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Glucose-responsive insulin delivery for type 1 diabetes: The artificial pancreas story.

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Bally, Lia 
Thabit, Hood 


Insulin replacement therapy is integral to the management of type 1 diabetes, which is characterised by absolute insulin deficiency. Optimal glycaemic control, as assessed by glycated haemoglobin, and avoidance of hyper- and hypoglycaemic excursions have been shown to prevent diabetes-related complications. Insulin pump use has increased considerably over the past decade with beneficial effects on glycaemic control, quality of life and treatment satisfaction. The advent and progress of ambulatory glucose sensor technology has enabled continuous glucose monitoring based on real-time glucose levels to be integrated with insulin therapy. Low glucose and predictive low glucose suspend systems are currently used in clinical practice to mitigate against hypoglycaemia, and provide the first step towards feedback glucose control. The more advanced technology approach, an artificial pancreas or a closed-loop system, gradually increases and decreases insulin delivery in a glucose-responsive fashion to mitigate against hyper- and hypoglycaemia. Randomised outpatient clinical trials over the past 5 years have demonstrated the feasibility, safety and efficacy of the approach, and the recent FDA approval of the first single hormone closed-loop system establishes a new standard of care for people with type 1 diabetes.



Artificial pancreas, Closed-loop, Continuous glucose monitoring, Control algorithm, Insulin pump therapy

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International Journal of Pharmaceutics

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Wellcome Trust (100574/Z/12/Z)
Juvenile Diabetes Research Foundation Ltd (JDRF) (2-SRA-2014-256-M-R)
Department of Health (via National Institute for Health Research (NIHR)) (EME 14/23/09)
European Commission Horizon 2020 (H2020) Societal Challenges (731560)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
National Institute of Diabetes and Digestive and Kidney Diseases (UC4DK108520)
National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK112176)
NIHR Evaluation Trials and Studies Coordinating Centre (14/23/09)
LB received support from the Swiss National Science Foundation (P1BEP3_165297). Support for the Artificial Pancreas work by JDRF, National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Trust Strategic Award (100574/Z/12/Z), EC Horizon 2020 (H2020-SC1-731560), NIDDK (DP3DK112176 and 1UC4DK108520-01).