The changing landscape of automated insulin delivery in the management of type 1 diabetes

Rama Lakshman, Charlotte Boughton, Roman Hovorka, Rama Lakshman, Charlotte Boughton, Roman Hovorka

Abstract

Automated insulin delivery systems, also known as closed-loop or 'artificial pancreas' systems, are transforming the management of type 1 diabetes. These systems consist of an algorithm which responds to real-time glucose sensor levels by automatically modulating insulin delivery through an insulin pump. We review the rapidly changing landscape of automated insulin-delivery systems over recent decades, from initial prototypes to the different hybrid closed-loop systems commercially available today. We discuss the growing body of clinical trials and real-world evidence demonstrating their glycaemic and psychosocial benefits. We also address future directions in automated insulin delivery such as dual-hormone systems and adjunct therapy as well as the challenges around ensuring equitable access to closed-loop technology.

Keywords: artificial pancreas; automated insulin delivery; closed-loop systems; type 1 diabetes.

Conflict of interest statement

RL declares no duality of interest associated with the present manuscript. CKB has received consultancy fees from CamDiab and speaker honoraria from Ypsomed. RH reports having received speaker honoraria from Eli Lilly, Dexcom, and Novo Nordisk, receiving consultancy fees from Abbott Diabetes Care, receiving license fees from BBraun, and being director at CamDiab.

Figures

Figure 1
Figure 1
A closed-loop automated insulin delivery system comprising (1) a subcutaneous glucose monitor which communicates real-time glucose levels to (2) a device hosting the control algorithm which responds by regularly adjusting insulin delivery via (3) a subcutaneous insulin pump. Communication between systems is wireless. (Created with BioRender.com).
Figure 2
Figure 2
Early automated insulin delivery systems (A) The first insulin pump, developed by Kadish. (B) The Biostator computer-based glucose-controlled insulin infusion system. Reproduced with permission from Alsaleh FM, Smith FJ, Keady S & Taylor KM, ’Insulin pumps: from inception to the present and toward the future’, Journal of Clinical Pharmacy and Therapeutics, copyright 2010 John Wiley and Sons (93).
Figure 3
Figure 3
The six developmental stages of artificial pancreas device systems as originally described by JDRF (https://www.jdrf.org/blog/2011/02/09/artificial-pancreas-and-fda-the-latest/). (Created with BioRender.com).
Figure 4
Figure 4
Commercially available hybrid closed-loop systems. (A) MiniMed TM 780G with Guardian 4 sensor; ©2023 Medtronic. All rights reserved. Used with the permission of Medtronic. (B) CamAPS FX algorithm on a smartphone with Dana or YpsoPump and Dexcom G6 or Freestyle Libre 3 sensor; CamAPS FX copyright University of Cambridge 2023. (C) Tandem t:slim X2 pump with Dexcom G6 sensor; copyright 2023 Tandem Diabetes Care. (D) Insulet Omnipod 5 with patch pump and Dexcom G6 sensor; © 2023 Insulet Corporation. (E) Diabeloop DBLG1 algorithm with Kaleido patch-pump and Dexcom G6 sensor; © 2023 Diabeloop SA.

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Source: PubMed

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