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Review
. 2021 May;64(5):1007-1015.
doi: 10.1007/s00125-021-05391-w. Epub 2021 Feb 6.

New closed-loop insulin systems

Charlotte K Boughton  1 , Roman Hovorka  2
Affiliations
Review

New closed-loop insulin systems

Charlotte K Boughton et al. Diabetologia. 2021 May.

Erratum in

Abstract

Advances in diabetes technologies have enabled the development of automated closed-loop insulin delivery systems. Several hybrid closed-loop systems have been commercialised, reflecting rapid transition of this evolving technology from research into clinical practice, where it is gradually transforming the management of type 1 diabetes in children and adults. In this review we consider the supporting evidence in terms of glucose control and quality of life for presently available closed-loop systems and those in development, including dual-hormone closed-loop systems. We also comment on alternative 'do-it-yourself' closed-loop systems. We remark on issues associated with clinical adoption of these approaches, including training provision, and consider limitations of presently available closed-loop systems and areas for future enhancements to further improve outcomes and reduce the burden of diabetes management.

Keywords: Artificial pancreas; Automated insulin delivery; Hybrid closed-loop; Review; Type 1 diabetes.

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Figures

Fig. 1
Fig. 1
Schematic of the configuration of closed-loop insulin delivery. A CGM transmits information about interstitial glucose concentrations to an algorithm hosted on a smartphone or insulin pump that translates information from the glucose sensor and computes the amount of insulin to deliver. An insulin pump delivers a rapid-acting insulin analogue subcutaneously. Insulin delivery is modulated in real time by the control algorithm. Communication between system components is wireless. CSII, continuous subcutaneous insulin infusion. Figure adapted from [36]. This figure is available as part of a downloadable slideset
Fig. 2
Fig. 2
Key developmental milestones towards a truly artificial pancreas. This figure is available as part of a downloadable slideset
Fig. 3
Fig. 3
Hybrid closed-loop glucose control. (a) 24 h of sensor glucose data. Green shaded area is the target glucose range (3.9–10 mmol/l). Green triangles indicate carbohydrate (carbs) intake. (b) Algorithm-driven insulin delivery and manual insulin boluses. Data in both graphs derived from a Cambridge closed-loop study participant (the individual provided permission to share this anonymised data for the purpose of advancement of science). The graphs were generated using the data management platform Diasend (https://diasend.com//en). Image credit: Glooko Inc. All rights reserved. 2021. The x-axes show time in hours. This figure is available as part of a downloadable slideset
Fig. 4
Fig. 4
Median percentage time with sensor glucose in target range during closed-loop insulin delivery (red line) and sensor-augmented pump therapy (blue line) in adults and adolescents ≥14 years of age, using the Tandem Control-IQ closed-loop system [12]. The red and blue shaded areas indicate the interquartile range for each treatment. Figure adapted from [12]. Copyright: ©2019 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society. This figure is available as part of a downloadable slideset
See this image and copyright information in PMC

References

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