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Review
. 2024 Mar;47(3):513-521.
doi: 10.1007/s40618-023-02193-2. Epub 2023 Sep 15.

The artificial pancreas: two alternative approaches to achieve a fully closed-loop system with optimal glucose control

M K Åm  1 , I A Teigen  2   3 , M Riaz  2   4 , A L Fougner  5 , S C Christiansen  2   4 , S M Carlsen  2   4
Affiliations
Review

The artificial pancreas: two alternative approaches to achieve a fully closed-loop system with optimal glucose control

M K Åm et al. J Endocrinol Invest. 2024 Mar.

Abstract

Introduction: Diabetes mellitus type 1 is a chronic disease that implies mandatory external insulin delivery. The patients must monitor their blood glucose levels and administer appropriate insulin boluses to keep their blood glucose within the desired range. It requires a lot of time and endeavour, and many patients struggle with suboptimal glucose control despite all their efforts.

Materials and methods: This narrative review combines existing knowledge with new discoveries from animal experiments.

Discussion: In the last decade, artificial pancreas (AP) devices have been developed to improve glucose control and relieve patients of the constant burden of managing their disease. However, a feasible and fully automated AP is yet to be developed. The main challenges preventing the development of a true, subcutaneous (SC) AP system are the slow dynamics of SC glucose sensing and particularly the delay in effect on glucose levels after SC insulin infusions. We have previously published studies on using the intraperitoneal space for an AP; however, we further propose a novel and potentially disruptive way to utilize the vasodilative properties of glucagon in SC AP systems.

Conclusion: This narrative review presents two lesser-explored viable solutions for AP systems and discusses the potential for improvement toward a fully automated system: A) using the intraperitoneal approach for more rapid insulin absorption, and B) besides using glucagon to treat and prevent hypoglycemia, also administering micro-boluses of glucagon to increase the local SC blood flow, thereby accelerating SC insulin absorption and SC glucose sensor site dynamics.

Keywords: Blood glucose; Diabetes mellitus; Glucagon; Insulin infusion system; Type 1.

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Conflict of interest statement

The Norwegian University of Science and Technology (NTNU), the university where the several of the author reside, has a patent filed related to the use of micro-boluses of glucagon. The authors SMC, SCC, and ALF are some of the inventors. The remaining authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Illustration of an intraperitoneal (IP) artificial pancreas with possible use of glucagon to achieve a fully closed-loop system; A glucagon is used to prevent or treat hypoglycemia, B glucagon micro-boluses are used to enhance continuous glucose monitoring (CGM) performance by increasing local SC blood flow. If glucagon is not used to enhance CGM performance, it will be delivered at another SC site than CGM
Fig. 2
Fig. 2
Illustration of a subcutaneous (SC) artificial pancreas with possible uses of glucagon to achieve a fully closed-loop system; A glucagon is used to prevent or treat hypoglycemia, B glucagon micro-boluses are used to enhance continuous glucose monitoring (CGM) performance by increasing local SC blood flow, C glucagon micro-boluses are used to accelerate absorption of insulin by increasing local SC blood flow
See this image and copyright information in PMC

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