1016/j.ecl.2019.10.007. Epub 2019 Dec 16.

Automated Insulin Delivery in Adults

Charlotte K Boughton  1 , Roman Hovorka  2
Affiliations
Review

Automated Insulin Delivery in Adults

Charlotte K Boughton et al. Endocrinol Metab Clin North Am. 2020 Mar.

Abstract

Hybrid closed-loop (artificial pancreas) systems have recently been introduced into clinical practice for adults with type 1 diabetes. This reflects successful translation from research studies in highly supervised settings to evaluation of the technology in free-living home settings. We review the different closed-loop approaches and the key clinical evidence supporting adoption of hybrid closed-loop systems for adults with type 1 diabetes. We also discuss the growing evidence for automated insulin delivery in pregnant women and in hospitalized patients with hyperglycemia. We consider the psychosocial impact of closed-loop systems and the challenges and potential future advancements for automated insulin delivery.

Keywords: Artificial pancreas; Hybrid closed-loop; Inpatient diabetes; Psychosocial impact; Type 1 diabetes.

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Conflict of interest statement

Disclosure R. Hovorka reports having received speaker honoraria from Eli Lilly and Novo Nordisk, serving on advisory panel for Eli Lilly and Novo Nordisk, receiving license fees from B. Braun and Medtronic; having served as a consultant to B. Braun, patents and patent applications related to closed-loop, and being shareholder of CamDiab. C.K. Boughton declares no duality of interest associated with this article.

Figures

Figure 1.
Figure 1.
JDRF Pathway to the Artificial Pancreas. The six developmental stages of artificial pancreas systems From JDRF. Artificial Pancreas Project. Avaliable at: https://www.jdrf.ca/our-research/treat/artificial-pancreas-project/; with permission.
Figure 2.
Figure 2.
Automated insulin delivery (artificial pancreas). A subcutaneous continuous glucose monitor (rectangle on abdomen) transmits the interstitial glucose levels to a controller (hand held device), which hosts a control algorithm and the user interface. An insulin pump (in pocket) delivers subcutaneous rapid-acting insulin analogue. Insulin delivery is adjusted in real-time by the control algorithm. Communication between system components is wireless From Hovorka R. Closed-loop insulin delivery: from bench to clinical practice. Nature Reviews Endocrinology. 2011;7(7):385–395; with permission.
Figure 3.
Figure 3.
Fully closed-loop insulin delivery in inpatients receiving enteral and/or parenteral nutrition. Sensor glucose concentration during closed-loop (red) and control (blue) interventions from midnight to midnight (lines indicate median, shaded areas indicate IQRs). The glucose target range is 5.6–10.0 mmol/l (100–180mg/dL) From Boughton CK, Bally L, Martignoni F, et al. Fully closed-loop insulin delivery in inpatients receiving nutritional support: a two-centre, open-label, randomised controlled trial. The Lancet Diabetes & Endocrinology. 2019;7(5):368–377; with permission.
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