Is an artificial pancreas (closed-loop system) for Type 1 diabetes effective?
Diabetic medicine : a journal of the British Diabetic Association
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Boughton, C., & Hovorka, R. (2019). Is an artificial pancreas (closed-loop system) for Type 1 diabetes effective?. Diabetic medicine : a journal of the British Diabetic Association, 36 (3), 279-286. https://doi.org/10.1111/dme.13816
The artificial pancreas is now a viable treatment option for people with type 1 diabetes (T1DM) and has demonstrated improved glycaemic outcomes whilst also reducing the onus of self-management of T1DM. Closed-loop glucose-responsive insulin delivery guided by real-time sensor glucose readings can accommodate highly variable day-to-day insulin requirements and reduce the hypoglycaemia risk observed with tight glycaemic control in T1DM. In 2011, the James Lind Alliance research priorities for T1DM were produced and priority 3 was to establish whether an artificial pancreas (closed-loop system) for T1DM is effective. This review focuses on the progress that has been made in the evolution of closed-loop systems as an effective treatment option for T1DM. Development of closed-loop systems has advanced from feasibility evaluations in highly supervised settings over short periods of time, to clinical studies in free-living, unsupervised conditions lasting several months. The approval in the US of the first hybrid closed-loop system (MiniMed® 670G pump, Medtronic, Northridge, CA) in 2016 for use in T1DM reflects these advancements. We discuss the evidence from clinical studies that closed-loop systems are effective with improved glycaemic outcomes, reduced hypoglycaemia and had positive end-user acceptance in children, adolescents, adults and pregnant women with T1DM. We also present the outlook for future closed-loop systems in the treatment of T1DM and identify the challenges facing the wide-spread clinical adoption of this technology.
Humans, Pregnancy in Diabetics, Diabetes Mellitus, Type 1, Insulin, Blood Glucose, Blood Glucose Self-Monitoring, Treatment Outcome, Insulin Infusion Systems, Pancreas, Artificial, Pregnancy, Adolescent, Adult, Child, Female
Wellcome Trust (100574/Z/12/Z)
Juvenile Diabetes Research Foundation Ltd (JDRF) (2-SRA-2014-256-M-R)
European Commission Horizon 2020 (H2020) Societal Challenges (731560)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Department of Health (via National Institute for Health Research (NIHR)) (EME 14/23/09)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (UC4DK108520)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (1DP3DK112176-01)
External DOI: https://doi.org/10.1111/dme.13816
This record's URL: https://www.repository.cam.ac.uk/handle/1810/285355