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Review
. 2020 Jul;17(7):707-720.
doi: 10.1080/17434440.2020.1784724. Epub 2020 Jul 3.

Closed-loop control in insulin pumps for type-1 diabetes mellitus: safety and efficacy

Julia Fuchs  1 , Roman Hovorka  1   2
Affiliations
Review

Closed-loop control in insulin pumps for type-1 diabetes mellitus: safety and efficacy

Julia Fuchs et al. Expert Rev Med Devices. 2020 Jul.

Abstract

Introduction: Type 1 diabetes is a lifelong disease with high management burden. The majority of people with type 1 diabetes fail to achieve glycemic targets. Algorithm-driven automated insulin delivery (closed-loop) systems aim to address these challenges. This review provides an overview of commercial and emerging closed-loop systems.

Areas covered: We review safety and efficacy of commercial and emerging hybrid closed-loop systems. A literature search was conducted and clinical trials using day-and-night closed-loop systems during free-living conditions were used to report on safety data. We comment on efficacy where robust randomized controlled trial data for a particular system are available. We highlight similarities and differences between commercial systems.

Expert opinion: Study data shows that hybrid closed-loop systems are safe and effective, consistently improving glycemic control when compared to standard therapy. While a fully closed-loop system with minimal burden remains the end-goal, these hybrid closed-loop systems have transformative potential in diabetes care.

Keywords: Artificial pancreas; automated insulin delivery; closed-loop; continuous glucose monitoring; insulin pump; type 1 diabetes.

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Conflict of interest statement

Declaration of Interest

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 BBraun and Medtronic; having served as a consultant to BBraun, patents and patent applications related to closed-loop insulin delivery, shareholder and director at CamDiab Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
Hybrid closed loop systems. (a) Medtronic 670G Hybrid Closed System with Guardian Link 3 transmitter and the COUNTOUR NEXT LINK blood glucose meter (reproduced with permission of Medtronic, Inc.) (b) Diabeloop system with DLBG1 Algorithm with Kaleido insullin patch-pump (reproduced with permission of Diabelop SA) (c) Omnipod Horizon Hybrid Closed Loop System (Insulet Crop., Acton, MA, USA) paired with a Dexcom G6 sensor (Dexcom, San Diego, CA, USA)(Copyrighted image used with permission. © 2019 Insulet Corporation. All rights reserved.) (d) CamAPS FX algorithm with Dexcom G6 sensor and Dana Diabecare RS Sooil insulin pump (Sooil Development, Seoul, Korea) (reproduced with permission of CamDiab Ltd.) (e) Tandem tslim X2 insulin pump (Tandem Diabetes Care, San Diego, CA, USA) paired with a Dexcom G6 Sensor (Dexcom, San Diego, CA, USA).
See this image and copyright information in PMC

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