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Review
. 2022 Nov;19(11):859-875.
doi: 10.1080/17434440.2022.2142556. Epub 2022 Nov 4.

Closed-loop insulin delivery: update on the state of the field and emerging technologies

Julia Ware  1   2 , Roman Hovorka  1   2
Affiliations
Review

Closed-loop insulin delivery: update on the state of the field and emerging technologies

Julia Ware et al. Expert Rev Med Devices. 2022 Nov.

Abstract

Introduction: Over the last five years, closed-loop insulin delivery systems have transitioned from research-only to real-life use. A number of systems have been commercialized and are increasingly used in clinical practice. Given the rapidity of new developments in the field, understanding the capabilities and key similarities and differences of current systems can be challenging. This review aims to provide an update on the state of the field of closed-loop insulin delivery systems, including emerging technologies.

Areas covered: We summarize key clinical safety and efficacy evidence of commercial and emerging insulin-only hybrid closed-loop systems for type 1 diabetes. A literature search was conducted and clinical trials using closed-loop systems during free-living conditions were identified to report on safety and efficacy data. We comment on emerging technologies and adjuncts for closed-loop systems, as well as non-technological priorities in closed-loop insulin delivery.

Expert opinion: Commercial hybrid closed-loop insulin delivery systems are efficacious, consistently improving glycemic control when compared to standard therapy. Challenges remain in widespread adoption due to clinical inertia and the lack of resources to embrace technological developments by health care professionals.

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

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Conflict of interest statement

Declaration of Interest

JW reports having received speaker honoraria from Ypsomed. RH reports having received speaker honoraria from Eli Lilly and Novo Nordisk, serving on advisory panel for Eli Lilly and Novo Nordisk; receiving personal fees from BBraun and Abbott Diabetes Care; patents related to closed-loop insulin delivery, shareholder and director at CamDiab. 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.
A closed-loop insulin delivery systemcomprising (1) a glucose sensor, (2) a device hosting the control algorithm, and (3) an insulin pump (image created with Biorender.com). All components communicate wirelessly via Bluetooth.
See this image and copyright information in PMC

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